Cystoscopy is a procedure used by a urologist to examine the interior of the bladder and urethra. During the procedure, a cystoscope—a thin, hollow tube with a lens—is inserted into the urethra and guided into the bladder. This allows the doctor to inspect the area and address any issues. The test is typically performed in a specialized room where a local anesthetic jelly is applied to numb the urethra. Alternatively, general anesthesia may be used. The specific method for the cystoscopy will depend on the underlying issue being investigated.
Cystoscopy is used to diagnose, treat, and monitor issues related to the bladder and urethra. It is recommended in the following situations:
• To investigate symptoms such as an overactive bladder, blood in urine, or urinary incontinence (leaking or frequent urination). It can also help diagnose urinary pain during urination.
• To identify the cause of frequent urinary infections, although cystoscopy is not solely for infections.
• To diagnose bladder conditions such as bladder cancer, inflammation (cystitis), or bladder stones.
• To treat bladder issues, such as removing small tumors or abnormal tissues using specialized tools within the cystoscope.
To assess an enlarged prostate, a condition where the urethra narrows as it passes through the prostate gland. Cystoscopy can determine if the narrowing has occurred.
Seek medical advice if you experience any of the following severe symptoms:
• Persistent abdominal pain and nausea
• Difficulty urinating after a cystoscopy
• Chills
• Bright red blood clots in your urine
• A high fever (above 101.4°F)
• A burning sensation during urination lasting more than two days
If you have a weakened immune system or a UTI, you might need to take antibiotics before and after the procedure. The doctor will collect a urine sample before the test, so it's best to schedule the appointment for early morning when your bladder is full.
You may receive general anesthesia for the procedure:
• Arrange for someone to drive you home afterward.
• Rest at home before resuming work.
Check with your urologist about any medications you may need to take to manage excessive bleeding.
There are two types of cystoscopy: flexible and rigid. Both serve the same purpose, but the approach differs.
Flexible Cystoscopy: This uses a thin, pencil-like device (cystoscope) that is easily bendable. No anesthesia is required, so you remain awake during the procedure. It’s generally not painful, though you might feel a sensation of needing to urinate.
Rigid Cystoscopy: This involves a non-flexible device. You may receive either general anesthesia, making you fully unconscious, or local anesthesia to numb only the lower part of your body. While the injection might be uncomfortable, you won’t feel pain during the procedure if you are unconscious.
You will start by emptying your bladder and then change into a hospital gown, lying on the treatment bed. Your feet may be placed in stirrups for convenience. The nurse might administer antibiotics as a precaution against bladder infection.
Depending on the type of anesthesia given, you could be fully unconscious or awake with a numbed lower area. The doctor will apply a gel to your urethra to minimize discomfort and coat the cystoscope before insertion. You may feel a burning sensation and a strong urge to urinate as the cystoscope is inserted.
Once the cystoscope reaches the bladder, the doctor uses the lens to inspect the area and injects a sterile solution to expand the bladder, improving visibility. With local anesthesia, the procedure typically takes less than five minutes; with general anesthesia, it may take between fifteen to thirty minutes.
After undergoing a cystoscopy, you may encounter some risks:
• A burning sensation while urinating that can last for two or three days.
• Increased frequency of urination, which may lead to blood clots or blockages if not managed.
• Possible bleeding during urination.
• Swelling of the urethra, which can make urination difficult. If you cannot urinate for more than 8 hours, consult your doctor.
• Risk of urinary tract infection, indicated by fever, nausea, strong-smelling urine, and lower back pain.
• Persistent stomach pain should also be evaluated by a doctor.
Complications may include:
• Infection: Cystoscopy can occasionally introduce germs into the urinary tract, leading to infection. Antibiotics are usually provided to prevent this. Risks include anatomical anomalies, smoking, and advanced age.
• Pain: Mild abdominal pain and a burning sensation during urination are common but should diminish over time.
• Bleeding: Mild bleeding may occur during urination. If bleeding is severe, seek medical advice.
Post-procedure discomfort is normal and usually subsides with time. Avoid aspirin, as it may increase bleeding. To alleviate discomfort:
• Apply a warm, moist cloth to the urethra opening.
• Consider taking a warm bath, but check with your doctor first.
Drink plenty of water, about half a liter per hour, and urinate frequently to help flush the bladder.
During a cystoscopy, the doctor will administer sedation or anesthesia, depending on the procedure. The process usually takes 15 to 30 minutes. Here’s what to expect:
1. Preparation: You’ll need to empty your bladder and lie down on the examination table.
2. Anesthesia/Sedation: Depending on the type of cystoscopy, you may receive either sedation (keeping you aware but relaxed) or anesthesia (making you unconscious). Both are administered through an intravenous line.
3. Insertion of Cystoscope: The doctor will apply anesthetic jelly to the urethra to minimize discomfort during insertion. Smaller cystoscopes are used for simple inspections, while larger ones may collect tissue samples.
4. Sterilization and Inspection: The doctor will sterilize the urethra and introduce fluid through the cystoscope to enhance visibility. The lens attached to the scope allows for detailed examination, often displayed on a screen using a special camera.
Post-procedure, you may be prescribed antibiotics. Avoid alcohol for at least 24 hours. Common side effects include:
• Slightly pink or red urine.
• A burning sensation during urination.
• Increased frequency of urination.
Results may be discussed immediately if the doctor has sufficient information. If further analysis is needed, particularly for cases like bladder cancer, the samples will be sent to a lab. A follow-up appointment will be required to review the results.
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