A B C D E F G H I J K L M N O P R S T U V W

CYSTOSCOPY AND OTHER PROCEDURES

What is a Cystoscopy ?

To appreciate these procedures, an understanding of the urinary tract is helpful. The urethra is the tube which conducts urine from the bladder to the outside and is therefore the natural route of entry for telescopic instruments to examine the bladder and other structures. The lining of the urethra is always inspected (urethroscopy) on the way into the bladder. The bladder is very commonly inspected (cystoscopy) and the instrument used is called a cystoscope. Urine enters the bladder through two narrow tubes called ureters, which pass down, one each side, from the kidneys. The ureters can become blocked (usually by small stones) and may then also require inspection (ureteroscopy) using an instrument called an ureteroscope.

Why is a Cystoscopy performed ?

Most often cystoscopy is performed to discover a cause for blood in the urine. Such a procedure is called a diagnostic cystoscopy. Usually diagnosis is only possible after a specimen of tissue has been taken from an area which looks abnormal (a biopsy). Often treatment is also possible at the time of diagnosis. For example, in the case of bladder stone, the urologist can diagnose the stone during cystoscopy and then crush and remove it at the same time. A cystoscopy may discover infection, inflammation, a bladder growth or stone. At cystoscopy a specimen of the bladder tissue can be taken for examination, and growths can be removed or cauterized. A cystoscopy may also reveal enlargement of the prostate. Sometimes this can be removed during the same procedure. Occasionally, cystoscopy reveals narrowing of the urethra and this can be treated at the same time by making a little internal cut to widen the tube. A ureteroscopy can be performed when there is a blockage in the ureter tube, usually by a stone. Sometimes the stone can be removed using the ureteroscope. Other causes of blockage of the ureter can also be diagnosed.

Preparations needed for a Cystoscopy

Most cystoscopies are performed as a day case and many will not require a general anaesthetic. Because so many different procedures can be performed at the same time, you must ask the urologist precisely what is planned.

What Happens during a Cystoscopy

A cystoscopy means the passage of a narrow telescope into the bladder for inspection and treatment. A check cystoscopy describes the regular inspections necessary for bladder tumours, once they have been treated. All these tumours may become malignant and further cystoscopies to check for recurrence will always be necessary. If there is a likelihood of recurrence requiring diathermy or removal, the cystoscopy will require a general anaesthetic and possibly one to two nights in hospital. When the chances of recurrence are small, and for most other uses, a flexible cystoscopy will usually be arranged. Most hospitals are equipped with flexible cystoscopes which can be passed into the bladder through the urethra. Local anaesthetic jelly is first squeezed into the urethra, so that the urethra does not hurt when the cystoscope is passed into the bladder. You will therefore avoid all the risks of a general anaesthetic, and can leave the hospital within an hour of the completion of the procedure. Most check cystoscopies are now performed in this way. Some people are concerned that the local anaesthetic will not work. However, it is most unusual for a local anaesthetic to be ineffective. Some narrowings of the urethra, called strictures, need to be inspected (endoscopically) and can then be widened by cutting. This procedure usually requires a general anaesthetic and can usually be completed as a day case. About half of these urethral strictures come back again and will therefore require repeated treatment. Ureteroscopy is most commonly performed for a stone which has become stuck in the ureter between the kidney and the bladder. Most of these small (about half a centimetre in diameter) stones pass by themselves so that only a few need treatment. Therefore the reasons for removing a stone in the ureter may be complex and it is wise to discuss this fully with the urologist. The urologist will explain that the object of the procedure is to avoid open (cutting) surgery. It is sometimes impossible to predict the success of the first attempt to remove the stone, but generally 1 to 2 nights in hospital will be necessary to check that the attempt has been successful.

Possible Complications during a Cystoscopy

Whenever an instrument has been passed through the urethra, there will be soreness on passing urine. This may persist for 24 hours. Some urologists prescribe antibiotics to prevent the urine from becoming infected. Whenever an endoscopic operation has been performed, a little bleeding is common for the first 48 hours. If this persists or if you notice any heavy bleeding in the first month after the procedure, you should contact the GP immediately.

If a Cystoscopy is not performed

Missing a check cystoscopy for a growth may mean that the growth gets out of hand and then requires a larger operation to deal with it. Certain x-rays and external examinations may provide some idea of what is causing urinary tract symptoms. They do not replace cystoscopy, which is a very direct way of seeing (and often treating) the problem in a single procedure.