Cystoscopy: What is it? Preparation, Procedure, Advantages, Risks and Post-Exam Instructions

It is a procedure in which a direct visual examination of the urethra is performed to view the lining of the bladder using an endoscope.

This procedure takes a few minutes and is usually done under local anesthesia. The cystoscope is lubricated and gently inserted into the natural urinary opening .

It is generally painless, but may cause mild discomfort during the procedure.

A cystoscopy allows us to find the cause and make a differential diagnosis, thanks to a non-invasive procedure.

Urinary system

The urinary system is made up of kidneys, bladder, ureters, and urethra. The kidneys filter the blood to remove waste products and form urine.

Urine flows from the kidneys, down through the ureters to the bladder. From here it passes through another tube called the urethra to the outside when urinating.

Alternative procedures to cystoscopy

Although doctors can tell a certain number of other tests, a cystoscopy can give them a more complete picture of the patient’s condition.

The only real alternative is an operation to examine the inside of the bladder, but this is avoided whenever possible.

A cystoscopy is faster and has fewer side effects than an operation.

Preparation

Cystoscopy cannot be performed safely if the patient has a urinary tract infection.

The doctor will order a urine test and culture.

If the patient is receiving treatment with anti-inflammatory drugs, such as alleve, celebrex, motrin or vioxx, anticoagulants such as plavix or coumadin, it is necessary to temporarily suspend them.

The flexible cytoscopy

The flexible cystoscopes, unlike the rigid ones, combine the optical system and the working and irrigation channel in a single unit.

The optical system is made up of a set of optical fibers that are responsible for the transmission of images and two similar bundles responsible for the transmission of light.

The optical fibers are insulated, in parallel, they can transmit the image and the light even if they are bent.

The optical fibers are connected to a lens system that serves to magnify and focus the image.

Similar to rigid cystoscopes, the optical system features a marking in the visual field (often located at 12 o’clock) that is intended to facilitate orientation during cystoscopy.

The properties of optical fibers and their parallel distribution have allowed the development of a distal deflection mechanism controlled by a button located near the viewer.

The degree of distal deflection in a single plane ranges from 220 ° to 350 °, while the maximum deflection in a single direction ranges from 180 ° to 220 °.

In the case of flexible cystoscopes, the working channel is designed to allow the passage of various instruments and also to ensure the flow of the irrigation fluid.

Instruments that can be used through the working channel of flexible cystoscopes include biopsy forceps, basket catheters, guides, flexible lithotripsy catheters, laser fibers, flexible needles, among others.

Advantages of flexible cystoscopes

Among the advantages of the flexible cystoscope:

  • They require only local anesthesia.
  • A comprehensive and detailed bladder assessment can be performed with a single instrument.
  • They can be used particularly in patients with joint or neurological disorders, which cannot be placed in the classic lithotomy position for rigid cystoscopy.
  • Flexible cystoscopy is indicated in patients with a semi-rigid or “frozen pelvis” penile prosthesis.
  • Connecting the video camera to the cystoscope telescope allows the examination to be viewed on a TV monitor and offers greater convenience for the physician.
  • Allows binocular vision, reduced infectious contamination (the doctor avoids contact with the patient’s urine).
  • Allows documentation of procedure results by recording video images and implicitly monitoring or tracking bladder changes over time.

Process

A flexible cystoscopy involves a telescopic examination of the bladder and urethra.

A lubricating gel and local anesthetic will be used to make the passage of the cystoscope as comfortable as possible.

Most patients find the procedure uncomfortable rather than painful.

A flexible tube containing a small telescopic camera and light source will be inserted through the urethra, from where urine is passed into the bladder.

The doctor will then fill the bladder with sterile fluid so that the entire lining of the bladder can be inspected.

The procedure will only take a few minutes. If necessary, a biopsy can be performed to confirm or rule out any diagnosis.

Risks of a cystoscopy

Cystoscopy is an important and useful diagnostic procedure that has a very low incidence of complications if properly prepared.

All anesthetics carry the risk of complications, but this is very small in the case of cystoscopy.

Side effects are short-lived and not severe.

There is a small risk of infection or damage to the inside of the bladder with a cystoscopy.

Special attention should be paid in case of:

  • Develop a fever
  • Have excessive blood in the urine.
  • Have a lot of pain or difficulty urinating.

Post-cystoscopy instructions

  1. You may notice blood-tinged urine or experience mild discomfort when urinating after a cystoscopy. This is normal and usually resolves in two to three days. Aspirin, blood thinners, or anti-inflammatory medications should not be taken for at least three days after the cystoscopy.
  2. Increasing your fluid intake for several days after the cystoscopy is advised, especially if there is visible blood in the urine.
  3. In certain cases, the urologist may prescribe antibiotics before and after this procedure. In these cases, make sure you finish taking all medications as directed, even if you feel fine.
  4. The patient should contact the physician immediately if unable to urinate, develops excessive bleeding, abdominal pain, or fever after a cystoscopy.