Cystoscopy and Ureteroscopy

A cystoscope is used to see inside the bladder and urethra. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscope. These lenses allow visualization of the inner surfaces of the urinary tract. Some cystoscopes use optical fibers (flexible glass fibers) that carry an image from the tip of the instrument to a viewing piece at the other end. The cystoscope is as thin as a pencil and has a light at the tip. Many cystoscopes have extra tubes to guide other instruments for procedures to treat urinary problems.

Indications of cystoscopy

  • Frequent urinary tract infections
  • Blood in your 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 prostate enlargement, stricture, or narrowing of the urinary tract
  • Stone in the urinary tract
  • Unusual growth, polyp, tumor, or cancer

If a stone is lodged higher in the urinary tract, the cystoscope may be extended through the bladder and up into the ureter. The ureter is the tube that carries urine from the kidney to the bladder. When used to view the ureters, the cystoscope is called a ureteroscope. The stone can then be seen and removed with a small basket at the end of a wire inserted through an extra tube in the ureteroscope. The extra tube in the cystoscope may also be used to extend a flexible fiber that carries a laser beam to break the stone into smaller pieces that can then pass out of the body in urine. There are generally two types of cystoscopes: Rigid and semirigid cystoscopes.

A urine sample is taken before the test to check for infection. Avoid urinating for an hour before this part of the test.

A hospital gown is worn for the examination, and the lower part of the patient's body is covered with a sterile drape. In most cases, the patient lies on his/her back with his/her knees raised and apart. A nurse or technician should clean the area around the urethral opening and apply a local anesthetic. In cases where a ureteroscopy is performed, it may be better to give a spinal or general anesthetic.

Test Procedures

The tip of the cystoscope is gently inserted into the urethra and then slowly glide it up into the bladder. A sterile liquid (water or saline) is injected through the cystoscope to slowly fill the bladder and stretch it to allow for a better view of the bladder wall.

As the bladder reaches capacity, the patient will feel some 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 a stone is found and is being removed. 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.

After the Test

The patient may notice a mild burning feeling upon urination, and may see small amounts of blood in urine. These problems should not last more than 24 hours. To relieve discomfort, the patient is advised to drink two 8-ounce glasses of water each hour for 2 hours. An antibiotic is prescribed for 1 or 2 days to prevent an infection.

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