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Cystoscopy, Here's What You Need to Know

Cystoscopy is a medical procedure that aims to examine the urinary tract. This procedure is done with a cystoscope, which is a device shaped like a hose that has a camera at the end for visual observation. Through cystoscopy, the doctor can observe the condition of the channel after the bladder (urethra) and bladder in the form of images that can be enlarged if needed. There are two types of cystoscopes that can be used for cystoscopy procedures, namely flexible cystoscopes and rigid cystoscopes. Flexible cystoscope is a cystoscope that can be curved according to the curve of the urinary tract and patient's organs. Patients who undergo a cystoscopic procedure using a flexible cystoscope are usually only given local anesthesia (anesthesia) during the procedure. Whereas a rigid cystoscope is a cystoscope that cannot bend following the urinary tract indentations like a flexible cystoscope. Patients who undergo a cystoscopic procedure using a rigid cystoscope are usually given general anesthesia (general anesthesia), so that the patient will fall asleep during the procedure. Flexible cystoscopy is used to observe the condition of the patient's urinary tract. Whereas rigid cystoscopy is used if the patient also requires treatment on the inside of the urinary tract.

Cystoscopy Indications

Patients will be recommended to undergo a cystoscopic procedure if there are complaints that are suspected to be due to urinary tract disorders, such as:
  • Pain when urinating.
  • Too often want to urinate.
  • Pelvic area pain.
  • Frequent urinary tract infections.
These complaints can arise in several types of urinary related diseases, such as:
  • Bladder stones.
  • Urinary obstruction.
  • Enlarged prostate gland.
  • Bladder cancer.
  • Non-cancerous tissue growth.
As mentioned above, in addition to diagnosing a disease, cystoscopy can be performed as a treatment procedure. Conditions that can be treated with cystoscopy include:
  • Narrowing of the urethra or urethral stricture.
  • Overcoming stones, tumors, or sores in the bladder.
  • Lifting foreign matter in the bladder.
  • Injections of botulinum toxin for overactive bladder.
  • Reverse urine flow (vesicoureteral reflux) in children.

Cystoscopy warning

Before doing cystoscopy, discuss with your doctor if you have severe disorders in blood clotting, or have a urinary tract infection with fever.

Risk of cystoscopy

Cystoscopy is a fairly safe medical procedure. Blood in the urine, feeling like urinating, or burning sensation during urination are normal after cystoscopy, and will disappear on their own. However, other heavier risks can also occur after undergoing cystoscopy, such as:
  • Infection due to bacterial entry into the urinary tract. Symptoms of infection that generally appear are fever, chills, nausea, low back pain, and urine that smells weird.
  • Urethral swelling that causes difficulty urinating. If this condition lasts more than 8 hours after the cystoscopy procedure, the patient should immediately contact a doctor.

Cystoscopy preparation

Urologists can ask patients to take urine samples for cystoscopic supportive examinations, such as urinalysis or urine culture. After that, the doctor will give antibiotics for the patient to consume before and after cystoscopy. Antibiotics can help prevent urinary tract infections if the patient's immune system is having problems, and prevent infections from getting worse if the patient is experiencing a urinary tract infection. If the patient is taking certain medications, you should tell your doctor because some medicines can cause serious bleeding. Patients will be given anesthesia according to the purpose of the cystoscopic procedure performed, it can be either local, half body (regional), or total anesthesia (anesthesia). Therefore, there should be a family member who accompanies the patient before and after undergoing a cystoscopic procedure. If planned to be given general anesthesia, the patient will be asked to fast from the night before.

Cystoscopy Procedure

The patient will be asked to urinate so that the bladder is empty. After changing his clothes with special surgical clothes, the patient is positioned to sleep on the operating table with his legs bent and wide open. The patient is then given anesthesia, either local or regional anesthesia which keeps the patient awake during surgery, as well as general anesthesia which causes the patient to fall asleep during the operation. For patients who are given local and regional anesthesia, the doctor can also provide sedation so that the patient relaxes during the cystoscopy procedure. The doctor will lubricate the cystoscope with a special gel to make it easier to enter the urethra. After lubricating enough, the doctor will slowly insert the cystoscope into the urethra. In this procedure, the conscious patient can still feel the entry of the cystoscope, but not the pain. With the entry of the cystoscope, the doctor will examine the urethra and bladder through the visual image produced by the cystoscope. If needed, the doctor will do a biopsy to take tissue samples from the bladder or urinary tract. Biopsy is usually done if the patient is undergoing cystoscopy using a rigid cystoscope. To facilitate the examination, the doctor will spray sterile liquid into the urinary tract and bladder through a cystoscope. Spraying this liquid will cause a strange sensation for the patient and feels like he wants to urinate. If the patient underwent cystoscopy with local anesthesia, the cystoscopy procedure can take approximately 5-15 minutes. However, if the patient undergoes cystoscopy with general anesthesia, this procedure can last for 15-30 minutes.

After cystoscopy

Cystoscopic observation results can be notified directly to the patient's doctor after the examination is complete. However, if the patient also undergoes cystoscopic biopsy, the results of new biopsy observations can be notified by the doctor a few days later. Patients who have undergone cystoscopy can feel pain, burning, and discomfort in the urinary tract. But the patient can resume activities as usual. Patients are encouraged to drink more and urinate to reduce irritation. Patients can compress their genitals by using warm water to reduce pain. If needed, the patient can take a shower with warm water. If the patient undergoes cystoscopy with regional or general anesthesia, the head sensation may feel heavy and dizzy after the procedure is finished. Therefore, it needs longer monitoring, even to be treated in hospital. When permitted to go home, patients are not allowed to drive their own vehicle and there must be someone who drove home. To reduce pain, doctors can provide pain relievers, such as paracetamol or ibuprofen.