Cystoscopy

views updated May 29 2018

Cystoscopy

Definition
Purpose
Description
Preparation
Aftercare
Risks
Normal results
Alternatives

Definition

Cystoscopy (cystourethroscopy) is a diagnostic procedure that uses a cystoscope, which is an endoscope especially designed for urological use to examine the bladder, lower urinary tract, and prostate gland. It can also be used to collect urine samples, perform biopsies, and remove small stones.

Purpose

Cystoscopy is performed by urologists to examine the entire bladder lining and take biopsies of any questionable areas. Cystoscopy may be prescribed for patients who display the following conditions:

  • blood in the urine (hematuria)
  • inability to control urination (incontinence)
  • urinary tract infection (UTI)
  • signs of congenital abnormalities in the urinary tract
  • suspected tumors in the bladder
  • bladder or kidney stones
  • signs or symptoms of an enlarged prostate
  • pain or difficulty urinating (dysuria)
  • disorders of or injuries to the urinary tract
  • symptoms of interstitial cystitis

Blood and urine studies, in addition to x rays of the kidneys, ureters, and bladder, may be performed before a cystoscopy to obtain as much diagnostic information as possible. During the cystoscopy, a retrograde pyelogram may also be performed to examine the kidneys and ureters.

Description

There are two types of cystoscopes used to carry out the procedure, a rigid type and a flexible type. Both types are used for the same purposes and differ only in their method of insertion. The rigid type requires that the patient adopt the lithotomy position, meaning that the patient lies on his or her back with knees up and apart. The flexible cystoscope does not require the lithotomy position.

A cystoscopy typically lasts from 10-40 minutes. The patient is asked to urinate before surgery and advised that relaxing pelvic muscles will help make this part of the procedure easier. A well-lubricated flexible or rigid cystoscope (urethroscope) is passed through the urethra into the bladder where a urine sample is taken. There may be some discomfort as the instrument is inserted. Fluid is then injected to inflate the bladder and allow the urologist to examine the entire bladder wall. The cystoscope uses a lighted tip for guidance and enables biopsies to be taken or small stones to be removed through a hollow channel in the cystoscope.

During a cystoscopy, the urologist may remove bladder stones or kidney stones, gather tissue samples, and perform x-ray studies. To remove stones, an instrument that looks like a tiny basket or grasper is inserted through the cystoscope so that small stones can be extracted through the scope’s channel. For a biopsy, special forceps are inserted through the cystoscope to pinch off a tissue sample. Alternatively, a small brush-like instrument may be inserted to scrape off some tissue. To perform x-ray studies such as a retrograde pyelogram, a dye is injected into the ureter by way of a catheter passed through the cystoscope. After completion of all required tests, the cystoscope is removed.

Preparation

Before cytoscopy, patients may be asked to give a urine sample to check for infection and to avoid urinating for an hour before the procedure. A sedative may be given about one hour prior to the operation to help the patient relax. The region of the urethra is cleansed and a local anesthetic is applied. Spinal or general anesthesia may also be used for the procedure. Distension of the bladder with fluid is particularly painful, and if it needs to be done, as in the case of evaluating interstitial cystitis, general anesthesia is required. A signed consent form is necessary for this procedure.

Aftercare

After removal of the cystoscope, the urethra is usually sore, and patients should expect to feel a burning sensation while urinating for one or two days following the procedure. To alleviate discomfort or pain, patients may be prescribed pain medication, and antibiotics may also be required to prevent infection. Minor pain may also be treated with over-the-counter, nonprescription drugs such as acetaminophen. To relieve discomfort, patients may be advised to drink two 8-oz glasses of water each hour for two hours and to take a warm bath to relieve the burning feeling. If not able to bathe, they may be advised to hold a warm, damp washcloth over the urethral opening.

Patients who have undergone a cystoscopy are instructed to:

  • take warm baths to relieve pain.
  • rest and refrain from driving for several days, especially if general anesthesia was used.

KEY TERMS

Anesthetic— A drug that causes loss of sensation. It is used to lessen the pain of surgery and other medicalprocedures.

Bladder— The bladder is located in the lower part of the abdomen; it is a structure like a small balloon that collects urine for temporary storage and is emptied from time to time by urinating.

Catheter— A tubular, flexible surgical instrument for with drawing fluids from (or introducing fluids into) a body cavity, especially one for introduction into the bladder through the urethra for the withdrawal of urine.

Cystoscope— Endoscope especially designed for urological use to examine the bladder, lower urinary tract, and prostate gland.

Diverticula— A pouch or sac occurring normally or from a herniation or defect in a membrane.

Endoscope— A highly flexible, thin viewing instrument used to see inside body cavities.

Endoscopy— A minimally invasive procedure that involves examination of body organs or cavities using an endoscope.

Interstitial cystitis— A chronic inflammatory condition of the bladder involving symptoms of bladder pain, frequent urination, and burning during urination.

Retrograde pyelogram— A pyelography or x-ray technique in which a dye is injected into the kidneys through the ureters.

Ureter— The tube that carries urine from each kidney to the bladder.

Urethra— The tube that carries urine from the bladder to outside the body. In females, the urethral opening is between the vagina and clitoris; in males, the urethra travels through the penis, opening at the tip.

Urogynecologist— A physician that specializes in female medical conditions concerning the urinary and reproductive systems.

Uroradiologist— A radiologist that specializes in diagnostic imaging of the urinary tract and kidneys.

  • expect any blood in the urine to clear up in one to two days.
  • avoid strenuous exercise during recovery.
  • postpone sexual relations until the urologist determines that healing is complete.

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 contact their physician if they experience any of the following symptoms after the procedure, including pain, redness, swelling, drainage, or bleeding from the surgical site; signs of generalized infection, which may include headache, muscle aches, dizziness, or an overall ill feeling and fever; nausea or vomiting; or difficult or painful urination.

Cystoscopy is a commonly performed procedure, but it is an invasive technique that involves small yet significant risk. If anesthesia is required, there is additional risk, particularly for people who are obese, smoke, or are in poor health. Those undergoing anesthesia must inform the doctor of any medications they are taking.

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. In this case, the bladder wall appears smooth and the bladder is seen to be of normal size, shape, and position, without obstructions, growths, or stones.

The treating physician can tell the patient what was seen inside the bladder right after the procedure. If a biopsy sample was taken, this will take several days to be examined and tested.

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. Cystoscopy with bladder distention can also evaluate interstitial cystitis. Bladder stones, urethral strictures, diverticula, or congenital abnormalities can also be detected.

Alternatives

There are procedures that can provide some information about the lining of the bladder, for example, x rays; however, none of these provide as much information to the doctor as a cystoscopy.

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Cystoscopy is typically performed on an outpatient basis, but up to three days of recovery in the hospital is sometimes required. The procedure can be performed in a hospital, doctor’s office, cystoscopy suite, or urology office, depending on the condition of the patient and the anesthesia required. If general anesthesia is required, an anesthesiologist is present to administer the anesthesia and monitor the patient. The cystoscopy procedure is performed by a urologist, urologic surgeon, or urogynecologist, with assistance from nurses experienced in urologic procedures. If x rays are taken during the procedure, a uroradiologist or radiologic technologist is required to operate the x-ray equipment. Biopsy tissue samples are sent to the clinical laboratory for examination by a pathologist.

Resources

BOOKS

Khatri, V. P., and J. A. Asensio. Operative Surgery Manual 1st ed. Philadelphia: Saunders, 2003.

Townsend, C. M., et al. Sabiston Textbook of Surgery 17th ed. Philadelphia: Saunders, 2004.

Wein, A. J., et al. Campbell-Walsh Urology 9th ed. Philadelphia: Saunders, 2007.

PERIODICALS

Fraczyk, L., H. Godfrey, and R. Feneley. “Flexible Cystoscopy: Outpatients or Domiciliary?” British Journal of Community Nursing 7 (February 2002): 69–74.

Jabs, C. F., and H. P. Drutz. “The Role of Intraoperative Cystoscopy in Prolapse and Incontinence Surgery.” American Journal of Obstetrics and Gynecology 185 (December 2001): 1368–1371.

Kwon, C. H., R. Goldberg, S. Koduri, and P. K. Sand. “The Use of Intraoperative Cystoscopy in Major Vaginal and Urogynecologic Surgeries.” American Journal of Obstetrics and Gynecology 187 (December 2002): 1471–1472.

Payne, D. A., and R. C. Kockelbergh. “Improving the View at Flexible Cystoscopy.” Annals of The Royal College of Surgeons of England 85 (March 2003): 132–138.

Sant, Grannum R., and Philip M. Hanno. “Interstitial Cystitis: Current Issues and Controversies in Diagnosis.” Urology 57, Supplement 6A (June 2001): 82–88.

QUESTIONS TO ASK THE DOCTOR

  • What will happen during the procedure?
  • How do I prepare for cytoscopy?
  • Will cystoscopy hurt?
  • How long will the test last?
  • How many cytoscopies do you perform each year?
  • Are there any risks associated with the procedure?

Satoh, E., N. Miyao, H. Tachiki, and Y. Fujisawa. “Prediction of Muscle Invasion of Bladder Cancer by Cystoscopy.” European Urology 41 (February 2002): 178–181.

ORGANIZATIONS

American Urologic Association Foundation. P. O. Box 79183, Baltimore, MD 21279-0183. (800) 242-2383. http://www.auafoundation.org (accessed March 11, 2008).

American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. http://www.auanet.org (accessed March 11, 2008).

Interstitial Cystitis Association. 51 Monroe Street, Suite 1402, Rockville, MD 20850. (301) 610-5300. http://www.ichelp.org (accessed March 11, 2008).

Society of Urologic Nurses and Associates. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. http://suna.inurse.com/ (accessed March 11, 2008).

OTHER

“Cystoscopy.” Harvard Medical School.http://www.health.harvard.edu/fhg/diagnostics/cysto/cystoWhat.shtml (accessed March 11, 2008).

“Cystoscopy.” Medline Plus.http://www.nlm.nih.gov/medlineplus/ency/article/003903.htm (accessed March 11, 2008).

“What Is IC? Interstitial Cystitis Fact Sheet.” Interstitial Cystitis Association.http://www.ichelp.org/whatisic/ICFActSheet.html (accessed March 11, 2008).

Jennifer E. Sisk

Monique Laberge, PhD

Rosalyn Carson-DeWitt, MD

Cystoscopy

views updated Jun 11 2018

Cystoscopy

Definition

Cystoscopy (cystourethroscopy) is a diagnostic procedure that uses a cystoscope, which is an endoscope especially designed for urological use to examine the bladder, lower urinary tract, and prostate gland. It can also be used to collect urine samples, perform biopsies, and remove small stones.


Purpose

Cystoscopy is performed by urologists to examine the entire bladder lining and take biopsies of any questionable areas. Cystoscopy may be prescribed for patients who display the following conditions:

  • blood in the urine (hematuria)
  • inability to control urination (incontinence)
  • urinary tract infection
  • signs of congenital abnormalities in the urinary tract
  • suspected tumors in the bladder
  • bladder or kidney stones
  • signs or symptoms of an enlarged prostate
  • pain or difficulty urinating (dysuria)
  • disorders of or injuries to the urinary tract
  • symptoms of interstitial cystitis

Blood and urine studies, in addition to x rays of the kidneys, ureters, and bladder, may be performed before a cystoscopy to obtain as much diagnostic information as possible. During the cystoscopy, a retrograde pyelogram may also be performed to examine the kidneys and ureters.


Description

There are two types of cystoscopes used to carry out the procedure, a rigid type and a flexible type. Both types are used for the same purposes and differ only in their method of insertion. The rigid type requires that the patient adopt the lithotomy position, meaning that the patient lies on his or her back with knees up and apart. The flexible cystoscope does not require the lithotomy position.

A cystoscopy typically lasts from 1040 minutes. The patient is asked to urinate before surgery and advised that relaxing pelvic muscles will help make this part of the procedure easier. A well-lubricated flexible or rigid cystoscope (urethroscope) is passed through the urethra into the bladder where a urine sample is taken. There may be some discomfort as the instrument is inserted. Fluid is then injected to inflate the bladder and allow the urologist to examine the entire bladder wall. The cystoscope uses a lighted tip for guidance and enables biopsies to be taken or small stones to be removed through a hollow channel in the cystoscope.

During a cystoscopy, the urologist may remove bladder stones or kidney stones, gather tissue samples, and perform x-ray studies. To remove stones, an instrument that looks like a tiny basket or grasper is inserted through the cystoscope so that small stones can be extracted through the scope's channel. For a biopsy, special forceps are inserted through the cystoscope to pinch off a tissue sample. Alternatively, a small brush-like instrument may be inserted to scrape off some tissue. To perform x-ray studies such as a retrograde pyelogram, a dye is injected into the ureter by way of a catheter passed through the cystoscope. After completion of all required tests, the cystoscope is removed.


Preparation

Patients may be asked to give a urine sample before cytoscopy to check for infection and to avoid urinating for an hour before this part of the procedure. They wear a hospital gown during the procedure and the lower part of the body is covered with a sterile drape. A sedative may be given about one hour prior to the operation to help the patient relax. The region of the urethra is cleansed and a local anesthetic is applied. Spinal or general anesthesia may also be used for the procedure. Distension of the bladder with fluid is particularly painful, and if it needs to be done, as in the case of evaluating interstitial cystitis, general anesthesia is required. A signed consent form is necessary for this procedure.


Aftercare

After removal of the cystoscope, the urethra is usually sore, and patients should expect to feel a burning sensation while urinating for one to two days following the procedure. To alleviate discomfort or pain, patients may be prescribed pain medication, and antibiotics may also be required to prevent infection. Minor pain may also be treated with over-the-counter, nonprescription drugs such as acetaminophen . To relieve discomfort, patients may be advised to drink two 8-oz glasses of water each hour for two hours and to take a warm bath to relieve the burning feeling. If not able to bathe, they may be advised to hold a warm, damp washcloth over the urethral opening.

Patients who have undergone a cystoscopy are instructed to:

  • Take warm baths to relieve pain.
  • Rest and refrain from driving for several days, especially if general anesthesia was used.
  • Expect any blood in the urine to clear up in one to two days.
  • Avoid strenuous exercise during recovery.
  • Postpone sexual relations until the urologist determines that healing is complete.


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 contact their physician if they experience any of the following symptoms after the procedure, including pain, redness, swelling, drainage, or bleeding from the surgical site; signs of generalized infection, which may include headache, muscle aches, dizziness, or an overall ill feeling and fever; nausea or vomiting; or difficult or painful urination.

Cystoscopy is a commonly performed procedure, but it is an invasive technique that involves small yet significant risk. If anesthesia is required, there is additional risk, particularly for people who are obese, smoke, or are in poor health. Those undergoing anesthesia must inform the doctor of any medications they are taking.


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. In this case, the bladder wall appears smooth and the bladder is seen to be of normal size, shape, and position, without obstructions, growths, or stones.

The treating physician can tell the patient what was seen inside the bladder right after the procedure. If a biopsy sample was taken, this will take several days to be examined and tested.

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. Cystoscopy with bladder distention can also evaluate interstitial cystitis. Bladder stones, urethral strictures, diverticula, or congenital abnormalities can also be detected.

Alternatives

There are procedures that can provide some information about the lining of the bladder, for example, x rays; however, none of these provide as much information to the doctor as a cystoscopy.


Resources

books

Buckman, Robert. "Bladder." In What You Really Need To Know About Cancer: A Comprehensive Guide for Patients and Their Families. Baltimore, MD: The Johns Hopkins University Press, 1997.

Miller, B. E., ed. An Atlas of Sigmoidoscopy and Cystoscopy. Boca Raton: CRC Press-Parthenon Publishers, 2001.

Segen, Joseph C., and Joseph Stauffer. "Cystoscopy." In The Patient's Guide To Medical Tests: Everything You Need To Know About The Tests Your Doctor Prescribes. New York: Facts On File, 1998.

Tierney, Lawrence M. Jr., Stephen J. McPhee, and Maxine A. Papadakis, eds. "Urology." In Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1996.

periodicals

Fraczyk, L., H. Godfrey, and R. Feneley. "Flexible Cystoscopy: Outpatients or Domiciliary?" British Journal of Community Nursing 7 (February 2002): 6974.

Jabs, C. F., and H. P. Drutz. "The Role of Intraoperative Cystoscopy in Prolapse and Incontinence Surgery." American Journal of Obstetrics and Gynecology 185 (December 2001): 13681371.

Kwon, C. H., R. Goldberg, S. Koduri, and P. K. Sand. "The Use of Intraoperative Cystoscopy in Major Vaginal and Urogynecologic Surgeries." American Journal of Obstetrics and Gynecology 187 (December 2002): 14711472.

Payne, D. A., and R. C. Kockelbergh. "Improving the View at Flexible Cystoscopy." Annals of The Royal College of Surgeons of England 85 (March 2003): 132138.

Sant, Grannum R., and Philip M. Hanno. "Interstitial Cystitis: Current Issues and Controversies in Diagnosis." Urology 57, Supplement 6A (June 2001): 8288.

Satoh, E., N. Miyao, H. Tachiki, and Y. Fujisawa. "Prediction of Muscle Invasion of Bladder Cancer by Cystoscopy." European Urology 41 (February 2002): 178181.

organizations

American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. <http://www.auanet.org>.

American Foundation for Urologic Disease. 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383. <http://www.afud.org>.

Interstitial Cystitis Association. 51 Monroe Street, Suite 1402, Rockville, MD 20850. (301) 610-5300. <http://www.ichelp.org>.

Society of Urologic Nurses and Associates. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. <http://suna.inurse.com/>.


other

"Cystoscopy." Harvard Medical School. <www.health.harvard.edu/fhg/diagnostics/cysto/cystoWhat.shtml>.

"Cystoscopy." Medline Plus. <www.nlm.nih.gov/medline plus/ency/article/003903.htm>.

"What Is IC? Interstitial Cystitis Fact Sheet." Interstitial Cystitis Association. <http://www.ichelp.org/whatisic/ICFAct Sheet.html>.


Jennifer E. Sisk Monique Laberge, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Cystoscopy is typically performed on an outpatient basis, but up to three days of recovery in the hospital is sometimes required. The procedure can be performed in a hospital, doctor's office, cystoscopy suite, or urology office, depending on the condition of the patient and the anesthesia required. If general anesthesia is required, an anesthesiologist is present to administer the anesthesia and monitor the patient. The cystoscopy procedure is performed by a urologist, urologic surgeon, or urogynecologist, with assistance from nurses experienced in urologic procedures. If x rays are taken during the procedure, a uroradiologist or radiologic technologist is required to operate the x-ray equipment. Biopsy tissue samples are sent to the clinical laboratory for examination by a pathologist.

QUESTIONS TO ASK THE DOCTOR


  • What will happen during the procedure?
  • How do I prepare for cytoscopy?
  • Will cystoscopy hurt?
  • How long will the test last?
  • How many cytoscopies do you perform each year?
  • Are there any risks associated with the procedure?

Cystoscopy

views updated May 09 2018

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 needs further information about a patient who displays the following symptoms or diagnosis:

  • blood in the urine (also known as hematuria)
  • incontinence, or the inability to control urination
  • a urinary tract infection
  • a urinary tract that 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 the procedure, a retrograde pyelo-gram may also be performed. Additional blood studies may be needed immediately following cystoscopy.

Precautions

While the cystoscopy procedure is commonly relied on 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 10-40 minutes to complete. The patient will be asked to urinate before the procedure, 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 the x-ray studies known as a 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

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

Aftercare

Patients who have undergone a cystoscopy will be instructed to follow these steps to ensure a quick recovery:

  • Because of soreness or discomfort that may occur in the urethra, especially while urinating, several warm baths a day are recommended to relieve any pain.
  • Allow four days for recovery.
  • Be aware that 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 cystoscopy.
  • 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, nonprescription 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 at or redness or swelling around the surgical site; drainage or bleeding from the surgical site; signs of infection, which may include headache, muscle aches, dizziness, 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.

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

BOOKS

Segen, Joseph C., and Joseph Stauffer. "Cystoscopy." In The Patient's Guide to Medical Tests: Everything you Need to Know about the Tests Your Doctor Prescribes. New York: Facts on File, 1998.

PERIODICALS

Chew, Lisa, and Stephan D. Fihn. "Recurrent cystitis in non-pregnant women." Western Journal of Medicine (May 1999)170: 274-277.

Gilmour, D.T., P.L. Dwyer, M.P. Carey. "Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy" Obstetrics and Gynecology (1999)5 (2):883-889.

Neumayer, Leigh, A., Mary K. Mastin, and Douglas M. Hinson. "Performance Standards: Piece of Cake or Pie in the sky?" Journal of Surgical Research (2000)88:47-50.

Weinberger, M.W. "Cytosurethroscopy for the Practicing Gynecologist." Clinical Obstetrics and Gynecology (September 1998)41 (2): 764-776.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Road, NE, Atlanta, GA 30329-4251. (800)ACS-2345. http://www.cancer.org/. The American Cancer Society (ACS) is a nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem and is the largest source of private, nonprofit cancer funds. The ACS hopes to prevent cancer, save lives, and diminish suffering from cancer through research, education, advocacy, and service.

Interstitial Cystitis Association (ICA), 51 Monroe Street, Suite1402, Rockville, MD 20850, 1-800-HELP-ICA, http://www.ichelp.org. Founded in 1984, the ICA is a not-for-profit health organization dedicated to providing patient and physician educational information and programs, patient support, public awareness, and research funding.

National Institute of Diabetes & Digestive & Kidney Disease, Office of Communications and Public Liaison, NIDDK, NIH, 31 Center Drive, MSC 2560, Bethesda, MD 20892-2560, [email protected]. http://www.niddk.nih.gov. Mission to understand, treat, and prevent diseases, such as diabetes and obesity, digestive diseases such as hepatitis and inflammatory bowel disease, kidney and uro-logic diseases such as kidney failure and prostate enlargement, and blood diseases such as the anemias.

National Kidney and Urologic Diseases Information Clearing-house, 3 Information Way, Bethesda, MD 20892-3580, 1-800-891-5390, [email protected], http://www.niddk.nih.gov/health/kidney/nkudic.htm. Knowledge and understanding about diseases of the kidneys and uro-logic system among people with these conditions and their families, health care professionals, and the general public.

Beth A. Kapes

KEY TERMS

Cystoscopy with bladder distention (hydrodistention)

Under anesthesia, the bladder is stretched to capacity (distended) with either liquid or gas and then examined with a cystoscope. The examination will detect bladder wall inflammation; thick, stiff bladder wall; Hunner's ulcers; and glomerulations.

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.

Glomerulation

Pinpoint bleeding caused by recurrent irritation that can appear on the bladder wall.

Retrograde pyelogram

A pyelography or x-ray technique in which 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 the clitoris; in the male the urethra travels through the penis, opening at the tip.

QUESTIONS TO ASK THE DOCTOR

  • Why do I need a cystoscopic examination?
  • How long will a cystoscopic procedure take?
  • How long is recovery from a cystoscopic procedure?

Cystoscopy

views updated May 17 2018

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 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
  • 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

views updated Jun 27 2018

Cystoscopy

Definition

Cystoscopy (cystourethroscopy) is a diagnostic procedure that uses an endoscope especially designed for urological use to examine the bladder, lower urinary tract, and prostate gland. It can also be used to collect urine samples, perform biopsies, and remove small stones.

Purpose

Cystoscopy is performed by urologists to examine the entire bladder lining and take biopsies of any questionable areas. Cystoscopy may be prescribed for patients who display the following:

  • blood in the urine (hematuria)
  • inability to control urination (incontinence)
  • urinary tract infection
  • signs of congenital abnormalities in the urinary tract
  • suspected tumors in the bladder
  • bladder or kidney stones
  • signs or symptoms of an enlarged prostate
  • pain or difficulty urinating (dysuria)
  • disorders of or injuries to the urinary tract
  • symptoms of interstitial cystitis

Blood and urine studies, in addition to x rays of the kidneys , ureters, and bladder, may be performed before a cystoscopy to obtain as much diagnostic information as possible. During the cystoscopy, a retrograde pyelogram may also be performed to examine the kidneys and ureters.

Precautions

Cystoscopy is a commonly performed procedure, but it is an invasive technique that involves small yet significant risk. If anesthesia is required, there is additional risk, particularly for people who are obese, smoke, or are in poor health. Those undergoing anesthesia must inform the doctor of any medications they are taking.

Description

A cystoscopy typically lasts from 10 to 40 minutes. The patient is asked to urinate before surgery. A well- lubricated flexible or rigid cystoscope (urethroscope) is inserted through the urethra into the bladder where a urine sample is taken. Fluid is then injected to inflate the bladder and allow the urologist to examine the entire bladder wall. The cystoscope uses a lighted tip for guidance and enables biopsies to be taken or small stones to be removed through a hollow channel in the cystoscope.

During a cystoscopy, the urologist may remove bladder stones or kidney stones, gather tissue samples, and perform x-ray studies. To remove stones, an instrument that resembles a tiny basket or grasper is inserted through the cystoscope so that small stones can be extracted through the scope's channel. For a biopsy, specially designed forceps are inserted through the cystoscope to

pinch off a tissue sample. Alternatively, a small brush like instrument may be inserted to scrape off some tissue. To perform x-ray studies such as a retrograde pyelogram, a dye is injected into the ureters by way of a catheter passed through the cystoscope. After completion of all needed tests, the cystoscope is removed.

Preparation

Cystoscopy can be performed in a hospital, doctor's office, or outpatient surgical facility. Spinal or general anesthesia may be used for the procedure. Distension of the bladder with fluid is particularly painful, and if it needs to be done, as in the case of evaluating interstitial cystitis, general anesthesia is required. Cystoscopy is typically performed on an outpatient basis, but up to three days of recovery in the hospital is sometimes required.

Aftercare

Patients who have undergone a cystoscopy are instructed to:

  • take warm baths to relieve pain
  • rest and refrain from driving for several days, especially if general anesthesia was needed
  • expect any blood in the urine to clear up in one to two days
  • avoid strenuous exercise during recovery
  • postpone sexual relations until the urologist determines that healing is complete

Patients may be prescribed pain relievers and antibiotics following surgery. Minor pain may also be treated with over-the-counter, non-prescription drugs such as acetaminophen.

Complications

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 contact their physician if they experience any of the following symptoms following the procedure: pain, redness, swelling, drainage or bleeding from the surgical site; signs of generalized infection, which may include headache, muscle aches, dizziness or an overall ill feeling and fever ; nausea or vomiting; or difficult or painful urination.

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.

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. Cystoscopy with bladder distention can also evaluate interstitial cystitis. Bladder stones, urethral strictures, diverticula, or congenital abnormalities can also be detected.

Health care team roles

Cystoscopy is performed in a hospital operating room, cystoscopy suite, or urologist's office, depending on the condition of the patient and the anesthesia required. If general anesthesia is required, an anesthesiologist is necessary to administer the anesthesia and monitor the patient. The cystoscopy procedure is performed by a urologist, urologic surgeon, or urogynecolo- gist, with assistance from nurses experienced in urologic procedures. If x rays are taken during the procedure, a uroradiologist or radiologic technologist is required to operate the x-ray equipment. Biopsy tissue samples are sent to the clinical laboratory for examination by a pathologist.

Resources

BOOKS

Buckman, Robert. "Bladder." In What You Really Need to Know about Cancer: A Comprehensive Guide for Patients and Their Families. Baltimore, MD: The Johns Hopkins University Press, 1997.

Segen, Joseph C., and Joseph Stauffer. "Cystoscopy." In The Patient's Guide to Medical Tests: Everything You Need to Know about the Tests Your Doctor Prescribes. New York: Facts On File, 1998.

Tierney, Lawrence M. Jr., Stephen J. McPhee, and Maxine A. Papadakis, eds. "Urology." In Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1996.

PERIODICALS

Sant, Grannum R., and Philip M. Hanno. "Interstitial Cystitis: Current Issues and Controversies in Diagnosis." Urology 57, Supplement 6A (June 2001): 82-88.

ORGANIZATIONS

American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. <http://www.auanet.org>.

Interstitial Cystitis Association. 51 Monroe Street, Suite 1402, Rockville, MD 20850. (301) 610-5300. <http://www.ichelp.org>.

Society of Urologic Nurses and Associates. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. <http://suna.inurse.com/>.

OTHER

"What is IC? Interstitial Cystitis Fact Sheet." Interstitial Cystitis Association. <http://www.ichelp.org/whatisic/ICFActSheet.html>.

Jennifer E. Sisk


KEY TERMS


Diverticula —A pouch or sac occurring normally or from a herniation or defect in a membrane. Cystoscopy can detect diverticula in the urinary tract.

Endoscopy —A minimally invasive procedure that involves examination of body organs or cavities using an endoscope (a lighted optical instrument used to see inside body cavities). A cystoscope is a type of endoscope.

Interstitial cystitis —A chronic inflammatory condition of the bladder involving symptoms of bladder pain, frequent urination, and burning during urination. Diagnosis is confirmed by cystoscopy with the bladder distended by fluid.

Retrograde pyelogram —A pyelography or x-ray technique in which radiopaque dye is injected into the kidneys through the ureters.

Ureter —The tube that carries urine from the kidneys to the bladder.

Urethra —The tube that carries urine from the bladder to outside the body. In females, the urethral opening is between the vagina and clitoris; in males the urethra travels through the penis, opening at the tip.

Urogynecologist —A physician that specializes in female medical conditions concerning the urinary and reproductive systems.

Uroradiologist —A radiologist who specializes in diagnostic imaging of the urinary tract and kidneys.


Cystoscopy

views updated May 18 2018

Cystoscopy

Definition

Cystoscopy (cystourethroscopy) is a diagnostic procedure that uses an endoscope especially designed for urological use to examine the bladder, lower urinary tract, and prostate gland. It can also be used to collect urine samples, perform biopsies, and remove small stones.

Purpose

Cystoscopy is performed by urologists to examine the entire bladder lining and take biopsies of any questionable areas. Cystoscopy may be prescribed for patients who display the following:

  • blood in the urine (hematuria)
  • inability to control urination (incontinence)
  • urinary tract infection
  • signs of congenital abnormalities in the urinary tract
  • suspected tumors in the bladder
  • bladder or kidney stones
  • signs or symptoms of an enlarged prostate
  • pain or difficulty urinating (dysuria)
  • disorders of or injuries to the urinary tract
  • symptoms of interstitial cystitis

Blood and urine studies, in addition to x rays of the kidneys, ureters, and bladder, may be performed before a cystoscopy to obtain as much diagnostic information as possible. During the cystoscopy, a retrograde pyelogram may also be performed to examine the kidneys and ureters.

Precautions

Cystoscopy is a commonly performed procedure, but it is an invasive technique that involves small yet significant risk. If anesthesia is required, there is additional risk, particularly for people who are obese, smoke, or are in poor health. Those undergoing anesthesia must inform the doctor of any medications they are taking.

Description

A cystoscopy typically lasts from 10 to 40 minutes. The patient is asked to urinate before surgery. A well-lubricated flexible or rigid cystoscope (urethroscope) is inserted through the urethra into the bladder where a urine sample is taken. Fluid is then injected to inflate the bladder and allow the urologist to examine the entire bladder wall. The cystoscope uses a lighted tip for guidance and enables biopsies to be taken or small stones to be removed through a hollow channel in the cystoscope.

During a cystoscopy, the urologist may remove bladder stones or kidney stones, gather tissue samples, and perform x-ray studies. To remove stones, an instrument that resembles a tiny basket or grasper is inserted through the cystoscope so that small stones can be extracted through the scope's channel. For a biopsy, specially designed forceps are inserted through the cystoscope to pinch off a tissue sample. Alternatively, a small brush-like instrument may be inserted to scrape off some tissue. To perform x-ray studies such as a retrograde pyelogram, a dye is injected into the ureters by way of a catheter passed through the cystoscope. After completion of all needed tests, the cystoscope is removed.

Preparation

Cystoscopy can be performed in a hospital, doctor's office, or outpatient surgical facility. Spinal or general anesthesia may be used for the procedure. Distension of the bladder with fluid is particularly painful, and if it needs to be done, as in the case of evaluating interstitial cystitis, general anesthesia is required. Cystoscopy is typically performed on an outpatient basis, but up to three days of recovery in the hospital is sometimes required.

Aftercare

Patients who have undergone a cystoscopy are instructed to:

  • take warm baths to relieve pain
  • rest and refrain from driving for several days, especially if general anesthesia was needed
  • expect any blood in the urine to clear up in one to two days
  • avoid strenuous exercise during recovery
  • postpone sexual relations until the urologist determines that healing is complete

Patients may be prescribed pain relievers and antibiotics following surgery. Minor pain may also be treated with over-the-counter, non-prescription drugs such as acetaminophen.

Complications

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 contact their physician if they experience any of the following symptoms following the procedure: pain, redness, swelling, drainage or bleeding from the surgical site; signs of generalized infection, which may include headache, muscle aches, dizziness or an overall ill feeling and fever; nausea or vomiting; or difficult or painful urination.

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.

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. Cystoscopy with bladder distention can also evaluate interstitial cystitis. Bladder stones, urethral strictures, diverticula, or congenital abnormalities can also be detected.

Health care team roles

Cystoscopy is performed in a hospital operating room, cystoscopy suite, or urologist's office, depending on the condition of the patient and the anesthesia required. If general anesthesia is required, an anesthesiologist is necessary to administer the anesthesia and monitor the patient. The cystoscopy procedure is performed by a urologist, urologic surgeon, or urogynecologist, with assistance from nurses experienced in urologic procedures. If x rays are taken during the procedure, a uroradiologist or radiologic technologist is required to operate the x-ray equipment. Biopsy tissue samples are sent to the clinical laboratory for examination by a pathologist.

KEY TERMS

Diverticula— A pouch or sac occurring normally or from a herniation or defect in a membrane. Cystoscopy can detect diverticula in the urinary tract.

Endoscopy— A minimally invasive procedure that involves examination of body organs or cavities using an endoscope (a lighted optical instrument used to see inside body cavities). A cystoscope is a type of endoscope.

Interstitial cystitis— A chronic inflammatory condition of the bladder involving symptoms of bladder pain, frequent urination, and burning during urination. Diagnosis is confirmed by cystoscopy with the bladder distended by fluid.

Retrograde pyelogram— A pyelography or x-ray technique in which radiopaque dye is injected into the kidneys through the ureters.

Ureter— The tube that carries urine from the kidneys to the bladder.

Urethra— The tube that carries urine from the bladder to outside the body. In females, the urethral opening is between the vagina and clitoris; in males the urethra travels through the penis, opening at the tip.

Urogynecologist— A physician that specializes in female medical conditions concerning the urinary and reproductive systems.

Uroradiologist— A radiologist who specializes in diagnostic imaging of the urinary tract and kidneys.

Resources

BOOKS

Buckman, Robert. "Bladder." In What You Really Need to Know About Cancer: A Comprehensive Guide for Patients and Their Families. Baltimore, MD: The Johns Hopkins University Press, 1997.

Segen, Joseph C., and Joseph Stauffer. "Cystoscopy." In The Patient's Guide to Medical Tests: Everything You Need to Know About the Tests Your Doctor Prescribes. New York: Facts On File, 1998.

Tierney, Lawrence M., Jr., Stephen J. McPhee, and Maxine A. Papadakis, eds. "Urology." In Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1996.

PERIODICALS

Sant, Grannum R., and Philip M. Hanno. "Interstitial Cystitis: Current Issues and Controversies in Diagnosis." Urology 57, Supplement 6A (June 2001): 82-88.

ORGANIZATIONS

American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. 〈http://www.auanet.org〉.

Interstitial Cystitis Association. 51 Monroe Street, Suite 1402, Rockville, MD 20850. (301) 610-5300. 〈http://www.ichelp.org〉.

Society of Urologic Nurses and Associates. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. 〈http://suna.inurse.com/〉.

OTHER

"What is IC? Interstitial Cystitis Fact Sheet." Interstitial Cystitis Association. 〈http://www.ichelp.org/whatisic/ICFActSheet.html〉.

cystoscopy

views updated Jun 11 2018

cystoscopy (sis-tos-kŏpi) n. examination of the bladder by means of an instrument (cystoscope) inserted via the urethra.