Cystoscopy, medically cystoscopy or urethrocystoscopy, is an endoscopic examination of the urinary bladder through the ureter using a rigid or flexible cystoscope. Cystoscopy is one of the modern urological examination procedures and a special endoscope for the examination was first introduced in Vienna in 1879.
How it works
Schematic diagram showing the anatomy and structure of the urinary bladder. Click to enlarge. The cystoscope used in a cystoscopy has lenses through which a detailed view of the inside of the urinary tract can be made. The endoscope for cystoscopy, which is no more than nine millimeters thick, is equipped with a light at the tip and may have optical fibers that transmit the image. For medical procedures, the cystoscope may have tubes through which medical instruments can be passed during cystoscopy. Local anesthesia is usually administered for cystoscopy, especially with a rigid endoscope. If a surgical procedure is performed on the urinary bladder at the same time as the cystoscopy, general anesthesia may be necessary. If a flexible endoscope is used, anesthesia during cystoscopy may not be necessary. The following medical indications may prompt the physician to perform a cystoscopy:
- Noticeably frequent urinary tract infections.
- Blood or cells in the urine
- Suspicion of a tumor or during tumor follow-up.
- Incontinence, bladder overactivity or bladder emptying disorders.
- Insertion of a bladder catheter
- Suspected urethral stricture, fistula formation, or foreign body in the urinary tract.
Application
Cystoscopy is performed with the patient lying down using a rigid or flexible endoscope. Adults may have local or full anesthesia to relieve pain, while children are usually placed under general anesthesia for cystoscopy. No special diet is necessary prior to cystoscopy and the patient can return to normal activities following the examination. Prior to the cystoscopy, a urinalysis may be performed to look for germs. To ensure that the cystoscopy is largely sterile, the urinary tract is flushed with sterile fluid during the examination procedure, which is passed through the cystoscope. It gradually fills the urinary bladder during cystoscopy, which can thus be better examined during cystoscopy while the patient may feel the need to relieve himself. Usually, the images of the cystoscopy are displayed on a monitor and patients who do not receive general anesthesia can watch the examination on the screen. For men, cystoscopy routinely involves examination of the entire urethra as well as the urinary bladder. In women, on the other hand, only the urinary bladder is usually examined. A cystoscopy without additional procedures is usually done in about fifteen minutes.
Side effects and dangers
Following the cystoscopy, many patients experience uncomfortable burning or mild pain in the abdomen. Continuous drinking of one liter of water for the first two hours after cystoscopy and a warm bath may provide relief. During cystoscopy, urinary tract infections carry the risk of spreading pathogens. To avoid this, antibiotics were administered before and during cystoscopy in the past. However, because the frequent use of antibiotics without indication can cause pathogens to develop resistance, this use is now discouraged. Another risk is mechanical injury to the mucosa or even perforation of the tissue during cystoscopy. Mucosal injury can lead to urethral stricture. In men, cystoscopy can lead to chronic inflammation of the prostate, prostatitis.