Refers to endoscopy of the urinary bladder via the urethra.
It is carried out by using a cystoscope.
White light cystocopy is the current standard in evaluation and staging of bladder cancer.
White light cystoscopy has a high sensitivity for detecting papillary lesions and has limited ability to discern non-papillary and flat lesions for inflammatory lesions, reducing its accuracy of tumor staging.
Small or multi focal lesions are more difficult to detect and enhanced imaging including blue light cystoscopy and narrowband imaging can enhance identification of lesions.
Blue light cystoscopy identifies malignant cells through the absorption of photo sensitizing drugs into the urothelial cytoplasm where it enters him –biosynthesis metabolism.
Flexible cystoscope is invasive, relatively expensive, associated with some discomfort, triggers reduce compliance with established follow up regimens.
Cystoscopes range from pediatric to adult sizes.
There are two main types of cystoscopes:flexible and rigid.
Flexible cystoscopy is carried out with local anesthesia.
Typically, a topical anesthetic, most often xylocaine is employed, and 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.
Cystoscopy may be recommended for:
Urinary tract infections
Hematuria.
Incontinence or overactive bladder.
It is not recommend that cystoscopy, urodynamics, or diagnostic renal and bladder ultrasound be part of initial diagnosis for uncomplicated 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.
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, general anesthetic administration can lead to more comfort, particularly for men.
The procedure is more painful for men than for women due to the length and narrow diameter of the male urethra.
Sterile liquid (water, saline, or glycine solution) flows through the cystoscope to fill the bladder and stretch it so visualization of the bladder is improved.
In most cases, the entire examination will take about 15 to 20 minutes.
Following the procedure,patients often have dysuria when they urinate and often see small amounts of blood in their urine.
Approximately 10% of patients develop a UTI, and 10 to 20% of tuomors are missed by conventional white light cystoscopy.
Rigid instrumentation may result in urinary incontinence and leakage from urethral damage.
Common (non-invasive) prescriptions to relieve discomfort after the test may include:
Common to prescribe an antibiotic to prevent an infection prior to the performance of the cystoscopy, and as part of the pre-operative workup.
Some patients are prescribe an oral urinary analgesic, phenazopyridine or a combination (urinary) analgesic/anti-infective/anti-spasmodic medication containing methylene blue, methanamine, hyoscyamine sulfate and phenyl salicylate for irritation and/or dysuria that patients may experience after the procedure.