Urethroscopy-Cystoscopy

What is Urethroscopy-Cystoscopy?

Urethroscopy-Cystoscopy is a diagnostic test to investigate the interior of the urethra and bladder, with the use of a thin instrument called 'cystoscope'. When investigating a urethral disease, there is no need to insert the cystoscope into the bladder, and therefore only the urethra is examined (Urethroscopy). When the bladder is examined, the cystoscope is inserted into the bladder (Cystoscopy). The cystoscope comprises a very small camera, a light source and 2 channels: one channel for the infusion of normal saline that fills the bladder slowly and one working channel for passing very thin instruments (usually biopsy forceps or special catheters).

Contemporary cystoscopes are flexible and allow the examination to be done with local anaesthesia through the urethra with xylocain in the form of gel. There is also the potential for video recording the test in a DVD.

When is Urethroscopy-Cystoscopy performed?

Urethroscopy-Cystoscopy may be needed:

  • to identify problems of the urinary tract, such as urethral obstruction originating from the prostate, urethral stricture, stones or tumors. 
  • to identify the cause of symptoms, such as hematuria (blood in urine), dysuria (painful urination), urinary incontinence, frequency, retention or urgency.
  • To identify the cause of urinary tract problems, such as frequent and recurrent urinary tract infections (UTIs)
  • To evaluate problems that cannot be shown by radioscopic examinations or to further investigate problems that were initially identified by ultrasound or pyelogram or CT scan.
  • To perform cold bladder biopsy.
  • To remove small foreign bodies from the bladder.
  • To place ureteral catheters (stents), for facilitating urine to pass down from kidneys to the bladder.
  • To treat urinary tract problems, e.g. bladder hemorrhage or stones obstructing the urethra. 

What preparation is needed for Urethroscopy-Cystoscopy?

Inform your physician about the following:

  • If you are allergic to any drugs, including antiseptics, local anaesthetics and antibiotics.
  • If you have ever had problems of persistent hemorrhage in the past or if you have been diagnosed with a blood disease.
  • If you take heparin or any drug affecting blood coagulation and causing haemorrhagic predisposition, such as aspirin  (Salospir®, Aspirin®, Aggrenox®), clopidogrel (Plavix® and Iscover®), ticlopidine (Ticlid® and Ticlodone®), asenocoumarol (Sintrom®), warfarin (Panwarfin®), prasugrel (Effient®), dabigatran (Pradaxa®).
  • If you are pregnant.

Cystoscopy is usually done with local anaesthesia in the urethra, and patients can resume straight away to their activities (can even leave on their own from the physician’s office).  Should there be use of epidural or dorsal or general anaesthesia for any special reason (e.g. particularly sensitive or stressful patients), Cystoscopy takes place at a clinic or hospital setting (not at the physician’s office). The entire examination procedure lasts 30-45 minutes.

In case of general or spinal anaesthesia, do not eat or drink anything for at least 6 hours before the examination. Discuss with your physician which is the best method for you. If your Anaesthesiologist allows you to leave hospital after Cystoscopy with anaesthesia, make sure that there will be a relative or friend of yours to help you go home.

Also, you will be given some antibiotic regimen (usually a little while before Cystoscopy) to prevent any urinary tract infection that might potentially occur because of the examination.

How is Urethroscopy-Cystoscopy performed?

The patient lies on a special bed, and the physician cleanses the genital region with antiseptic. Then the local anaesthetic agent is infused to the urethra. 10 minutes later, the cystoscope is inserted into the urethra and slowly advanced towards the bladder. The direct visual contact of the urethra and bladder allows the Urologist to diagnose any potential impairment that cannot be identified with any other diagnostic test (ultrasound, CT and MRI scan). The forceps that can be inserted through the cystoscope allows the physician to remove small tissue specimens for biopsy. Lastly, special forceps are used to remove very small stones or the ureteral catheter placed earlier. This potential diminishes the need for a more extensive intervention under sedation.

How are the results of Urethroscopy-Cystoscopy interpreted?

Following the examination, you may urinate frequently, probably with some burning sensation during and after urination, the next one or two days. Also, your urine may present blood or a pink color on the first examination day and the following day, particularly if biopsy is done. You should consume a lot of fluids, to help minimize symptoms and prevent urinary tract infection.

Your physician will give you a report with the cystoscopic results and, in case of biopsy, a report of the tissue examination. Should there be any abnormal finding (papilloma, stone etc),  your physician will infom you about the therapeutic options that are available for you.