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Cystoscopy – – – Urethroscopy – – -Cystourethroscopy

The Australian Centre for Female Pelvic and Vaginal Rejuvenation
The Australian Centre for Female Pelvic and Vaginal Rejuvenation

Cystoscopy – What is it?

Cystoscopy is a form of endoscopy {a method of looking inside an organ – in this case the bladder}. A special telescope is passed through the urethra into the bladder. As the telescope is passed through the urethra, this is inspected, a procedure called urethroscopy. When visualising the bladder, this is know as cystoscopy. Thus, the combined procedure of looking inside the urethra and then the bladder is called a cystourethroscopy.

Direct visualisation

In any type of investigation, there are few better modalities than direct visualisation. Sometimes, depending on the nature and location of the problem this may not be possible. Cystoscopy is superior to other investigations (such as ultrasound, urinalysis, CT and MRI) in identifying conditions such as cystitis, bleeding, bladder tumours, stones and structural abnormalities.

Rigid cystoscopy

The rigid cystoscope can be used in the outpatient and operating room setting. The diameter at the end tends to be a little bigger than that of the flexible cystoscopes. The instrument is shorter and has the advantage of a number of channels through which a variety of devices can be passed or for material to be injected into the bladder or paraurethral area.

Flexible cystoscopy

Flexible cystoscopes are most commonly used in the outpatient setting. The telescope is thinnest at the end which passes into the urethra and bladder first. The tip is flexible and can be moved so that the surgeon can look all around the bladder. Modern instruments do have some operating channels that allow thin instruments to be passed so that biopsies of the bladder can be obtained.

Indications for cystoscopy

  • Symptoms of urinary incontinence or of an overactive bladder.
  • Recurrent or frequent urinary tract infections.
  • Haematuria (blood in the urine). This is described as macroscopic if the blood is visible to the naked eye and microscopic if the blood can only be seen under a microscope.
  • Pain presumed to be originating from either the bladder or urethra. The pain may or may not occur during the act of voiding.
  • Atypical urinary tract cells found in a urine sample.
  • During or after lower abdominal or pelvic surgery (such as prolapse surgery, incontinence surgery and a hysterectomy). The aim is to ensure that there has not been an inadvertent injury to bladder or ureters, and if there has been an injury, to allow for appropriate management.

Images of the urethra

Images of the bladder: normal and with pathology

Preparation for cystoscopy

If you are having your cystoscopy under local anaesthesia then you will be able to eat and drink normally prior to the test.  If you are having a general anaesthetic there will be specific instructions on eating, drinking and which of your usual tablets you can take prior to surgery. Always confirm this with your doctor. You will be informed of what time to arrive either at your doctors surgery or at the hospital. You are likely to be required to sign a consent form. At some point prior to surgery you will be asked to provide a urine sample to exclude a urinary tract infection.

About the test

The cystoscopy can be carried out in the doctors’ office or in the operating theatre. It will be done under a general or local anaesthesia. The procedure takes about 15-20 mins. Additional time will be incurred if biopsies are obtained, some form of treatment undertaken or a hydrodilatation performed. In most cases, whether awake or asleep, you will be positioned lying on your back with your knees raised and apart. Usual aseptic (clean) techniques will be used to reduce the risk of infection. Local anaesthetic gel may be applied to the urethra.

The surgeon will insert the cystoscope through the urethra and into the bladder. If you are awake you are likely to find this the most sensitive part of the procedure due to the receptors lining the urethra. Most women tolerate the test very well but if you find it too stressful or uncomfortable the surgeon may chose to continue under a general anaesthetic either at the same time or on a different day.

Typically, the urethra is short in women {about 2-4cm} and collapsed, so it is best visualised right at the beginning when the telescope is first introduced and water is flowing to keep it open. Inspection of the bladder is then carried out. About 200-300ml of water is used to distend the bladder after the urine in it has been emptied. Emptying the bladder prior to inspection of the bladder has a number of advantages; urine can be sent off for testing {microscopy, culture ± cytology}, urine is yellow, whereas water is clear making inspection more efficient and the surgeon knows how much fluid is in the bladder if it starts off empty.

Risks associated with cystoscopy

The risks associated with cystoscopy are low and include:

  • Urinary tract infection
  • Bleeding
  • Injury to the bladder or urethra

General advice

Temporary mild burning on urination may improve if you have a warm bath, apply a warm flannel to the urethral opening or use an alkalising agent such as Ural. Drink about 3 litres of water over the next 24 hours to reduce the risk of a urinary tract infection. If you have any signs of an infection (dysuria, a temperature, offensive urine) call your doctor.

Afterwards

In most cases you should be able to return to work and drive 24 hours after surgery. It is important that you confirm this with your doctor and your insurance company. If you operate machinery at work then take some advice about this.

Laser Vaginal Rejuvenation Institute of Adelaide
Laser Vaginal Rejuvenation Institute of Adelaide