Cystoscopy
Overview
Cystoscopy is endoscopy
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...

 of the urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...

 via the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

. It is carried out with a cystoscope.

Diagnostic cystoscopy is usually carried out with local anaesthesia. General anaesthesia
General anaesthesia
General anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents...

 is sometimes used for operative cystoscopic procedures.

The urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

 is the tube that carries urine
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...

 from the bladder to the outside of the body.
The cystoscope has lenses like a telescope
Telescope
A telescope is an instrument that aids in the observation of remote objects by collecting electromagnetic radiation . The first known practical telescopes were invented in the Netherlands at the beginning of the 1600s , using glass lenses...

 or microscope
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...

. These lenses let the doctor focus on the inner surfaces of the urinary tract.
Encyclopedia
Cystoscopy is endoscopy
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...

 of the urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...

 via the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

. It is carried out with a cystoscope.

Diagnostic cystoscopy is usually carried out with local anaesthesia. General anaesthesia
General anaesthesia
General anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents...

 is sometimes used for operative cystoscopic procedures.

The urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

 is the tube that carries urine
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...

 from the bladder to the outside of the body.
The cystoscope has lenses like a telescope
Telescope
A telescope is an instrument that aids in the observation of remote objects by collecting electromagnetic radiation . The first known practical telescopes were invented in the Netherlands at the beginning of the 1600s , using glass lenses...

 or microscope
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...

. These lenses let the doctor focus on the inner surfaces of the urinary tract. Some cystoscopes use optical fibres
Optical fiber
An optical fiber is a flexible, transparent fiber made of a pure glass not much wider than a human hair. It functions as a waveguide, or "light pipe", to transmit light between the two ends of the fiber. The field of applied science and engineering concerned with the design and application of...

 (flexible glass fibres) that carry an image from the tip of the instrument to a viewing piece at the other end. Cystoscopes range from between the thickness of a pencil, up to approximately 9mm and have a light at the tip. Many cystoscopes have extra tubes to guide other instruments for surgical procedures to treat urinary problems.

There are two main types of cystoscopy - flexible
Flexible
Flexible may refer to:* Flexible electrical cable, also known as a power cord* Flexible electronics* Flexible response* Flexible mold* Flextime* Flexible-fuel vehicle* Flexible rake receiver* Flexible spending account, a tax-advantaged savings account...

 and rigid
Rigid
In mathematics, a rigid collection C of mathematical objects is one in which every c ∈ C is uniquely determined by less information about c than one would expect....

 - differing in the flexibility of the cystoscope. Flexible cystoscopy is carried out with local anaesthesia on both sexes. Typically, a topical anesthetic, most often xylocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...

 gel (common brand names are Anestacon and Instillagel) is is employed. The medication is instilled into the urethra via the urinary meatus
Urinary meatus
The urinary meatus is an orifice of the urethra. It is the point at which urine and, in males, semen exits the urethra. The meatus features varying degrees of sensitivity to the touch among males and females....

 five to ten minutes prior to the beginning of the procedure. Rigid cystoscopy can be performed under the same conditions, but is generally carried out under general anaesthesia, particularly in male subjects, due to the pain caused by the probe.

Medical uses

Cystoscopy may be recommended for any of the following conditions:
  • Frequent urinary tract infection
    Urinary tract infection
    A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...

    s
  • Blood
    Blood
    Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

     in the urine (hematuria
    Hematuria
    In medicine, hematuria, or haematuria, is the presence of red blood cells in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract , ranging from trivial to lethal...

    )
  • Loss of bladder control (incontinence
    Urinary incontinence
    Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...

    ) or overactive bladder
  • Unusual cells found in urine sample
  • Need for a bladder catheter
    Catheter
    In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...

  • Painful urination, chronic pelvic pain
    Pelvic pain
    Pelvic pain is a symptom that can affect both women and men. The pelvic pain that persists for a period of 3 months or more to be considered chronic while less than this duration is considered acute. The pain may indicate the existence of poorly-understood conditions that likely represent abnormal...

    , or interstitial cystitis
    Interstitial cystitis
    Interstitial cystitis or bladder pain syndrome is a chronic, oftentimes severely debilitating disease of the urinary bladder...

  • Urinary blockage such as from prostate
    Prostate
    The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....

     enlargement, stricture, or narrowing of the urinary tract
  • Stone
    Kidney stone
    A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...

     in the urinary tract
  • Unusual growth, polyp
    Polyp (medicine)
    A polyp is an abnormal growth of tissue projecting from a mucous membrane. If it is attached to the surface by a narrow elongated stalk, it is said to be pedunculated. If no stalk is present, it is said to be sessile. Polyps are commonly found in the colon, stomach, nose, sinus, urinary bladder...

    , tumor
    Tumor
    A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...

    , or cancer
    Cancer
    Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...


Male and female urinary tracts

If a patient has a stone lodged higher in the urinary tract, the doctor may use a much finer calibre scope called a ureteroscope through the bladder and up into the ureter
Ureter
In human anatomy, the ureters are muscular tubes that propel urine from the kidneys to the urinary bladder. In the adult, the ureters are usually long and ~3-4 mm in diameter....

.
(The ureter is the tube that carries urine from the kidney to the bladder).
The doctor can then see the stone and remove it with a small basket at the end of a wire which is inserted through an extra tube in the ureteroscope.
For larger stones, the doctor may also use the extra tube in the ureteroscope to extend a flexible fiber that carries a laser
Laser
A laser is a device that emits light through a process of optical amplification based on the stimulated emission of photons. The term "laser" originated as an acronym for Light Amplification by Stimulated Emission of Radiation...

 beam to break the stone into smaller pieces that can then pass out of the body in the urine.

Test Procedures

Doctors may have special instructions, but in most cases, patients are able to eat normally and return to normal activities after the test.
Patients are sometimes asked to give a urine sample before the test to check for infection.
These patients should ensure that they do not urinate for a sufficient period time, such that they are able to urinate prior to this part of the test.

Patients will have to remove their clothing covering the lower part of the body, although some doctors may prefer if the patient wears a hospital gown
Hospital gown
A hospital gown, also known as a patient gown, exam gown, johnny shirt or johnny gown, is a short-sleeved, thigh-length garment worn by patients in hospitals and other medical facilities.-Utility:...

 for the examination and covers the lower part of the body with a sterile drape.
In most cases, patients lie on their backs with their knees slightly parted. Occasionally, a patient may also need to have their knees raised. This is particularly when undergoing a Rigid Cystoscopy examination. For flexible cystoscopy procedures the patient is almost always alert and a local anesthetic is applied to reduce discomfort. In cases requiring a rigid cystoscopy it is not unusual for the patient to be given a general anesthetic, as these can be more uncomfortable, particularly for men.
A doctor, nurse or technician will clean the area around the urethral opening and apply a local anesthetic. The local anesthetic is applied direct from a tube or needleless syringe into the urinary tract. Often, skin preparation is performed with Hibitane

Patients receiving a ureteroscopy may receive a spinal
Spinal anaesthesia
Spinal anaesthesia , also called spinal analgesia or sub-arachnoid block , is a form of regional anaesthesia involving injection of a local anaesthetic into the subarachnoid space, generally through a fine needle, usually 9 cm long...

 or general anaesthetic
General anaesthetic
A general anaesthetic is a drug that brings about a reversible loss of consciousness. These drugs are generally administered by an anaesthesia provider to induce or maintain general anaesthesia to facilitate surgery...

.

The doctor will gently insert the tip of the cystoscope into the urethra and slowly glide it up into the bladder. The procedure is more painful for men than for women due to the length and narrow diameter of the male urethra.
Relaxing the pelvic muscles helps make this part of the test easier.
A sterile
Sterilization (microbiology)
Sterilization is a term referring to any process that eliminates or kills all forms of microbial life, including transmissible agents present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media...

 liquid (water, saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...

, or glycine
Glycine
Glycine is an organic compound with the formula NH2CH2COOH. Having a hydrogen substituent as its 'side chain', glycine is the smallest of the 20 amino acids commonly found in proteins. Its codons are GGU, GGC, GGA, GGG cf. the genetic code.Glycine is a colourless, sweet-tasting crystalline solid...

 solution) will flow through the cystoscope to slowly fill the bladder and stretch it so that the doctor has a better view of the bladder wall.

As the bladder reaches capacity, patients typically feel some mild discomfort and the urge to urinate.

The time from insertion of the cystoscope to removal may be only a few minutes, or it may be longer if the doctor finds a stone and decides to remove it, or in cases where a biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

 is required.
Taking a biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...

 (a small tissue sample for examination under a microscope) will also make the procedure last longer. In most cases, the entire examination, including preparation, will take about 15 to 20 minutes.

Post Procedural Care and Information

After the test, patients often have some burning feeling when they urinate and often see small amounts of blood in their urine. Procedures using rigid instrumentation often result in urinary incontinence and leakage from idiopathic causes to urethral damage. Occasionally, patients may feel some lower abdominal pains, reflecting bladder muscle spasms, but these are not common.

Common (non-invasive) prescriptions to relieve discomfort after the test may include:
  • Drinking 32 fluid ounces (1 L) of water over 2 hours.
  • Taking a warm bath to relieve the burning feeling.
  • Holding a warm, damp washcloth over the urethral opening.


Prior to the early 1990s, it was common practice for the physician performing the procedure to prescribe an antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...

 to take for a few days to prevent an infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

. Since that time, many urologists will order a "Urine C & S" (urinalysis with bacterial/fungal cultures and testing for sensitivities to anti-infective medications) prior to the performance of the cystoscopy, and as part of the pre-operative workup. Depending on the results of the testing and other circumstances, he or she may elect to prescribe a 10 to 14 day course of antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...

 or other anti-infective treatment, commencing 3 days before the cystoscopy is to be performed, as this may alleviate some inflammation of the urethra prior to the procedure. This practice may provide an additional benefit by preventing an accidental infection from occurring during the procedure. The full-course of antibiotic treatment also lessens the possibility of the bacteria becoming resistant to the antibiotic/anti-infective agent prescribed.

Physicians may also prescribe an oral urinary analgesic, Phenazopyridine
Phenazopyridine
Phenazopyridine is a chemical which, when excreted into the urine, has a local analgesic effect. It is often used to alleviate the pain, irritation, discomfort, or urgency caused by urinary tract infections, surgery, or injury to the urinary tract...

 or a combination (urinary) analgesic/anti-infective/anti-spasmodic medication containing Methylene Blue
Methylene blue
Methylene blue is a heterocyclic aromatic chemical compound with the molecular formula C16H18N3SCl. It has many uses in a range of different fields, such as biology and chemistry. At room temperature it appears as a solid, odorless, dark green powder, that yields a blue solution when dissolved in...

, Methanamine, Hyoscyamine Sulfate and Phenyl Salicylate
Phenyl salicylate
Phenyl salicylate, or salol, is a chemical substance, introduced in 1886 by Marceli Nencki of Basel. It can be created by heating salicylic acid with phenol. Once used in sunscreens, phenyl salicylate is now used in the manufacture of some polymers, lacquers, adhesives, waxes and polishes...

for irritation and/or dysuria patients may experience after the procedure. At two weeks post-procedure, the practitioner may order a follow-up evaluation including a repeat of the urinalysis with cultures and sensitivities, and a Uroflowmetric study (which evaluates the volume of urine released from the body, the speed with which it is released, and how long the release takes).
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