Cystoscopy

A cystoscopy can be carried out for numerous reasons. By definition, it is a small procedure wherein a doctor uses a cystoscope to examine the lining of the bladder through the urethra.

NB: The following information should be used only as a general guide. Each hospital may have a different set of arrangements and alternate ways of performing the tests. You should always adhere to the instructions which are provided by your local hospital or GP.

What is a cystoscope?

The cystoscope is a slim tube with a light at one end and a viewer (like in a camera) at the other. It is like a very thin telescope which is introduced into the bladder through the urethra - the tube which drains urine away from the body.

There are two main kinds of cystoscope:

1)      Flexible cystoscope: As its name suggests, this is a soft fibreoptic tube, around the thickness of a pencil. The flexibility in the cystoscope enables your doctor to see all areas of the urethra.

2)      Rigid cystoscope: This kind of cystoscope is the same thickness as the flexible type but is solid and rigid.

A doctor can see through the eye view of the cystoscope as well as viewing pictures on a monitor or VDU. Each of the cystoscopes has small side channels which can be used by the doctor to insert thin devices. For instances, a biopsy (sample) from the bladder lining may be required, and this can be achieved by passing thin grasping forceps down through the side channel.

The cystoscope more frequently used by doctors and hospitals is the flexible type. Due to its malleability, it passes more easily through the urethra curves. The supple tip can also be guided more directly by the doctor, making it much easier to see the inside of the bladder lining. Nonetheless, with the rigid cystoscope, a more significant number of devices that might be needed for a variety of procedures, can be passed down through the side channels.

When is it necessary to have a cystoscopy?

To help with diagnosis
A cystoscopy may be done to help to find the cause of symptoms such as:

  • Frequent urinary tract infections.
  • Blood in your urine (haematuria).
  • Incontinence.
  • Unusual cells found in a urine sample.
  • Persistent pain when you pass urine.
  • Difficulty in passing urine (which may be due to prostate enlargement or a stricture (narrowing) of the urethra).

Often, a cystoscopy is normal. However, this helps to rule out certain causes of symptoms. Cystoscopy may also be done to monitor progress of conditions. For example, some people have a routine cystoscopy every now and then after treatment for a bladder tumour. This helps to detect any early recurrence which can be treated before it spreads further.

What happens during a cystoscopy?

A cystoscopy will typically be carried out as a ‘day case’ or ‘outpatient’. You are awake during the procedure. Some individuals have a sedative to help them relax during the cystoscopy.

Wearing a hospital gown, you will lie down flat on a couch on your back. Your genitals and the skin immediately surrounding it are cleaned with an antiseptic wipe. A local anaesthetic gel is then spread onto your urethra. This provides a minor numbing to the lining of your urethra and aids the cystoscope to pass through without any problems and with minimal discomfort to you.

The cystoscope is then gently pushed into your bladder by your doctor who will examine the lining and urethra thoroughly. Through the side channel of the cystoscope, your doctor will add sterile water which will slowly fill up your bladder. By doing this, the doctor can more easily see the lining. You may well feel the need to urinate as your bladder starts to fill and this may be a little uncomfortable.

Overall, the procedure typically takes between 5-10 minutes if your doctor is just looking inside your bladder. However, if for instance, a biopsy (sample) is needed from the lining, it may take longer. Once the doctor has finished the examination, the cystoscope is withdrawn gently. Your doctor may tell you what he saw in your bladder after finishing the test. Although, if a biopsy is taken, then the sample will be sent to a research laboratory to be examined through a microscope. If this happens, it may be a few days before the results are sent back to your doctor.

In some instances, a cystoscopy is done under general anaesthetic, and mostly when a rigid cystoscope is used. When a spinal cystoscopy is necessary, an anaesthetic is injected into the spine which causes the lower section of the body to go numb.

 

Do you get any side-effects or complications from having a cystoscopy?

On the whole, no problems occur from having a cystoscopy. In the 24 hours after the procedure, you may feel a minor burning sensation during urination and have the urge to go more than usual. Also, your urine may appear pink - this is due to slight bleeding which predominantly occurs if a biopsy is taken. A urine infection occasionally occurs following a cystoscopy. This can bring about a fever (elevated temperature) and discomfort when urinating. It is quite rare that a cystoscope injures or punctures the bladder.

Following a cystoscopy, you should get in touch with your doctor if:

·        You are in pain, or there is severe bleeding.

·        You are in pain, or any bleeding lasts more than two days.

·        You start to develop symptoms of infection like a fever.