Indications for
these procedures include microscopic and gross heamaturia
(blood in urine), recurrent or persistent urinary tract
infection, irritative or obstructive voiding symptoms,
and bladder cancer surveillance.
Prior to the procedure a history of blood thinners should
be sought and stopped appropriately. A urine sample is
collected to rule out infection. Patients with artificial
joints, cardiac valvular disease, or prosthetic valves
will need prophylactic antibiotics to prevent subacute
bacterial endocarditis etc. The patient should also have
fasted prior to the procedure.
Unless the patient was on admission prior to the procedure,
cystoscopy is essentially an outpatient procedure i.e.
the patient comes from and goes home the same day.
The procedure is performed usually under local anaesthesia.
A special gel is intruded into the urethra to numb it.
The scope is then inserted through the urethra after waiting
for a while for the anaesthetic effect to commence.
The bladder may be filled with clear sterile fluid to
distend the bladder thus improve the visualization of its
walls. As the bladder reaches capacity, patients typically
feel some discomfort and the urge to urinate.
The tract may be viewed directly via the scope or via
a monitor connected to it.
If a tumour is observed, depending on the size, it may
be totally removed or biopsied (a part taken). This is
sent to the laboratory for microscopic examination. Stone
removal or cauterization (burning of the tissue with heat)
may also be performed with additional instruments.
At the end of the procedure, the bladder emptied of the
fluid content and the scope is retracted.
The procedure usually takes 15-20 minutes.
After the test, patients may have some burning feeling
when they urinate and often see small amounts of blood
in their urine. Occasionally, patients may feel some lower
abdominal pains, reflecting bladder muscle spasms, but
these are not common. (These problems should not last more
than 24 hours. Tell your doctor if bleeding or pain is
severe or if problems last more than a couple of days.)
The patient should be made to consume 1.5-2litres of water
after the procedure to increase micturation thus preventing
blood clot and its sequelae. Patients should report any
difficulty voiding, frank bleeding or clots, or symptoms
of urinary tract infection.
Cystoscopy though extremely safe, may rarely have some
risks and complication, fortunately those at risk can be
easily identified through a thorough history taking.
These include:
Anaesthetic effect
Bleeding which may be continuous, with clots resulting
in urinary retention
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