Introduction
A cystoscopy is a diagnostic procedure whereby a small camera is placed into the bladder through the urethra to inspect the lower urinary tract. This can be performed under local anaesthesia with the patient awake or under IV sedation or general anaesthesia. A cystoscopy is often performed before many other procedures on the urinary tract.
Indications
A cystoscopy can be performed to investigate the following:
- Haematuria.
- Recurrent urinary tract infections.
- Urinary incontinence.
- Chronic pelvic pain.
- Abnormal urine cytology.
- Voiding dysfunction.
- The presence of foreign bodies.
Preoperative Instructions
A urine test will be performed prior to the procedure to ensure there is no active urinary tract infection. An active infection will often require treatment prior to a cystoscopy. A cystoscopy can be safely performed even when the patient is taking medications that increase the risk of bleeding such as warfarin, clopidogrel, apixaban and rivaroxaban. A number of other tests such as an ultrasound or CT scan and urine cytology may also be performed prior to a cystoscopy.
Procedure
A cystoscopy can be performed with either a flexible or a rigid cystoscope. A flexible cystoscope allows the procedure to be performed with local anaesthesia only. The flexible cystoscope is generally only used for diagnostic purposes as it does not allow for other procedures to performed at the same time if an abnormality is found. A rigid cystoscope does give the surgeon the option to treat a condition at the same time as the cystoscopy but the use of the rigid cystoscope requires the patient to receive a general anaesthetic.
A cystoscopy is performed by first placing a clearing the external genitalia with an antiseptic before placing a lubricant anaesthetic gel into the urethra. The cystoscope is then passed through the urethra, and in men through the prostate, before entering the bladder. The bladder is then inspected for any abnormalities.
Postoperative Instructions
In the first 24-48 hours following a cystoscopy the patient may experience some burning and stinging whilst urinating. They may also notice some blood in the urine for up to a week. The patient is able go about their regular duties following a cystoscopy.
Risks
The risks of a cystoscopy include:
- Bleeding.
- Infection.
- Dysuria.
- Urethral stricture.