Cystoscopy and ureteroscopy

Cystoscopy(from ancient Greek kystis – “bladder”), urethrocystoscopy is a medical method of examination, examination of the inner surface of the urethra and bladder, a type of endoscopy. Cystoscopy is performed using a special endoscope – a cystoscope (tube-catheter with optical and lighting systems), which is inserted through the urethra and allows you to visually examine the urethra and bladder along its entire length for the presence of polyps, narrowings of the canal, atypical neoplasms and other pathologies.

Starting with the use of incandescent lamps in endoscopy, endoscopy (including cystoscopy) has become widespread and has significantly advanced the diagnosis of urinary tract diseases. Cystoscopy gradually acquired primary importance for the early recognition of volumetric pathology of the bladder and urethra, to identify the source of bleeding, to determine the location, type and size of a foreign body in the bladder cavity. Thus, it became possible to remove tumors in a timely manner, and it became possible to remove foreign bodies through natural channels in cases where without cystoscopy one would have to resort to surgery.

Indications for cystoscopy:

suspicion of interstitial cystitis
frequent exacerbations of cystitis
chronic urinary infection
blood in the urine (hematuria)
urinary incontinence or overactive bladder
detection of atypical cells in urine analysis
suspicion of bladder tuberculosis
impaired urine flow, difficulty or frequent urination
need for bladder catheterization
painful urination, chronic pelvic pain or interstitial cystitis
urinary retention due to prostate enlargement, stricture or narrowing of the urinary tract.
stone in the urinary tract
urinary tract neoplasm (polyp or tumor)

Cystoscopy is not only a diagnostic procedure, it allows for therapeutic manipulations:

injection of bulk-forming and antitumor agents into the bladder wall
elimination of bladder obstruction, restoration of urine outflow
stop bleeding from the bladder.
removal of papilloma, tumors,
endovesical electrocoagulation of a simple ulcer,
dissection of the ureteric orifice for ureterocele,
bougienage of the ureter with its stricture,
ureteral catheterization
removal of stones from the ureter using special devices – extractors,
cystolithotripsy (crushing stones),
transurethral electroresection (TUR) of prostate adenoma or cancer.

Contraindications for cystoscopy:

Acute inflammation of the urethral mucosa (acute urethritis)
Inflammation of the prostate gland (acute prostatitis)
Acute inflammation of the epididymis (acute epididymitis)
Acute inflammation of the bladder (acute cystitis)
Uretral (resorptive) fever.
Urethra injury

Preparation for cystoscopy

Make sure you are fully informed about the planned cystoscopy, and do not be afraid to ask clarifying questions. It is your right to know all the information about cystoscopy, as this is part of informed consent.
In addition, you should ask your doctor about preparing for a cystoscopy. Prepare for your visit to the doctor by jotting down any questions or concerns you have so you can ask your doctor.
If cystoscopy will be performed with anesthesia, then you must refrain from eating before the cystoscopy. The type of food restriction will depend on the type of anesthesia that will be used during cystoscopy.
If anesthesia is required for a cystoscopy, you will need assistance to return home. You will not be allowed to drive a car. Please follow all instructions given to you at the clinic or hospital.
Your doctor may have his own requirements for preparing for cystoscopy. These requirements must be strictly observed.
Consult your urologist if you should stop taking the medications you are taking:

aspirin
anticoagulants (warfarin, heparin)
medicines for the treatment of arthritis
painkillers
insulin.

What should you take with you to the clinic or hospital if you are having a cystoscopy?

Do not take valuables with you.
Leave all the jewelry at home.
Bring warm, comfortable clothing.
Bring with you the medications you usually take during the day. You may be able to avoid disrupting your intake schedule.
Take all medical documents, x-rays or CT scans with you.
You can grab something to read while you wait in line.
It is advisable to remove nail polish and not apply cosmetics.

How long does a cystoscopy take?

Cystoscopy is performed within 5 to 45 minutes.

How is the examination carried out?

A cystoscope is a tubular instrument equipped with a light and visual inspection devices that is used to examine the inside of the urinary tract. There are two types of cystoscopes: a standard rigid cystoscope and a flexible cystoscope. The choice of cystoscope directly depends on the purpose of the study.

Most cystoscopy is performed under local anesthesia, that is, a painkiller is injected into the urethra (urethra) to reduce discomfort. To do this, inject 10 ml of a warm 2% novocaine solution or lidocaine gel for 5-10 minutes. You remain awake during the cystoscopy as sedation is not required. General anesthesia is usually performed in patients with unstable mental health. However, if a bladder lesion is found that requires a biopsy or removal of the affected area, cystoscopy will often have to be repeated again, this time using general anesthesia.

Cystoscopy is performed with the patient lying on his back. Before inserting the cystoscope, it is lubricated with sterile glycerin. The entire procedure is carried out under aseptic conditions.

Because the cystoscope is inserted through the urethra, your urologist will examine the lining of the urethra for any abnormalities or obstructions. With the cystoscope in the bladder, the urologist slowly injects sterile water or saline to better see the entire lining of the bladder.

Your doctor will ask you a series of questions about how you feel when your bladder is full.

If any tissue is found to be abnormal, a biopsy (tissue sample) can be taken for analysis through a cystoscope. The entire procedure usually takes approximately 15 – 20 minutes.

Is the examination painful?

You may feel discomfort when the cystoscope is placed into the urethra and bladder. You may feel a strong need to urinate as water fills your bladder. If a biopsy is taken, you may feel a slight pinch.

After the procedure, your urethra may be sore and you may experience a burning sensation when urinating for one to two days.

After cystoscopy

Many urologists require that the patient urinate at least once before being allowed to go home. Before you go home, your doctor will discuss the results of the cystoscopy with you, your future treatment plan, and make any necessary recommendations.

In most cases, you will be able to lead a normal lifestyle without dietary restrictions, unless your doctor advises otherwise. Unless otherwise advised, you should drink more fluids to dilute your urine and reduce urinary discomfort, such as burning. Some burning sensation when urinating after cystoscopy is possible. A warm bath may be recommended to reduce urinary discomfort.

You may notice blood in your urine a short time after your cystoscopy, but the blood usually stops after one or two days. Consult your doctor about pain relief after cystoscopy, because… aspirin and other painkillers thin the blood and increase the risk of bleeding. You may be prescribed antibiotics to reduce the risk of infection.

What are the risks of cystoscopy?

Like any invasive method, cystoscopy can also have its negative manifestations. Risks of having a cystoscopy include:

Infection
Bleeding from the biopsy site (slight risk)
Bladder wall rupture (slight risk)
Contact your doctor if you notice the following symptoms after a cystoscopy:
fever and/or chills
frequent urination or a frequent urge to urinate
urinary retention (inability to urinate)
lower back pain
prolonged burning sensation when urinating
blood in urine.

If any complication occurs, you should immediately contact your doctor.