What is Cystoscope: Procedure and Benefits Explained

Urinary symptoms can range from inconvenient to alarming, prompting a need for internal examination. When your urologist seeks a detailed view inside your bladder and urethra, they often turn to a procedure called a Cystoscopy, utilising a specialised instrument known as a Cystoscope. This guide will explain What is Cystoscope, the procedure performed, and important considerations for your health.

What is Cystoscope?

Cystoscopy is a key procedure in Urology, allowing your urologist to directly examine the inside part of your bladder and urethra. Using a slender instrument called a Cystoscope, equipped with a light and camera, doctors can diagnose and treat a wide range of urinary issues. This includes everything from pinpointing the cause of urinary problems to detecting Bladder Cancer, removing stones or abnormal tissue, and addressing conditions like urethral strictures. It’s a precise way to gain a clear view for accurate diagnosis and effective intervention.

Understand the Symptoms of Bladder Cancer.

What is Cystoscopy used to diagnose?

A cystoscopy procedure can diagnose:

• Urethral or Bladder Cancer 
• Bladder Stones
• Bladder Control Problems (urinary incontinence or leaking pee).
• Enlarged Prostate (Benign Prostatic Hyperplasia [BPH]).
• Interstitial Cystitis / Bladder Pain Syndrome (ICS/BPS).
• Urinary Fistulas and Urethral strictures
• Urinary Tract Infections (UTIs).

Why do healthcare providers perform Cystoscopies?

It provides a direct visual inspection of the bladder and urethra for accurate diagnosis and targeted intervention. Healthcare providers perform cystoscopies primarily to:

• Investigate symptoms like blood in urine, frequent UTIs, or pain, and identify conditions like bladder cancer, stones, inflammation, or urethral blockages.
• Monitoring existing conditions, especially bladder cancer recurrence.
• Treat minor procedures like taking biopsies, removing small stones or tumors, injecting medications, or managing stents.

How does Cystoscopy Work?

Let’s break down step-by-step how a cystoscopy is performed, how a cystoscopy works, from preparation to what happens afterward. To understand the procedure, let us classify the process into 3 phases:

• Phase 1 (Preparation), 
• Phase 2 (Procedure) and,
• Phase 3 (Recovery).

Phase 1: Preparation

Upon consultation with your Urologist will explain why the cystoscopy is needed, what it involves, and potential risks. During the pre-procedure, you might be asked to provide a urine sample shortly to check for an active Urinary Tract Infection (UTI). If a UTI is present, the cystoscopy will usually be postponed and treated first.

• If you’re receiving sedation or general anesthesia (more common for rigid cystoscopy), you’ll be instructed to fast (no food or drink) for a specific number of hours before the procedure.
• Emptying Your Bladder: Just before the procedure begins, you’ll be asked to empty your bladder completely.

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Phase 2: Procedure

• Positioning:
  • You’ll lie on the examination table. Your knees will be bent, and your feet will be placed in stirrups, similar to a gynecological exam. It’s easy for the urologist to have clear access to your urethra.
• Anesthesia Application:
  • The urologist or nurse will clean the area around your urethral opening with an antiseptic solution. A local anesthetic gel will be applied directly into your urethra. This numbs the area, making the insertion of the cystoscope more comfortable.
  • It takes a few minutes for this to take full effect. If you’re receiving sedation, it will be administered intravenously, making you drowsy and relaxed. If you’re under general anesthesia, you’ll be asleep for the entire procedure.
• Cystoscope Insertion:
  • The urologist will gently and carefully insert the lubricated cystoscope into your urethral opening. They will slowly advance the scope up the urethra and into your bladder. You might feel some pressure, a sensation of fullness, or a mild urge to urinate during this step.
• Examination of Urethra:
  • As the cystoscope moves through the urethra, the urologist will examine its lining for any abnormalities, such as strictures (narrowing), inflammation, or growths, viewing the images on a monitor.
• Bladder Filling and Examination:
  • Once the cystoscope enters the bladder, a sterile fluid (usually saline solution) will be slowly infused through the scope into your bladder. This distends (fills) the bladder, stretching its walls and providing a clearer view of the entire lining. 
  • You will likely feel a strong sensation of bladder fullness or an increased urge to urinate. The urologist will systematically rotate and maneuver the cystoscope to carefully examine all areas of the bladder wall for any signs of inflammation, stones, polyps, tumors, or other irregularities.
• Intervention:
  • If any suspicious areas are identified, the urologist can pass tiny instruments through a channel in the cystoscope. These instruments might be used to take biopsies (small tissue samples) for laboratory analysis, remove small bladder stones, remove small, superficial bladder growths, Inject medication into the bladder wall, and Insert or remove ureteral stents.
  • Once the examination and any necessary interventions are completed, the fluid in your bladder may be drained. The cystoscope is then gently and slowly withdrawn from your urethra.

Phase 3: Recovery

On completing the procedure stage, it is advised to take proper rest. If you had local anesthesia during the procedure, you can usually get up and go home shortly after the procedure. If it was sedation or general anesthesia, you’ll be taken to a recovery area where nurses will monitor your vital signs until the anesthesia wears off and you are fully alert and stable.

Your doctor might discuss initial findings with you immediately after the procedure. If biopsies were taken, you’ll usually need to wait a few days to a couple of weeks for the lab results.

What are the Types of Cystoscopes?

There are two primary types of cystoscopes, each designed for different purposes and patient comfort levels. They are Flexible Cystoscopes and Rigid Cystoscopes. 

A Flexible Cystoscope is made of flexible, bendable material, allowing it to navigate the natural curves of the urethra. It has fiber optics or a digital camera that transmits images to an eyepiece or monitor. Whereas, a Rigid Cystoscope is a straight, stiff, metal tube. It typically provides a clearer, wider, and more stable view than a flexible scope. It also has larger working channels.

What are the potential risks of a Cystoscopy?

While a cystoscopy is generally considered a safe and routine procedure, like any medical intervention, it carries some potential risks and complications. These issues are mild and temporary, but it’s important to be aware. Here are the potential risks and complications of a cystoscopy:

• Urinary Tract Infection: This is the common complication. Bacteria can be introduced into the urinary tract during the procedure.
• Bleeding: Some blood in the urine is very common after a cystoscopy, making urine appear pink or light red for a day or two. This is usually due to minor irritation.
• Discomfort: You may experience a burning sensation during urination, mild lower abdominal discomfort, or bladder spasms for a few days after the procedure.
• Urinary Retention: Swelling of the urethra or swelling of the prostate after the procedure can temporarily make it difficult or impossible to urinate.
• Urethral Injury: The insertion of the cystoscope can cause minor injury to the urethra. This injury can lead to the formation of scar tissue and a narrowing of the urethra over time, which might require further treatment.
• Bladder Perforation: An extremely rare but serious complication where the cystoscope or instruments passed through it inadvertently puncture the bladder wall.
• Allergic Reaction: An allergic reaction to the antiseptic solution, lubricating gel, or anesthetic used during the procedure can occur.
• Risks of Anesthesia: Anesthesia or sedation is used (more common for rigid cystoscopy), there are inherent risks associated with these, such as nausea, vomiting, adverse drug reactions, or breathing complications.

Conclusion

In conclusion, You might understand What is Cystoscope and How Cystoscopy is performed. This invaluable instrument that empowers urologists to directly visualise, diagnose, and often treat a range of conditions affecting the urethra and bladder. While the procedure might sound intimidating, being aware of potential risks can help alleviate anxiety.

If your doctor recommends a cystoscopy, it’s a step towards gaining a clearer understanding of your urinary health and guiding the most effective treatment plan for you. Always have an open conversation with your healthcare provider about they concerns you may have.

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