cystoscopy


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Cystoscopy

 

Definition

Cystoscopy (cystourethroscopy) is a diagnostic procedure that is used to look at the bladder (lower urinary tract), collect urine samples, and examine the prostate gland. Performed with an optic instrument known as a cystoscope (urethroscope), this instrument uses a lighted tip for guidance to aid in diagnosing urinary tract disease and prostate disease. Performed by a urologist, this surgical test also enables biopsies to be taken or small stones to be removed by way of a hollow channel in the cystoscope.

Purpose

Categorized as an endoscopic procedure, cystoscopy is used by urologists to examine the entire bladder lining and take biopsies of any areas that look questionable. This test is not used on a routine basis, but may benefit the urologist who is needing further information about a patient who displays the following symptoms or diagnosis:
  • blood in the urine (also known as hematuria)
  • incontinence or the inabililty to control urination
  • a urinary tract infection
  • a urinary tract which display signs of congenital abnormalities
  • tumors located in the bladder
  • the presence of bladder or kidney stones
  • a stiffness or strained feeling of the urethra or ureters
  • symptoms of an enlarged prostate
Blood and urine studies, in addition to x rays of the kidneys, ureters and bladder may all occur before a cystoscopy. At the time of surgery, a retrograde pyelogram may also be performed. Additional blood studies may be needed immediately following surgery.

Precautions

While the cystoscopy procedure is commonly relied upon to gather additional diagnostic information, it is an invasive surgical technique that may involve risks for certain patients. Those who are extremely overweight (obese), smoke, are recovering from a recent illness, or are treating a chronic condition may face additional risks from surgery.
Surgical risk also increases in patients who are currently using certain drugs including antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta blockers; or cortisone. Those who use mind-altering drugs also put themselves at increased risk of complications during surgery. The following mind-altering drugs should be avoided: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

Description

Depending on the type of information needed from a cystoscopy, the procedure typically takes
Cystoscopy is a diagnostic procedure which is used to view the bladder, collect urine samples, and examine the prostate gland. This procedure also enables biopsies to be taken. The primary instrument used in cystoscopy is the cystoscope, a tube which is inserted through the penis into the urethra, and ultimately into the bladder.
Cystoscopy is a diagnostic procedure which is used to view the bladder, collect urine samples, and examine the prostate gland. This procedure also enables biopsies to be taken. The primary instrument used in cystoscopy is the cystoscope, a tube which is inserted through the penis into the urethra, and ultimately into the bladder.
(Illustration by Electronic Illustrators Group.)
10-40 minutes to complete. The patient will be asked to urinate before surgery which allows an accurate measurement of the remaining urine in the bladder. A well-lubricated cystoscope is inserted through the urethra into the bladder where a urine sample is taken. Fluid is then pushed in to inflate the bladder and allow the urologist to examine the entire bladder wall.
During an examination, the urologist may take the following steps: remove either bladder or kidney stones; gather tissue samples; and treat any suspicious lesions. In order to perform x-ray studies (retrograde pyelogram), a harmless dye is injected into the ureters by way of a catheter that is passed through the previously placed cystoscope. After completion of all needed tests, the cystoscope is removed.

Preparation

As procedure that can be completed in a hospital, doctor's office, or outpatient surgical facility, an injection of spinal or general anesthesia may be used prior to a cystoscopy. While this test is typically performed on an outpatient basis, a patient may require up to three days of recovery in the hospital.

Aftercare

Patients who have undergone a cystoscopy will be instructed to follow these steps to ensure a quick recovery:
  • due to soreness or discomfort that may occur in the urethra, especially while urinating, several warm baths a day are recommended to relieve any pain
A cystoscope helps the doctor examine the urethra, bladder, and prostate.
A cystoscope helps the doctor examine the urethra, bladder, and prostate.
(Illustration by Argosy Inc.)
  • allow four days for recovery
  • blood may appear in the urine-this is common, and soon clears up in one to two days following the procedure
  • avoid strenuous exercise for a minimum of two weeks following surgery
  • sexual relations may continue when the urologist determines that healing is complete
  • wait at least two days after surgery before driving
Patients may also be prescribed pain relievers and antibiotics following surgery. Minor pain may also be treated with over-the-counter, non-prescription drugs such as acetaminophen.

Risks

As with any surgical procedure, there are some risks involved with a cystoscopy. Complications may include: profuse bleeding; a damaged urethra; a perforated bladder; a urinary tract infection; or an injured penis.
Patients should also contact their physician if they experience any of the following symptoms following surgery: pain, redness, swelling, drainage, or bleeding from the surgical site; signs of infection that may include headache, muscle aches, dizziness or an overall ill feeling and fever; nausea or vomiting; strenuous or painful urination; or symptoms that may result as side-effects from the medication.

Normal results

A successful cystoscopy includes a thorough examination of the bladder and collection of urine samples for cultures. If no abnormalities are seen, the results are indicated as normal.

Key terms

Endoscopy — Examination of body organs or cavities through the use of an endoscope (a lighted optical instrument used to see inside body cavities), such as a cystoscope used to complete a cystoscopy.
Retrograde pyelogram — A pyelography or x-ray technique where radiopaque dye is injected into the kidneys from below, by way of the ureters, allowing further examination of the kidneys.
Ureter — The tube that carries urine from the kidney to the bladder, with each kidney having one ureter.
Urethra — A passageway from the bladder to the outside for the discharge of urine. In the female this canal lies between the vagina and clitoris; in the male the urethra travels through the penis, opening at the tip.

Abnormal results

Cystoscopy allows the urologist to detect inflammation of the bladder lining, prostatic enlargement, or tumors. If these are seen, further evaluation or biopsies may be needed in addition to the removal of some tumors.

Resources

Organizations

American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org.

cystoscopy

 [sis-tos´kah-pe]
examination of the bladder by means of a cystoscope, a hollow metal tube that is introduced into the urinary meatus and passed through the urethra and into the bladder. At the end of the cystoscope is an electric bulb that illuminates the bladder interior. By means of special lenses and mirrors the bladder mucosa is examined for inflammation, calculi, or tumors.

A catheter can be passed through the cystoscope into the bladder or, if necessary, beyond, into the ureters and kidneys. In this way samples of urine can be obtained for diagnostic purposes. Also, radiopaque fluids can be injected into the bladder or ureters for x-rays of the urinary tract (see also pyelography).
 Cystoscopy: examination of the male bladder. The cystoscope is passed through the urethra into the bladder. Although shown here as a flexible scope, usually the scope is rigid. Through the scope fluid is instilled to maintain bladder distention. From Beare and Myers, 1998.
Patient Care. Prior to the procedure the patient should be given an adequate explanation of its purpose and expected outcome, and of the need for proper preparation. Because the full cooperation of the patient is of crucial importance to a successful test, it is essential that the patient be told what is expected of him or her when the procedure is done under local anesthesia. During the procedure, if the patient is awake, the nurse or other attendant should be alert for indications of sudden pain, which could signify perforation of the urethra or other structures. Another complication that can occur in patients with a history of heart disease is cardiac arrhythmia.

The plan of care following cystoscopy should include observation of the amount and character of the urine. Some slight coloration from blood should be expected, but any frank bleeding and passing of clots should be reported to the surgeon. Other problems likely to require nursing intervention are discomfort from bladder spasms, back pain, a feeling of fullness and burning in the bladder region, and possible urinary retention. Nursing measures would include warm sitz baths, relaxation techniques to promote rest and provide relief from pain, and administration of prescribed medications.

If chilling and fever occur and do not respond to attempts to provide warmth and to increased fluid intake, there could be an infection in the urinary tract requiring antibacterial therapy.

cys·tos·co·py

(sis-tos'kŏ-pē),
The inspection of the interior of the bladder by means of a cystoscope.

cystoscopy

/cys·tos·co·py/ (sis-tos´kah-pe) visual examination of the urinary tract with an endoscope.cystoscop´ic

cystoscopy

[sistos′kəpē]
insertion of a rigid or flexible cystoscope into the urethra for visualization and instrumentation of the lower urinary tract. The procedure is often performed in urological offices with local anesthesia. The bladder is distended with water while the patient is supine or in the lithotomy position. After the examination the patient is observed for the common complications of local urethral trauma and signs of urinary infection. See also cystoscope. cystoscopic, adj.

cystoscopy

Urology The use of a cystoscope or urethroscope with a fiberoptic light source, to directly visualize the urethra and bladder, and detect lower urinary tract disease

cys·tos·co·py

(sis-tos'kŏ-pē)
The inspection of the interior of the bladder by means of a cystoscope.

cystoscopy

Examination of the inside the bladder with an optical instrument called a cystoscope, passed along the urethra. This requires general anaesthesia in the male but can be done under local anaesthesia in the female. Cystoscopy facilitates the diagnosis of conditions such as infections, polyps, cancers and stones in the bladder, and allows biopsies to be taken and local treatment by cautery, laser and other means to be given. It also makes it possible to pass fine catheters up the tubes leading to the kidneys (the ureters) through which a substance opaque to X-rays can be injected for X-ray studies (retrograde pyelography).

cystoscopy

examination of the bladder by means of a cystoscope, which is introduced into the urinary meatus and passed through the urethra and into the bladder.
A catheter can be passed through the cystoscope into the bladder or, if necessary, beyond, into the ureters and kidneys. In this way samples of urine can be obtained for diagnostic purposes. Also, radiopaque fluids can be injected into the bladder or ureters for x-rays of the urinary tract. See also pyelography.
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Urine for cytology study was collected during cystoscopy.
Currently, cystoscopy is performed in only a minority of indicated cases.
Conclusion: Suprapubic cystoscopy is an easy-to-perform adjunctive modality in perinea' urethroplasty.
If the test is positive for cancer cells, the next step is direct visual inspection of the urothelium and mucosa with white light cystoscopy to localize the tumors.
In the study, consecutive patients needing surveillance after treatment of superficial bladder cancer underwent these tests at study entry: cystoscopy, urine cytology, NMP22 BladderChek test (a urine test marketed by Inverness Medical Innovations that measures a protein associated with bladder cancer), and FISH (fluorescence in situ hybridization) UroVysion test (a urine test marketed by Abbott Molecular that detects chromosomal abnormalities associated with bladder cancer).
Screening workers exposed to 4,4'-methylenebis-(2-chloroaniline) for bladder cancer by cystoscopy.
One patient with superficial UCC died 1 month after TURT and was excluded from the analysis because the first control cystoscopy for detection of tumor recurrence is not performed earlier than 3 months after TURT.
Blood in the urine preceded a cancer diagnosis by cystoscopy in the workers by only 3 months on average, and unusual cell growth appeared only 8 months before diagnosis.
Medical tests that help identify, other conditions include a urinalysis, urine culture, cystoscopy, biopsy of the bladder wall and, in men, laboratory examination of prostate secretions.
As part of their surveillance, patients underwent cystoscopy and urine samples were analyzed using a combination of DNA (including FGFR3 mutational analysis and hypermethylation of NID2 and VIM genes) and protein (matrix metalloproteinase-2) biomarkers.
Chesapeake Urology's urologic oncologists are among the few physicians in the region to utilize Narrow Band Imaging (NBI) Cystoscopy and Blue Light Cystoscopy to diagnose the disease in patients.
Cystoscopy is invasive and expensive, and a urinary bladder test that is simple, quick, and inexpensive could be invaluable in this clinical scenario.