Cystoscopy
Definition
Cystoscopy (cystourethroscopy) is a diagnostic procedure that uses a cystoscope, which is an endoscope especially designed for urological use to examine the bladder, lower urinary tract, and prostate gland. It can also be used to collect urine samples, perform biopsies, and remove small stones.
Purpose
Cystoscopy is performed by urologists to examine the entire bladder lining and take biopsies of any questionable areas. Cystoscopy may be prescribed for patients who display the following conditions:
- blood in the urine (hematuria)
- inability to control urination (incontinence)
- urinary tract infection
- signs of congenital abnormalities in the urinary tract
- suspected tumors in the bladder
- bladder or kidney stones
- signs or symptoms of an enlarged prostate
- pain or difficulty urinating (dysuria)
- disorders of or injuries to the urinary tract
- symptoms of interstitial cystitis
Blood and urine studies, in addition to x rays of the kidneys, ureters, and bladder, may be performed before a cystoscopy to obtain as much diagnostic information as possible. During the cystoscopy, a retrograde pyelogram may also be performed to examine the kidneys and ureters.
Description
There are two types of cystoscopes used to carry out the procedure, a rigid type and a flexible type. Both types are used for the same purposes and differ only in their method of insertion. The rigid type requires that the patient adopt the lithotomy position, meaning that the patient lies on his or her back with knees up and apart. The flexible cystoscope does not require the lithotomy position.
A cystoscopy typically lasts from 10–40 minutes. The patient is asked to urinate before surgery and advised that relaxing pelvic muscles will help make this part of the procedure easier. A well-lubricated flexible or rigid cystoscope (urethroscope) is passed through the urethra into the bladder where a urine sample is taken. There may be some discomfort as the instrument is inserted. Fluid is then injected to inflate the bladder and allow the urologist to examine the entire bladder wall. The cystoscope uses a lighted tip for guidance and enables biopsies to be taken or small stones to be removed through a hollow channel in the cystoscope.
During a cystoscopy, the urologist may remove bladder stones or kidney stones, gather tissue samples, and perform x-ray studies. To remove stones, an instrument that looks like a tiny basket or grasper is inserted through the cystoscope so that small stones can be extracted through the scope's channel. For a biopsy, special forceps are inserted through the cystoscope to pinch off a tissue sample. Alternatively, a small brush-like instrument may be inserted to scrape off some tissue. To perform x-ray studies such as a retrograde pyelogram, a dye is injected into the ureter by way of a catheter passed through the cystoscope. After completion of all required tests, the cystoscope is removed.
Preparation
Patients may be asked to give a urine sample before cytoscopy to check for infection and to avoid urinating for an hour before this part of the procedure. They wear a hospital gown during the procedure and the lower part of the body is covered with a sterile drape. A sedative may be given about one hour prior to the operation to help the patient relax. The region of the urethra is cleansed and a local anesthetic is applied. Spinal or general anesthesia may also be used for the procedure. Distension of the bladder with fluid is particularly painful, and if it needs to be done, as in the case of evaluating interstitial cystitis, general anesthesia is required. A signed consent form is necessary for this procedure.
Aftercare
After removal of the cystoscope, the urethra is usually sore, and patients should expect to feel a burning sensation while urinating for one to two days following the procedure. To alleviate discomfort or pain, patients may be prescribed pain medication, and antibiotics may also be required to prevent infection. Minor pain may also be treated with over-the-counter, nonprescription drugs such as acetaminophen . To relieve discomfort, patients may be advised to drink two 8-oz glasses of water each hour for two hours and to take a warm bath to relieve the burning feeling. If not able to bathe, they may be advised to hold a warm, damp washcloth over the urethral opening.
Patients who have undergone a cystoscopy are instructed to:
- Take warm baths to relieve pain.
- Rest and refrain from driving for several days, especially if general anesthesia was used.
- Expect any blood in the urine to clear up in one to two days.
- Avoid strenuous exercise during recovery.
- Postpone sexual relations until the urologist determines that healing is complete.
Risks
As with any surgical procedure, there are some risks involved with a cystoscopy. Complications may include profuse bleeding, a damaged urethra, a perforated bladder, a urinary tract infection, or an injured penis.
Patients should contact their physician if they experience any of the following symptoms after the procedure, including pain, redness, swelling, drainage, or bleeding from the surgical site; signs of generalized infection, which may include headache, muscle aches, dizziness, or an overall ill feeling and fever; nausea or vomiting; or difficult or painful urination.
Cystoscopy is a commonly performed procedure, but it is an invasive technique that involves small yet significant risk. If anesthesia is required, there is additional risk, particularly for people who are obese, smoke, or are in poor health. Those undergoing anesthesia must inform the doctor of any medications they are taking.
Normal results
A successful cystoscopy includes a thorough examination of the bladder and collection of urine samples for cultures. If no abnormalities are seen, the results are indicated as normal. In this case, the bladder wall appears smooth and the bladder is seen to be of normal size, shape, and position, without obstructions, growths, or stones.
The treating physician can tell the patient what was seen inside the bladder right after the procedure. If a biopsy sample was taken, this will take several days to be examined and tested.
Cystoscopy allows the urologist to detect inflammation of the bladder lining, prostatic enlargement, or tumors. If these are seen, further evaluation or biopsies may be needed. Cystoscopy with bladder distention can also evaluate interstitial cystitis. Bladder stones, urethral strictures, diverticula, or congenital abnormalities can also be detected.
Alternatives
There are procedures that can provide some information about the lining of the bladder, for example, x rays; however, none of these provide as much information to the doctor as a cystoscopy.
Resources
BOOKS
Buckman, Robert. "Bladder." In What You Really Need To Know About Cancer: A Comprehensive Guide for Patients and Their Families. Baltimore, MD: The Johns Hopkins University Press, 1997.
Miller, B. E., ed. An Atlas of Sigmoidoscopy and Cystoscopy. Boca Raton: CRC Press-Parthenon Publishers, 2001.
Segen, Joseph C., and Joseph Stauffer. "Cystoscopy." In The Patient's Guide To Medical Tests: Everything You Need To Know About The Tests Your Doctor Prescribes. New York: Facts On File, 1998.
Tierney, Lawrence M. Jr., Stephen J. McPhee, and Maxine A. Papadakis, eds. "Urology." In Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1996.
PERIODICALS
Fraczyk, L., H. Godfrey, and R. Feneley. "Flexible Cystoscopy: Outpatients or Domiciliary?" British Journal of Community Nursing 7 (February 2002): 69–74.
Jabs, C. F., and H. P. Drutz. "The Role of Intraoperative Cystoscopy in Prolapse and Incontinence Surgery." American Journal of Obstetrics and Gynecology 185 (December 2001): 1368–1371.
Kwon, C. H., R. Goldberg, S. Koduri, and P. K. Sand. "The Use of Intraoperative Cystoscopy in Major Vaginal and Urogynecologic Surgeries." American Journal of Obstetrics and Gynecology 187 (December 2002): 1471–1472.
Payne, D. A., and R. C. Kockelbergh. "Improving the View at Flexible Cystoscopy." Annals of The Royal College of Surgeons of England 85 (March 2003): 132–138.
Sant, Grannum R., and Philip M. Hanno. "Interstitial Cystitis: Current Issues and Controversies in Diagnosis." Urology 57, Supplement 6A (June 2001): 82–88.
Satoh, E., N. Miyao, H. Tachiki, and Y. Fujisawa. "Prediction of Muscle Invasion of Bladder Cancer by Cystoscopy." European Urology 41 (February 2002): 178–181.
ORGANIZATIONS
American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. http://www.auanet.org .
American Foundation for Urologic Disease. 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383. http://www.afud.org .
Interstitial Cystitis Association. 51 Monroe Street, Suite 1402, Rockville, MD 20850. (301) 610-5300. http://www.ichelp.org .
Society of Urologic Nurses and Associates. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. http://suna.inurse.com/ .
OTHER
"Cystoscopy." Harvard Medical School. <www.health.harvard.edu/fhg/diagnostics/cysto/cystoWhat.shtml� 3E; .
"Cystoscopy." Medline Plus. http://www.nlm.nih.gov/medline plus/ency/article/003903.htm .
"What Is IC? Interstitial Cystitis Fact Sheet." Interstitial Cystitis Association. http://www.ichelp.org/whatisic/ICFAct Sheet.html .
Jennifer E. Sisk Monique Laberge, PhD
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Cystoscopy is typically performed on an outpatient basis, but up to three days of recovery in the hospital is sometimes required. The procedure can be performed in a hospital, doctor's office, cystoscopy suite, or urology office, depending on the condition of the patient and the anesthesia required. If general anesthesia is required, an anesthesiologist is present to administer the anesthesia and monitor the patient. The cystoscopy procedure is performed by a urologist, urologic surgeon, or urogynecologist, with assistance from nurses experienced in urologic procedures. If x rays are taken during the procedure, a uroradiologist or radiologic technologist is required to operate the x-ray equipment. Biopsy tissue samples are sent to the clinical laboratory for examination by a pathologist.
QUESTIONS TO ASK THE DOCTOR
- What will happen during the procedure?
- How do I prepare for cytoscopy?
- Will cystoscopy hurt?
- How long will the test last?
- How many cytoscopies do you perform each year?
- Are there any risks associated with the procedure?
catheter was installed .2 days later it came out and all was ok for 5 hours then another spasm and that was it i couldnt pee.
back in again for another catheter . it was taken out 2 days ago
i now have pain peing and in th eperineal area but so far no spasms.
one common factor that may explain why i have not had a spasm this time is .previously the nurses all said drink 2-3 litres a day of fluid which i did ,
on the last removal a district nurse said to me drink normally as i would every day so i have been drinking a lot less in fact not much at all and i only get a small stream due to the amount of drink im taking.
i may be wrong but i think the bladder needs time to recover slowly and over working it with loads of fluid intake may not be a good idea .my system had previouslt been flushed out so many times the urine was clear after initial bleeding,
my surgeon said i was unlucky .the district nurse who treated me was the ONLY one who seemed to care who regualry called me on the phone and who has now discharged me ,i still have burning pain and perineal pain and im hoping it will go soon.i am on diazapan and oxoflacin curently .
i am not over this yet but every day brings more time for the bladder to recover .i am hoping i never get a spasm again as not only is it painful but it tightens up your blader and you cannot urinate.
my experience is not typical so i hear but its happening to me
thank you for reading
was advised that I was gonna get some morphine
who was responsible for making sure I was sedated because
I'll tell you what, I'm still bleeding to this day when I urinate
what can I do ????????
to those of you who state that it wasn't so bad with no meds
stop talking bull s***t because it hurt like beyond hell
HOWEVER I MOVED TO FL 3 YEARS AGO AND DECIDED TO HAVE MY ROUTINE CYSTOSCOPY HERE AT A WELL KNOWN UROLOGIST OFFICE. I THOUGHT I HAD GONE BACK 15 YEARS OR BEYOND. THE EXAM WAS EXTREMELY PAINFUL, AFTERWORDS I HAD SUCH PAIN URINATING I COULD HARDLY STAND IT. THIS PAIN LASTED FOR OVER 2 WEEKS.
I NOW FLY BACK TO ST. LOUIS FOR MY EXAMS AND HAVE NEVER HAD ANY PAIN AT ALL. THE FLORIDA DR WAS A PROSTATE SPECIALIST, I DOUBT THAT HE DID MANY CYSTOS and his equipment was old, larger, and much more invasive. my advise find other patients in your area and get their experience AND ASK THE DR HOW MANY CYSTOS HE DOES PER WEEK.
I am a female that had a cystoscopy five days ago in the office with a local using a flexible scope. Had no pain whatsoever, he filled my bladder up which was uncomfortable as I have possible IC. Burning on urination for about six hours after. Burning bladder for three days. Today am bleeding a bit. Nurse told me that it is worse for men!
I had a urologist appointment this week recommended by the ER doctor due to a UTI that just won't go away since December. I was expecting a consultation and maybe a quick exam, being that it was the first appointment. Following the consultation Dr. says okay let's go get you examined and when I asked what will be done he replied internal and cystoscopy. Before going, I had read some things about a cystoscopy and my anxiety hit an all time high! I asked for a valium and he said it's really no big deal and I don't need one. Following the manual exam, Dr. notices I am very anxious and says, you've been catheterized, right? I said no, start crying (I am so embarrassed, 39 yr. old woman crying in the doctor's office like a two-year-old) He then says, okay, let's give you 3 more days on the Bactrim and if you're still in pain then you have to get the cysto but we'll do it at the hostpital under twilight.
Here's the problem. I am even more afraid of anestesia - had twilight once for oral surgery and right beforehand I had a breakdown in the waiting room, crying, again. (Please don't laugh- ok you can laugh but don't make fun of me I know I am a big baby and a horrible patient)
I think if I can have some anti-anxiety meds beforehand, and if they give me lidocaine, I can relax enough to let them do the procedure. Give it to me straight - what's the pain level from 1-10, and how long does it last? Also I couldn't help but notice the instruments and they are angled at the tip!! How in the world do they insert that without it hurting?? Someone please answer I am losing sleep over the prospect of this exam :(
Called the urologist's office and they told me to come right in and that I would need to be catheterized. I was awake for that and it took them 3 tries with different sized catheters to get one in. To say the process was excruciating is an understatement, its been 3 days and I get the catheter out in 3 more days, hopefully.
I am not sure I can voluntarily go through that again without being put to sleep, it backs up my reasoning for wanting to be unconscious for the cysto itself.
what do we advice the patient is it bleeds heavy
after the procedure..
I understand that normally it bleeds but if it bleeds non stop?
I was talking to a guy who had been in before me and he said it wasn't too bad, but i guess everyones different.
Google is your friend here you can look up the more modern equipment online ask lot's of questions such as. What type of anesthetic are you planning on using? If your a younger patient 45 and under my urologist recommended putting the individual asleep for the procedure. He stated older individuals can generally get by with properly administered local anesthetic. But younger individuals had difficulty relaxing and damage could potentially be done so putting the individual under entirely if possible is the best option.
Currently tumor free with clear urine. :)
Anyways, I'm very sorry if I scared you, but my experience was absolutely terrible. I have a few recommendations which I think will make this procedure MUCH more bearable:
1) Make sure you trust your doctor, and that he has good bedside manner. If he takes 10 seconds to explain the procedure, and seems irritated when you ask a question about it, see another doctor. Also, they should give you papers or something which explains the procedure. Make sure you educate yourself on the procedure! Don't be naive like me.
2) Ask your doctor if he's using the right size scope. I have a feeling that mine didn't.
3) ASK FOR A SEDATIVE!! And have somebody drive you, so you don't have to drive yourself. My 20 minute drive home was terribly unpleasant.
4) If your pain was as bad as mine when you urinate afterwards (and for your sake I hope it isn't) - please remember that the initial shock is the worst. If you keep tightening up, well that's about the worst thing you can do.
It's been about 36 hours now, I can finally urinate with only a slight stinging sensation. Unfortunately it feels like every tube from my urethra to my bladder to my kidneys are incredibly irritated... but I'm just happy I can go to the bathroom now without keeling over afterwards.
Yesterday was one of the worst days of my life... please follow steps 1-4 above and I'm sure your procedure will go MUCH better than mine!
This is unbelievable. Peeing up tissue after the procedure! Please, oh please, if anybody knows something about this stuff, please respond to this. I'm in hell right now.
thankss Adnan
Firstly, the specialists experience when performing such a sensitive operation and secondly to put it bluntly, if your not very big downstairs then, assuming that the implement they use are all a standard size, then logically smaller men will suffer most.
Now I don't mind admitting when at a relaxed state I probably fall in to the later therefore the pain during and after my procedure can be best described as, someone going up my manhood with a chainsaw, seriously, I feel like ive done 10 rounds with Edward scissor hands naked. Nobody told me that you could even be put to sleep, the nurses need Oscars in acting skills as they made me feel like I was preparing for a date with Rihanna when all along they knew exactly was in store, got to hand it to them, they really had me fooled, comes to something when the group of trainee women lined up all turned away, talk about embarrassment, they didn't mention anything about an audience. If it weren't enough being exposed in front of group of female onlookers, they had me thread my pinky through a hole in a blue surgical blanket, talk about drawing attention to the vital area, it must have looked like a new shoot coming through at spring.
There was a tv screen on the side while I was lay down, how awfully considerate of them to provide me with a little light entertainment while they had a look round, I soon realised that the purpose of the tv was so that I could actuality witness the horrors that took place before me. "I'm just putting some solution around the area sir" the specialist said, he kindly showed me a long set of metal tongs with a towel hanging off it and went about bashing my parts about like he was in a casino playing a roulette wheel, It was at that very moment that I realised all was not I was led to believe previously by the nurses. All I could do was take a deep breath and hope for the best O MY GOD what's he doing, I let out a screech and clenched my bottom while a nurse pinned my head down on the pillow "just putting the numbing gel in sir, it will soon be over, there's no need to worry", ah ah ah OUCH what the..."we are nearly in the bladder sir take a look at the screen if you can". Looking at the screen wasn't at the fore front of my thoughts while I was what felt like being ripped apart with a chainsaw. Apart from the pain levels bursting it's barriers there was more embarrassment to follow, o yes, indeed I was uncontrollably wetting myself like a new born on a changing mat. "ok sir we are on our way out its nearly done", some one hit my head with a hammer I thought this is truly unbearable, no no AH AH AH. "There's no problems to report sir, nothing to worry about at all, your all clear", like that was supposed to be of some comfort at this particular time of being a victim of brutal torture. Nobody told me that going to the toilet would present exactly the same pain as the operation, apparently the feeling of barbed wire being dragged through your stomach is perfectly normal.
If you are reading this before your cystoscopy I apologise if I have alarmed you, for all the above is a load of nonsense, but it just goes to show how people can interoperate things differently, its inevitable the there is going to be pain when performing such an operation, whilst I admit it did test my boundaries, the whole thing was lets say, a manageable experience. Obliviously there's going to be some embarrassment along the way but over all, it really isn't as bad as the above post would have you believe. Go and get your op and put your mind at rest.
Lastly, the NHS in England often get bad press but I have to say that the service by the all staff involved was nothing less than commendable, they where ver (...)
So go in being realistic. Yes, it very well may hurt due to the nature of the procedure. My boyfriend had a flexible cystoscopy done under local recently which he says was very very painful. But just try and be prepared with meds and keep it in perspective. Assumably everyone is in pain due to the condition which they are being investigated for- I certainly am. What's a few days of possibly worse pain if you can get diagnosed and treated?
Be brave, be prepared, be realistic - not everyone has such bad experiences. But if you do, you're still one step nearer to being treated and maybe even pain free for the rest of your life.
Best of luck to you :-)
BUT, during wasn't much at all, similar to the discomfort of a pap. But afterwards for about 3 hours...owww it burned. and they flushed my bladder with an antibiotic i had to hold in for 30 minutes. Now it burns like hell when I pee. drinking alot of water helps , as it dilutes the urine. I never had any blood though. should that be coming soon? I did not have a biopsy.
also, the doc could tell that i did not have IC. how can they tell that??
My brother died of bladder cancer and I was having some alarming symptoms, so having this done to make sure I'm ok was worth the time, cost, and discomfort in my opinion.
Other than high blood pressure I am in good health and feel fine. A CT scan showed nothing -- but my family wanted to know for sure that I am fine, so I finally made an appointment with a urologist and he recommended a cystoscopy. I had to wait about 3 weeks before the procedure and it was a really long 3 weeks. I did a lot research and I think I've read the comments here on this site about 10 times.
The procedure took place early Friday morning. The male nurse put a numbing lubricant inside me and clamped it shut. This stung a little bit but it wasn't bad. Then the doctor came in with a flexible scope and began to look around. It was a tiny bit uncomfortable, but easily manageable. Fortunately, the monitor was turned so I could see it. Pretty interesting trip down my urethral canal!
Unfortunately, the trip was interrupted by a stricture, which looked like two smaller tunnels with cobwebs hanging in front of them. The urologist tried to navigate through the stricture six or seven times with no luck. The last few tries hurt a bit.
The doctor then told me that I had three options: allow him to use a tool to widen the stricture, schedule an "operation" to "fix" the problem, or just forget about it. (He said the blood in my urine could be caused by the stricture.) I didn't want to have to come back so I told him to try and widen it.
Not sure what tool he used, but it was some kind of rod. No camera attached. The rod may have been bigger because it hurt a bit more going in and it became quite uncomfortable when he was trying to widen the stricture. After several minutes we both felt a "pop" and he went back in with the camera. There was a lot of blood now, which made visibility difficult. After several more minutes of trying he told me that I would have come back in and go under general anesthesia. I was NOT happy about this. I thought he was about to give up when he suddenly said, "And there's your bladder!" He looked around and everything looked great!
Because of the blood they decided to put in a catheter and this was pretty painful, but over in a few seconds. Once it was in the stinging was pretty bad and I thought there was no way I'd be able to take that for 3 days. But after about 15 minutes or so it felt a lot better and I was able to drive myself home.
The catheter was a little uncomfortable at first, but only when I moved around. I've read horror stories about catheter removal and painful urination after, so I was pretty nervous this morning when I pulled it out.
After taking a couple of Percocet and one of those pills that dye your urine to reduce stinging, I cut the little tube that keeps the balloon inflated. My research told me that there are two ways to remove the catheter. One smooth tug, or slower. When I first pulled it was uncomfortable, so I stopped and the pain went away. Then I eased it out a little bit until I felt some pain and stopped. Kept this up until it was completely out and it didn't really hurt much at all. (I've heard it can be worse when the catheter has been in longer.)
Now my only big worry was would I be able urinate, and how bad would it hurt? I've been drinking lots of water all morning and about 20 minutes ago I felt the urge. To my great surprise it didn't hurt at all!
So that's my story. If it hadn't been for the stricture (they are supposedly rare) it wouldn't have been a terrible experience. Not even close to what I had been imagining, anyway. I hope my experiences are helpful to someone else about to go through this procedure!
Good luck, you have no reason to be nervous, the people looking after you are trained proffesionals.
Hermione xx
I had a cystoscopy under general anaestetic on Tuesday 13 December. Personally, the procedure didn't hurt. In fact, when I woke up I felt fine and actually wanted to go home right there and then! I was kept in hospital for the next 1.5 days. The day after I was able to walk to the bathroom and take a shower and on day 3 they took the catheter off and then I was able to pee normally.
There was a little stinging but I didn't think anything of it as some Ural will take the sting away as well as Yarrow tea (drink at least 3 cups a day).
Due to the lab having inconclusive results of my biopsy, I had to have a CT scan on day 3. For the next few days I slept a lot as I felt quite tired (Thursday), then on Friday I had to have an internal ultrasound (they found two cysts) but still no news about this abnornal cell inside me.
On the 23rd Deecember I felt uncomfortable 'down there' and went to the Chemist to get some thrush cream (it alleaviated all discomfort) however, I started bleeding. I phoned my specialist who asked me to pick up some antibiotics and do a urine test. It is day 6 of antibiotics (tomorrow is the last day) and I will have a little burning feeling when I pee.
TAKING CARE: After the cystoscopy I was told not to drive for about 4 days; Not to lift anything heaving and to Report any unusual bleeding.
Ask any questions that may concern you, read about books, natural medicines that may assist in healing post procedure.
Good Luck!