Cystoscopy +/- biopsy
A Cystoscopy involves the placement of a small telescope into the bladder by way of the urethra (the tube through which you urinate). With this procedure, we are able to see tumours, areas of inflammation, abnormal variations in anatomy, stones etc. The procedure may be performed under local anaesthetc (usually by means of a flexible telescope – Flexible cystoscopy), or under full anaesthetic.
Through the cystoscope, we can pass instruments to take biopsies (tissue sample) of areas that we believe are abnormal. An area that we biopsy can also be cauterized (burned) if there is any bleeding. Cauterization can also be used to kill cells that we perceive to be abnormal.
Patients who undergo hospital procedures for kidney stones often have a stent placed during the procedure. This is a plastic tube that goes from the kidney down to the bladder. Except for unusual circumstances, we can remove a stent while doing a cystoscopy.
Please refer to the detailed instructions provided by the rooms, or download these from the website.
Before the procedure is performed, you may be asked to provide a urine specimen to detect the presence of any infection, which will be treated before the cystoscopy is performed. If a general anesthetic is used, you must have someone to drive you home. Some patients unexpectedly feel light-headed or uncomfortable after any procedure. If you do not have anyone available, we may ask that you relax for a while in our waiting room after the procedure before going home.
*For women of child-bearing age, it is important that you inform us whether you may be pregnant.
The Procedure Itself
The actual procedure typically takes a few minutes for a plain cystoscopy. Removal of a stent may add a bit more time. Biopsy(s) and possible cauterization can add more time. We will have you lie on your back. If a general anaesthetic is used, your legs will be placed in stirrups (holsters). If the procedure is performed under local anaesthetic using a flexible telescope, this is not necessary. Your urethra will be cleaned with an antiseptic to create a sterile field. Numbing jelly may be placed in your urethra and allowed to remain for a short time. Next, the scope is guided through the urethra (under direct vision) and into the bladder.
After the procedure, it is normal to experience stinging when you pass urine. This may last for a few days. You may see blood in the urine. This is more common in men with large and obstructing prostates, in situations where the urethra contains a stricture (narrowing due to scar tissue), or again in cases of stent removal.
If a bladder tumour is identified during the procedure and removed or cauterized, a special chemotherapy agent (Mitomycin C) may be instilled into the bladder to help prevent the tumour from growing back. This will be discussed with you in detail after the procedure, before the Mitomycin C is used.
Ideally, we would prefer that you take it easy at home for the remainder of the day or evening. If you received a general anesthetic, we insist that you return home with your family member or friend and relax for the remainder of the day or evening.
Possible Complications of the Procedure
The vast majority of patients will not experience any problem after a cystoscopy. However, any procedure, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. These may include, but are not limited to:
Urinary Tract Infection or Urosepsis (Bloodstream Infection)
Before this procedure can take place, we must confirm that you do not have an active urinary tract infection. If a urinary tract infection is not present, it is most unlikely that you will suffer sepsis after this procedure. In the rare event that you do, you will be given intravenous and oral antibiotics. This scenario is more common in diabetics, patients on long-term steroids, or in patients with disorders of the immune system.If you have symptoms such as high fever, shaking (rigors) after the procedure you must contact us immediately or go to the nearest public hospital.
Blood Clots in the Urine
Rarely, the scope can rub against a blood vessel on the surface of the prostate or less commonly in the bladder. In this instance, you may develop haematuria (blood in the urine). In patients having a biopsy, there is rarely any significant bleeding because we only take small samples. There are instances where a scab (from the cauterization) can fall off and a patient subsequently develops haematuria one or a few days later. This may occur as late as 2 weeks after the procedure. In almost all instances, the urine clears on its own over the next few days. Ongoing bleeding with the development of clots is uncommon. If the clots block the bladder, a catheter may need to be inserted to flush out the clots. If bleeding persists, we may have to look back in the bladder to control or cauterize the bleeding.
In men, the cystoscope will always rub against the prostate gland. This may lead to slight swelling of the prostate. As a result of this swelling, the flow of urine may be blocked leading to urinary retention. This is more common in men with a prior history of an enlarged prostate (BPH) or difficulty urinating. Typically, the man will notice increasing difficulty passing urine with frequent trips to the toilet with the urine only dribbling out. Eventually the blockage may become complete and significant discomfort results. If this occurs, you must attend your nearest casualty department. In most circumstances, urinary retention will resolve after a few days of catheterization. In rare circumstances a prostate operation is required.
The wall of the bladder can be perforated from a biopsy. In most cases, all we need to do is leave the catheter in for an extra few days to allow self-healing. If the perforation occurs in a specific area of the bladder, we may need to perform a formal bladder repair through an incision in the abdomen, or place a drainage tube in the lower abdomen to evacuate this fluid.
In most circumstances, the results of the cystoscopy will be discussed with you before discharge. Please follow the instructions given to you by the hospital regarding when you should make an appointment to see Dr Sved. Do not hesitate to call our office at any time if you have any concerns.