Cystoscopy

Overview

During this procedure your urologist views the inside lining of the bladder using a rigid or flexible cystoscope.  Cystoscopy is performed through the urethra, which is the tube that carries urine from your bladder to the outside of your body.  When having a cystoscopy in our outpatient Ambulatory Surgery Center (ASC) the following are the different types of procedures you may have done.  Each procedure is described in detail below.

• Cystoscopy with Stent Placement
• Cystoscopy with Urethral Dilation
• Cystoscopy with Resection of Bladder Tumor
• Cystoscopy with Litholapaxy (Bladder Stone Removal)
• Cystoscopy with Hydrodilation of the Bladder

Indications

• The patient is a male or female with a history of irritated bladder symptoms or blood in the urine.
• The patient may also have stone disease and require placement of a ureteral stent, have an incidental bladder tumor, or abnormal voided cytologies that require systematic biopsy or resection of tumor.
• The patient may have an incomplete IVP study that requires better anatomical delineation of upper collecting system anatomy by injecting dye under direct vision.

Analysis

If a biopsy specimen is recovered during the cystoscopy procedure, we will send it to the lab for analysis by a pathologist.  This is done to provide the physician with further information to effectively plan a course of treatment.

Types of Cystoscopy Procedures

Cystoscopy with stent placement

Stent placement is performed during the cystoscopy.  The placement of a ureteral stent is completed at the same time to alleviate any obstruction of the ureter because of stone, internal tumors or external compression from other disease processes. Anesthesia is usually a spinal or general.

Stents placed in the ureter serve several purposes.  In the case of a kidney stone being broken up by a laser, it provides a protective lining for larger stone fragments to pass without damaging the ureter. Stents also maintain dilation if the ureter swells from instrumentation during ureteroscopy. This will allow urine to pass unobstructed, consequently alleviating discomfort. Stents also serve as a support during the healing process.

Cystoscopy with urethral dilation

This procedure is used in males and females to widen (dilate) the urethra, the tube that empties urine from the bladder. This tube can become narrowed from inflammation and/or infection, then urine cannot empty properly. This procedure is sometimes necessary to ensure proper drainage of the bladder to avoid bladder/urethral infection and/or urine retention.

Cystoscopy with resectionof bladder tumor

During this procedure, urologists can remove tumors from the bladder. The procedure is performed using a resectoscope, a specialized telescope that allows the urologist to place instruments in the bladder to coagulate biopsy sites or remove bladder lesions. The procedure is performed through the urethra.

Cystoscopy with lithopaxy (bladder stone removal)

This procedure is used to remove a bladder stone through a telescope. If the bladder stone is not too large, the stone can be removed without an open operation by using a telescope. The telescope is used to pass various instruments that will help break the stone. These instruments include laser fibers, shockwave fibers, ultrasound wands, pneumatic stone jacks, and mechanical stone crushers.

Cystoscopy with hydrodilation of the bladder

This procedure is used to stretch the bladder under anesthesia for patients with Interstitial Cystitis, which can cause pain. The theory is that the distention causes microscopic damage to the nerve endings in the bladder, thus creating numbness and alleviation of pain. Patients frequently experience temporary relief from bladder pain for 1 to 6 months.
Sometimes a bladder biopsy is performed. If a biopsy is performed, the specimen will be sent to the lab for analysis. Following the biopsy and proper coagulation has been satisfied, the bladder is filled with water under gravity pressure for a period of time. Sometimes at this stage medications are instilled into the bladder as needed for certain types of conditions to be treated.

Pre-Operative Instructions

You will be contacted by a Registered Nurse who will obtain your medical history, provide complete instructions for your procedure, and answer any questions.

Diet and Medications

• Do not eat or drink anything after midnight prior to surgery
• Please notify the Surgery Department if you are taking any blood thinning medications in advance as soon as you are scheduled for your procedure.
• A Registered Nurse will instruct you regarding what medications to take prior to surgery.  If the RN instructs you to take any medication(s) the morning of your procedure, please take them with only a sip of water.

Special Instructions

• Wear loose fitting clothing.
• Leave all valuables at home such as jewelry, watches, and large amounts of cash.
• Due to the small waiting area, please limit family members to 2 per patient.
• You must have a friend or family member drive you home after your surgery. If this arrangement is not made, your procedure may be cancelled. It is advised that an adult stay with you the first post-operative night.

Post-Operative Instructions

Diet

After surgery, try to drink more liquid than normal, approximately 3 quarts per day minimum for at least 5 days.

Activity

Do not drive, drink alcoholic beverages, transact legal business, care for a dependent person, or take public transportation alone for 24 hours after your procedure. Rest for the first 24 hours, then increase activity as tolerated.

Follow Up Appointment

Your recovery room nurse will arrange your follow-up appointment. It is important for your care that you keep that appointment. Please reschedule within a few days of the original appointment if you have a date or time conflict.

What to Expect After Surgery

• You may have burning during urination for the rest of the day. You may sit in a tub of warm water for relief of burning.
• Small amounts of blood in the urine is normal for several days after the cystoscopy.
• Tylenol may be taken for lower abdominal discomfort or bladder spasm. Follow manufacturer’s instructions for Tylenol.

If symptoms are not relieved with a warm bath or Tylenol, or if you experience any problems, call your physician for assistance at (559) 321-2800.