CYSTOSCOPY

PRESENTED BY:
NEENU JACOB
INTRODUCTION

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 collecturine samples, perform biopsies, and
remove small stones

WHAT IS CYSTOSCOPY?
A cystoscopy is an examination of the inside of the
bladder and urethra, the tube that carries urine from
the bladder to the outside of the body. In men, the
urethra is the tube that runs through the penis. The
doctor performing the examination uses a
cystoscopea long, thin instrument with an eyepiece
on the external end and a tiny lens and a light on the
end that is inserted into the bladder. The doctor inserts
the cystoscope into the patients urethra, and the small
lens magnifies the inner lining of the urethra and
bladder, allowing the doctor to see inside the
hollow bladder. Many cystoscopes have extra channels
within the sheath to insert other small instruments
that can be used totreat or diagnose urinary problems
INDICATIONS

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

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.

differing in the flexibility of the cystoscope.
Flexible cystoscopy is carried out with local
anaesthesia on both sexes. Typically, a topical
anesthetic, most often xylocaine gel (common
brand names are Anestacon and Instillagel) is
employed. The medication is instilled into the
urethra via the urinary meatus five to ten
minutes prior to the beginning of the procedure.
Rigid cystoscopy can be performed under the
same conditions, but is generally carried out
under general anaesthesia, particularly in male
subjects, due to the pain caused by the probe.


INDICATIONS
Urinary tract infections
Blood in the urine (hematuria)
Loss of bladder control (incontinence) or overactive bladder
Unusual cells found in urine sample
Need for a bladder catheter
Painful urination, chronic pelvic pain, or interstitial cystitis
Urinary blockage such as
from prostate enlargement, stricture, or narrowing of the
urinary tract
Stone in the urinary tract
Unusual growth, polyp, tumor, or cancer


PROCEDURE
Physicians may have special instructions, but in
most cases, patients are able to eat normally and
return to normal activities after the test. Patients
are sometimes asked to give a urine sample
before the test to check for infection. These
patients should ensure that they do not urinate
for a sufficient period time, such that they are
able to urinate prior to this part of the test.
Patients will have to remove their clothing
covering the lower part of the body, although
some physicians may prefer if the patient wears
a hospital gown for the examination and covers
the lower part of the body with a sterile drape
. In most cases, patients lie on their backs with
their knees slightly parted. Occasionally, a
patient may also need to have their knees
raised. This is particularly when undergoing a
Rigid Cystoscopy examination. For flexible
cystoscopy procedures the patient is almost
always alert and a local anesthetic is applied
to reduce discomfort. In cases requiring a rigid
cystoscopy it is not unusual for the patient to
be given a general anesthetic, as these can be
more uncomfortable, particularly for men.
A physician, nurse or technician will clean the
area around the urethral opening and apply a
local anesthetic. The local anesthetic is applied
direct from a tube or needleless syringe into the
urinary tract. Often, skin preparation is
performed with Hibitane
Patients receiving a ureteroscopy may receive
a spinal or general anaesthetic.
The physician will gently insert the tip of the
cystoscope into the urethra and slowly glide it up
into the bladder. The procedure is more painful
for men than for women due to the length and
narrow diameter of the male urethra
Relaxing the pelvic muscles helps make this part of the
test easier. A sterile liquid (water, saline,
or glycine solution) will flow through the cystoscope to
slowly fill the bladder and stretch it so that the
physician has a better view of the bladder wall.
As the bladder reaches capacity, patients typically feel
some mild discomfort and the urge to urinate.
The time from insertion of the cystoscope to removal
may be only a few minutes, or it may be longer if the
physician finds a stone and decides to remove it, or in
cases where a biopsy is required. Taking a biopsy (a
small tissue sample for examination under a
microscope) will also make the procedure last longer.
In most cases, the entire examination, including
preparation, will take about 15 to 20 minutes.

POST PROCEDURE CARE
After the test, patients often have some
burning feeling when they urinate and often
see small amounts of blood in their urine.
Procedures using rigid instrumentation often
result in urinary incontinence and leakage
from idiopathic causes to urethral damage.
Occasionally, patients may feel some lower
abdominal pains, reflecting bladder muscle
spasms, but these are not common.

Common (non-invasive) prescriptions to relieve
discomfort after the test may include:
Drinking 32 fluid ounces (1 L) of water over 2 hours.
Taking a warm bath to relieve the burning feeling.
Holding a warm, damp washcloth over the urethral
opening.
Report any problems, such as
*bloody urine that lasts more than 24 hours
after the test
*severe pain
*chills
*fever


The Blue light (Hexaminolevulinate
fluorescence) cystoscopy involves instilling a
photosensitizing agent, such as Cysview, into the
bladder. The Blue light cystoscopy contains a light
source and light is transmitted through a fluid
light cable connected to an endoscope to light up
the area to be observed. The photosensitizing
agent preferentially accumulates porphyrins in
malignant cells as opposed to nonmalignant cells
of urothelial origin. Under subsequent blue-light
illumination, neoplastic lesions fluorescence red,
enabling visualization of tumors. The Blue light
cystoscopy is used to detect non-muscle invasive
papillary cancer of the bladder


After a cystoscopy , report any problems,
such as
bloody urine that lasts morethan 24 hours
after the test
severe pain
chills
fever

COMPLICATIONS
Profuse bleeding
Damaged urethra
Perforated bladder
Urinary tract infection
Injured penis