Cystoscopy - Types, Indications, Contraindications, Procedure, and Complications

Introduction:

Cystoscopy allows the doctor to view the urinary tract organs with the help of a special camera known as the cystoscope. In this procedure, a tube known as a cystoscope is inserted to examine the walls of the bladder and urethra. It is a diagnostic and therapeutic tool to address the problems of the urinary system.

The urinary system comprises the following organs:

1. Kidneys - Bean-shaped organs that form urine and filter the blood.

2. Ureters - Tube-like structures that carry urine from the kidneys to the urinary bladder.

3. Urinary Bladder - Balloon-shaped structure that stores urine.

4. Urethra - It is a tube-like structure that carries urine outside the body.

What Is a Cystoscopy?

Cystoscopy aims to eliminate the problems of the urinary system. In addition, it helps diagnose the diseases affecting the bladder and urethra, the cause of urinary tract infections, and prostate gland enlargement. A long, flexible tube known as the cystoscope is inserted into the urethra and moved up to the bladder. The tube usually contains a camera and a light source attached, allowing the doctor to look into the bladder and urethra. The treatment can also be done simultaneously because the cystoscope enables the passage of surgical instruments. During the examination, if the doctor suspects the presence of a tumor, a mass of tissue can also be removed for further evaluation (biopsy).

What Are the Different Types of Cystoscopy?

There are two types of cystoscopy described in the table below:

What Are the Indications of Cystoscopy?

Cystoscopy is similar to endoscopy because both procedures provide a view of the internal organs of the body. The patient needs to undergo cystoscopy due to the following reasons:

• Investigate the Causes of the Problems: There are a variety of conditions that affect the urinary system, and the patient presents with typical signs and symptoms, which are listed below:

  • Hematuria or the presence of blood in the urine.

  • Pain and burning sensation while passing urine.

  • Urinary incontinence or the leakage of urine.

  • Urge to urinate suddenly (overactive bladder).

  • Recurrence of urinary tract infections.

Cystoscopy helps to identify the causes of all the signs and symptoms mentioned above. Along with investigation, treatment of the conditions can also be done simultaneously in cystoscopy.

• Diagnosis of Diseases: When the doctor performs cystoscopy, the conditions or diseases of the bladder and urethra can also be diagnosed. So, cystoscopy helps diagnose the following:

  • Bladder stones.

  • Bladder and urethral cancer.

  • Inflammation of the bladder (cystitis).

  • Enlargement of the prostate gland.

  • Urethral strictures (narrowing of the urethra).

• Treatment of the Diseases: Cystoscopy not only helps to diagnose the disease but also treats them. A tube known as the cystoscope is inserted into the bladder through the urethra to view the condition. The surgical instruments passed through the cystoscope treat the disease present. The following treatment can be done through cystoscopy:

  • First, the stone present within the bladder or urethra can be removed.

  • If the tumor is of small size, it can be directly removed by cystoscopy.

  • Finally, medicines can be directly injected into the bladder and urethra to treat urinary incontinence (urine leakage).

  • The stent or the tube placed after ureteroscopy to facilitate urine drainage can also be removed by cystoscopy.

What Are the Contraindications of Cystoscopy?

Cystoscopy should not be performed in patients suffering from a urinary tract infection because it increases the risk of septicemia (blood poisoning). After the infection has subsided, a urine sample should be taken and checked under a microscope in the laboratory. The cystoscopy should be done only after the lab tests confirm the absence of infection. It is usually contraindicated if the patient feels pain and discomfort during flexible cystoscopy. If the urethra is narrow, inserting the cystoscope becomes impossible.

How to Prepare for a Cystoscopy?

Two types of cystoscopy are usually performed: flexible and rigid. During flexible cystoscopy, the patient is awake, and the cystoscope is inserted just for examination purposes. No treatment is performed in this type. In rigid cystoscopy, the patient is made to fall asleep by injecting the anesthesia, and treatment is done. The time to complete the procedure depends on the type of cystoscopy being performed. Flexible cystoscopy gets completed in five to ten minutes, and the patient is not required to stay in the hospital, unlike rigid cystoscopy. The following things are usually needed to be done before the procedure:

1. The doctor will review the X-rays and computed tomography (CT scans) before the procedure to ensure that the procedure can be safely performed on the patient without any complications.

2. The patient needs to collect the urine in a container to be examined for the presence of infection. If the test report indicates that the patient is suffering from a urinary tract infection, the procedure needs to be delayed until the infection subsides.

3. The patient should also inform the doctor about the medications he is taking or any allergies or disorders he is suffering from. For example, the doctor might ask to stop taking drugs like Aspirin and Ibuprofen before the surgery, as they can cause excessive bleeding.

4. It is essential to urinate before the procedure.

5. If the cystoscopy is being done only to examine the bladder and urethra, no changes are needed in the diet. Still, if treatment is to be carried out, the patient needs to stop eating and drinking a few hours before the surgery.

6. Female patients need to inform the doctor if they are pregnant or expecting to be.

What Happens During the Procedure of Cystoscopy?

The procedure of cystoscopy is carried out in the following way:

• First, the patient is asked to urinate before the procedure and laid down on his back with feet placed in stirrups and knees bent.

• General anesthesia or a sedative is administered to the patient depending upon the purpose of the cystoscopy. The sedative will relax the patient without putting him to sleep, and the patient will be aware of his surroundings. On the contrary, general anesthesia will make the patient fall asleep, and the patient will be completely unaware of the procedure.

• Next, the doctor applies a gel to the urethra so that the patient does not feel pain when inserting a cystoscope.

• After the area becomes numb, the doctor slowly inserts a small size into the urethra. A large cystoscope is inserted if the surgical instruments are passed through it to treat the disease or conduct a biopsy.

• A sterile liquid known as saline (saltwater) is inserted through the cystoscope to inflate the bladder and get a better view.

• The cystoscope resembles a telescope and consists of a lens at one end, allowing the doctor to view the magnified images of the bladder and the urethra on the screen.

• Surgical instruments can be inserted through the cystoscope to treat the condition affecting the bladder. Tissue samples can also be taken if the tumor is present.

• The patient might feel discomfort and the urge to urinate as the bladder is full, so the doctor will remove the liquid or allow the patient to urinate after the procedure.

What Happens After Cystoscopy?

The time at which the patient can go home after the procedure depends upon the type of anesthesia administered to the patient. Suppose the procedure was carried out under general anesthesia. The patient must wait for two to four hours in the hospital before going home to allow the anesthesia to wear off. The patient usually experiences the following for 24 hours after the procedure:

1. Burning sensation while passing urine.

2. Presence of a small amount of blood in the urine.

3. Pain or discomfort in the bladder while urinating.

4. A need to urinate frequently.

Following instructions need to be followed at home after the procedure:

• Drink two glasses (16 ounces) of water every hour after the procedure to flush out the bacteria and irritants.

• Warm baths must be taken to relieve the burning sensation.

• A warm damp washcloth placed over the urethral opening helps ease pain and discomfort.

• The medications prescribed by the doctor must be taken to avoid infection.

What Are the Complications of Cystoscopy?

The following complications are usually seen after cystoscopy:

1. Urethritis: It is the swelling and inflammation of the urethra. The urethra is a tube that carries urine outside the body. It becomes difficult for the patient to pass urine due to the pain. If the patient experiences difficulty urinating for more than eight hours, it is important to consult the doctor.

2. Bleeding: A small amount of blood in the urine is a common finding after the procedure, but report it to the doctor immediately if the bleeding is severe.

3. Infection: The bacteria might enter the urinary tract and cause infection. Fever, back pain, nausea, and foul-smelling urine are some of the symptoms of infection, but this happens rarely.

Conclusion:

Cystoscopy enables the doctor to diagnose and treat the disease simultaneously. A cystoscope is inserted into the urethra that brings out the magnified images of the bladder and helps detect the abnormalities present. The doctor does not have to make any incision to reach the urinary bladder, making it less painful. There are risks and side effects associated with it, but if the condition of the patient has been assessed thoroughly before the procedure, it does not cause any harm. The results are excellent if the procedure is performed under proper care and training.