Cystoscopy

What is a Cystoscopy?

Cystoscopy is a medical procedure that allows a doctor to examine the inside of the bladder and urethra using a thin, flexible instrument called a cystoscope.

A cystoscope, a flexible, lighted tube, helps identify abnormal changes in the normal smooth pink lining of the bladder and urethra as well as identify:

tumours,
bladder stones,
areas of narrowing, and
blockage or injury.

Who is Suitable for Cystoscopy?

Cystoscopy is typically recommended for individuals with symptoms of a urinary tract condition, such as blood in the urine, frequent urination, difficulty urinating, or pain during urination. It is also used to evaluate the cause of incontinence, recurrent urinary tract infections, or abnormalities found during a physical examination.

Additionally, it may be used as a diagnostic tool for people with a family history of bladder or kidney cancer or those exposed to certain chemicals known to increase the risk of bladder cancer.

However, in some cases, the procedure may not be suitable for people with certain medical conditions, such as a severe bleeding disorder, an allergy to the anaesthesia used during the procedure, or a history of certain types of bladder or urethral surgery.

What are the Benefits of Cystoscopy?

Cystoscopy is a valuable diagnostic tool that can help identify and evaluate various urinary tract conditions. Some of the key benefits of the procedure include the following:

Early detection and diagnosis: Cystoscopy allows doctors to detect and diagnose bladder and urethral conditions early on when they are most treatable.
Identification of the cause of symptoms: The procedure can help to identify the underlying cause of symptoms, such as blood in the urine, frequent urination, or pain during urination.
Evaluation of incontinence: Cystoscopy can help evaluate the cause and determine the best course of treatment.
Evaluation of bladder or urethral abnormalities: The procedure can help to identify and evaluate abnormal growths or other changes in the bladder or urethra.
Minimally invasive: Cystoscopy is a minimally invasive procedure that does not require an incision and has a relatively short recovery time compared to open surgery.
Help in treatment: Some cystoscopy procedures can be therapeutic as well. For example, TURBT (Transurethral resection of bladder tumour) can remove the bladder tumours during the procedure.

These benefits may vary depending on the individual case, and your doctor will be able to provide more specific information about the potential benefits of cystoscopy in your particular case.

What are the Types of Cystoscopy?

There are two main types of cystoscopy: flexible cystoscopy and rigid cystoscopy.

Flexible cystoscopy: This type of cystoscope is a thin, flexible instrument inserted through the urethra into the bladder. It is the most common type of cystoscopy and is typically used for diagnostic purposes.
Rigid cystoscopy: This type of cystoscope is a stiffer, more rigid instrument inserted through the urethra into the bladder. It is less common than flexible cystoscopy and is typically used for more complex procedures, such as removing bladder stones or tumours.

Another way to classify cystoscopy is based on the route of access, which can be:

Transurethral cystoscopy (TUC): The scope is inserted through the urethra
Transabdominal cystoscopy (TAC): The scope is inserted through the abdomen, usually done by a specialist surgeon

Finally, cystoscopy can be performed under different anaesthetic modalities, from local anaesthesia to general anaesthesia, depending on the case and the patient's preference.

Alternative Options to Cystoscopy

While cystoscopy is a valuable diagnostic tool for evaluating urinary tract conditions, alternative options may be used in some instances. These include:

Ultrasound: An ultrasound is a non-invasive imaging test that uses high-frequency sound waves to create images of the urinary tract. It can be used to detect kidney stones, tumours, and other abnormalities in the urinary tract.
CT scan: A computed tomography (CT) scan is an imaging test that uses X-rays and computer technology to create detailed images of the urinary tract. It can be used to detect tumours, stones, and other abnormalities in the urinary tract.
MRI: Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to create detailed images of internal organs and structures. It can detect tumours, abnormal growths, and other changes in the urinary tract.
Urine tests: Urine tests can detect blood, protein, red and white blood cells, and other substances in the urine that may indicate a urinary tract problem.
Urodynamic studies are a series of tests that evaluate the function of the urinary tract, such as the bladder's ability to store and empty urine and the flow of urine.
Blood tests: Blood tests may be done to check for infection, inflammation, or cancer.

These alternative options provide a different level of detail or accuracy than cystoscopy. In some cases, a combination of tests may be needed to diagnose and evaluate a urinary tract condition properly.

Dr Wang will be able to recommend the best course of action in your case and will explain the advantages and disadvantages of each option.

Before a Cystoscopy Procedure

Dr Wang will give you instructions on preparing for the procedure, which may include fasting for a certain period before the procedure and avoiding certain medications or supplements. You will be asked to sign a consent form indicating that you understand the risks and benefits of the procedure. You will be asked about your medical history and about any allergies or sensitivities you may have.

How is Cystoscopy Performed?

Cystoscopy is usually done as an outpatient procedure. You may be required to fast or be on a special diet before the procedure.

The procedure involves the following steps:

A sedative may be administered to help you relax. You will lie on your back with your knees up and spread.
An anaesthetic gel is used to numb the urethra.
Dr Wang introduces the cystoscope through the urethra and gradually advances it to the bladder, carefully examining the lining mucosa for abnormalities.
Water or saline may be instilled through the cystoscope to expand the bladder, which gives your doctor a better view.
There is good evidence that cystic distention (filling the bladder with normal saline and holding the volume for one minute) can alleviate the symptoms of urinary urgency (detrusor overactivity).
The cystoscope may be used to irrigate and suction instils substances into specific areas. Surgical instruments may be introduced through the cystoscope to remove stones, obtain tissue samples or perform other procedures.

During deflation, the bladder is viewed under direct vision to check for petechial haemorrhages, which can be associated with interstitial cystitis.

A cystoscopy is performed as a Day Stay procedure under general anaesthesia.

Recovery After Cystoscopy

Following the procedure, you may experience some discomfort or a burning sensation when you urinate for the first few days after the procedure. You may also have some blood in your urine.

You will be given instructions on caring for yourself after the procedure, such as drinking plenty of fluids to flush out the urinary tract and avoiding certain foods or drinks that may irritate the bladder.

Dr Wang may also give you medication to help with discomfort or burning sensation.

You may be asked to come back for a follow-up appointment to discuss the procedure's results and any further treatment that may be needed.

Cystoscopy Prognosis

The prognosis for cystoscopy is generally good, as it is a relatively safe and commonly performed procedure. The procedure carries a low risk of complications, and most people can return to normal activities soon after.

Cystoscopy Risks

Cystoscopy is a relatively safe and commonly performed procedure, but like any medical procedure, it does carry some risks. Here are some of the potential risks associated with cystoscopy:

Infection: As with any medical procedure involving inserting an instrument into the body, there is a small risk of infection.
Bleeding: Cystoscopy may cause some bleeding, especially if a biopsy is taken or if a lesion is removed during the procedure.
Allergic reactions: Some people may be allergic to anaesthesia or other medications used during the procedure.
Urethral injury: There is a small risk of injury to the urethra during the procedure, which can cause pain, bleeding, or difficulty urinating.
Retention of urine: In rare cases, the patient may have difficulty passing urine after the procedure.
Perforation: There is a rare risk of perforating the bladder or urethra during the procedure.
Urinary tract infections: There is a small risk of developing a urinary tract infection after the procedure.
Discomfort: Some discomfort, pain, or burning sensation while urinating may be experienced after the procedure.

These risks are rare, and most people undergoing cystoscopy do not experience complications. Your doctor will be able to provide more information about the specific risks associated with the procedure in your case.

What if Cystoscopy is Delayed?

Cystoscopy is a valuable diagnostic tool that can help identify and evaluate various urinary tract conditions. If the procedure is delayed, it may delay the diagnosis and treatment of the underlying condition. This could lead to the condition's progression and make it more challenging to treat.

However, there are situations where the procedure might need to be delayed, such as when the patient is not medically stable or when an alternative test can provide the necessary information.

In some cases, if the cystoscopy is delayed, the patient may have to be monitored closely. Further tests, such as blood tests, urine tests, or imaging studies, may be necessary to evaluate their condition. This can be done until the patient is medically stable or until the cystoscopy can be performed safely.

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