Cystoscopy
| Cystoscopy | |
|---|---|
 Diagram showing a cystoscopy for a male and a female | |
| Pronunciation | sis-ˈtäs-kə-pē |
| ICD-9-CM | 57.31-57.33 |
| MeSH | D003558 |
| MedlinePlus | 003903 |
Cystoscopyisendoscopyof theurinary bladdervia theurethra.It is carried out with acystoscope.
Theurethrais the tube that carriesurinefrom the bladder to the outside of the body. The cystoscope has lenses like atelescopeormicroscope.These lenses let the physician focus on the inner surfaces of theurinary tract.Some cystoscopes useoptical fibres(flexible glass fibres) that carry an image from the tip of the instrument to a viewing piece at the other end. Cystoscopes range from pediatric to adult and from the thickness of a pencil up to approximately 9 mm and have a light at the tip. Many cystoscopes have extra tubes to guide other instruments forsurgical proceduresto treat urinary problems.
There are two main types of cystoscopy—flexible andrigid—differing in the flexibility of the cystoscope. Flexible cystoscopy is carried out with local anaesthesia on both sexes. Typically, a topical anesthetic, most oftenxylocainegel (common brand names are Anestacon and Instillagel) is employed. The medication is instilled into the urethra via theurinary meatusfive 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 anesthesia, particularly in male subjects, due to the pain caused by the probe. The sizes of the sheath of the rigid cystoscope are 17French gauge(5.7 mm diameter), 19 Fr gauge (6.3 mm diameter), and 22 Fr gauge (7.3 mm diameter).
Medical uses
[edit]
Cystoscopy may be recommended for any of the following conditions:[1]
- urinary tract infections;
- bloodin the urine (hematuria);
- loss of bladder control (incontinence) oroveractive bladder;(Although, the American Urogynecologic Society does not recommend that cystoscopy, urodynamics, or diagnostic renal and bladder ultrasound are part of initial diagnosis for uncomplicated overactive bladder.)[2][3]
- unusual cells found in urine sample;
- need for a bladdercatheter;
- painful urination, chronicpelvic pain,orinterstitial cystitis;
- urinary blockage such as fromprostateenlargement,stricture,or narrowing of the urinary tract;
- stonein the urinary tract; and
- unusual growth,polyp,tumor,orcancer.
Male and female urinary tracts
[edit]
If a patient has a stone lodged higher in the urinary tract, the physician may use a much finer calibre scope called aureteroscopethrough the bladder and up into theureter.(The ureter is the tube that carries urine from the kidney to the bladder.) The physician can then see the stone and remove it with a small basket at the end of a wire that is inserted through an extra tube in the ureteroscope. For larger stones, the physician may also use the extra tube in the ureteroscope to extend a flexible fiber that carries alaserbeam to break the stone into smaller pieces that can then pass out of the body in the urine.[citation needed]
Test procedures
[edit]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 of 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 ahospital gownfor 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 his or her knees raised. This is particularly true 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 theurethral openingand 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 withchlorhexidine.[4]
Patients receiving a ureteroscopy may receive aspinalorgeneral 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 themale urethra,and results of a 2019 systematic review of the literature found that intraurethral lidocaine greatly reduces this painful procedure in men.[5]Rela xing thepelvic muscleshelps make this part of the test easier. Asterileliquid (water,saline,orglycinesolution) 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.[citation needed]
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 abiopsyis 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.[citation needed]
Blue light
[edit]In blue light cystoscopyhexyl aminolevulinate hydrochlorideis instilling a photosensitizing agent, 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 accumulatesporphyrinsin malignant cells as opposed to nonmalignant cells of urothelial origin. Under subsequent blue light illumination,neoplastic lesionsfluoresce red, enabling visualization of tumors. The blue light cystoscopy is used to detect non-muscle invasive papillary cancer of the bladder.[6][7]
Indications before and after the procedure
[edit]Before the procedure
[edit]Prior to the early 1990s, it was common practice for the physician performing the procedure to prescribe anantibioticto take for a few days to prevent aninfection.Since that time, many urologists will order a "urine C & S" (urinalysiswith bacterial/fungal cultures and testing for sensitivities to anti-infective medications) prior to the performance of the cystoscopy, and as part of the pre-operative workup. Depending on the results of the testing and other circumstances, he or she may elect to prescribe a 10- to 14-day course of antibiotic or other anti-infective treatment, commencing 3 days before the cystoscopy is to be performed, as this may alleviate some inflammation of the urethra prior to the procedure.[citation needed]
This practice may provide an additional benefit by preventing an accidental infection from occurring during the procedure. When antibiotics are given for UTI prevention in adults undergoing a cystoscopy, they may reduce the risk of infections that go into the bloodstream and infections limited to the bladder.[8]However, antibiotics may have little to no effect on only the risk of serious infections that go in the bloodstream. From review data, antibiotics do not appear to cause serious unwanted side effects or affect the occurrence of minor side effects, but more research is needed to confirm these findings.[8]The full-course of antibiotic treatment also lessens the possibility of the bacteria becoming resistant to the antibiotic/anti-infective agent prescribed.
Physicians may also prescribe an oral urinaryanalgesic,phenazopyridine,or a combination (urinary) analgesic/anti-infective/anti-spasmodicmedication containingmethylene blue,methanamine,hyoscyamine sulfateandphenyl salicylatefor irritation and/ordysuriapatients may experience after the procedure. At two weeks post-procedure, the practitioner may order a follow-up evaluation including a repeat of the urinalysis with cultures and sensitivities, and a uroflowmetric study (which evaluates the volume of urine released from the body, the speed with which it is released, and how long the release takes)
After the procedure
[edit]Patients often experience a burning sensation during urination and often see small amounts of blood in their urine. Procedures using rigid instrumentation more frequently result in short-termurinary incontinenceand leakage due to urethral damage. Occasionally, patients may feel somelower abdominal pains,reflecting bladdermuscle 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; and
- holding a warm, damp washcloth over the urethral opening.
Other animals
[edit]Cystoscopy has similar indications in animals, including visualisation and biopsy of mucosa, retrieval or destruction of urinary bladder stones and diagnosis of ectopic ureters.[9][10][11]
Inturtleand tortoises, cystoscopy has additional value as it permits the visualisation of internal organs due to the thinurinary bladderwall.[12]In young individuals in whichsex determinationwould not be feasible by visualisation of external morphologic features, this technique permits noninvasive visualisation of gonads, and therefore sex determination.[13]
References
[edit]- ^"Cystoscopy and Ureteroscopy".The Doctors Lounge.Archived fromthe originalon 2011-07-10.Retrieved2008-01-29.
- ^American Urogynecologic Society(May 5, 2015)."Five Things Physicians and Patients Should Question".Choosing Wisely:an initiative of theABIM Foundation.American Urogynecologic Society.RetrievedJune 1,2015.
- ^Gormley EA, Lightner DJ, Faraday M, Vasavada SP (May 2015). "Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment".The Journal of Urology.193(5): 1572–80.doi:10.1016/j.juro.2015.01.087.PMID25623739.
- ^"Pharmaceutical Information – Hibitane".RxMed. Archived fromthe originalon 2014-02-03.Retrieved2013-06-09.
- ^Raskolnikov D, Brown B, Holt SK, Ball AL, Lotan Y, Strope S, Schroeck F, Ullman R, Lipman R, Smith AB, Gore JL (2019)."Reduction of Pain during Flexible Cystoscopy: A Systematic Review and Meta-Analysis".Journal of Urology.202(6): 1136–1142.doi:10.1097/JU.0000000000000399.ISSN0022-5347.PMID31219763.S2CID195192577.
- ^"Photodynamic Diagnostic D-Light C (PDD) System – P050027".FDA. Archived fromthe originalon 18 January 2017.
- ^Mark JR, Gelpi-Hammerschmidt F, Trabulsi EJ, Gomella LG (April 2012)."Blue light cystoscopy for detection and treatment of non-muscle invasive bladder cancer"(PDF).The Canadian Journal of Urology.19(2): 6227–31.PMID22512972.
- ^abZeng S, Zhang Z, Bai Y, Sun Y, Xu C, et al. (Cochrane Urology Group) (February 2019)."Antimicrobial agents for preventing urinary tract infections in adults undergoing cystoscopy".The Cochrane Database of Systematic Reviews.2019(2): CD012305.doi:10.1002/14651858.CD012305.pub2.PMC6383548.PMID30789676.
- ^Morgan M, Forman M (July 2015). "Cystoscopy in dogs and cats". review.The Veterinary Clinics of North America. Small Animal Practice.45(4): 665–701.doi:10.1016/j.cvsm.2015.02.010.PMID26002795.
- ^Childress MO, Adams LG, Ramos-Vara JA, Freeman LJ, He S, Constable PD, Knapp DW (August 2011). "Results of biopsy via transurethral cystoscopy and cystotomy for diagnosis of transitional cell carcinoma of the urinary bladder and urethra in dogs: 92 cases (2003-2008)".Journal of the American Veterinary Medical Association.239(3): 350–6.doi:10.2460/javma.239.3.350.PMID21801049.
- ^Smith AL, Radlinsky MG, Rawlings CA (July 2010)."Cystoscopic diagnosis and treatment of ectopic ureters in female dogs: 16 cases (2005-2008)".Journal of the American Veterinary Medical Association.237(2): 191–5.doi:10.2460/javma.237.2.191.PMID20632793.
- ^Di Girolamo N, Selleri P (September 2015). "Clinical Applications of Cystoscopy in Chelonians".The Veterinary Clinics of North America. Exotic Animal Practice.18(3): 507–26.doi:10.1016/j.cvex.2015.04.008.PMID26336001.
- ^Selleri P, Di Girolamo N, Melidone R (June 2013). "Cystoscopic sex identification of posthatchling chelonians".Journal of the American Veterinary Medical Association.242(12): 1744–50.doi:10.2460/javma.242.12.1744.PMID23725439.
- An earlier version of this article was adapted from thepublic domainNIH Publication No. 01-4800,which says, "This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired."
Further reading
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