Bladder cystoscopy in women, men and children

Examination of the internal walls of the bladder using a specific device called a cystoscope is called "cystoscopy". Why is this diagnostic method necessary?

The fact is that certain disorders in the urinary organs – for example, ulcers, small polyps – cannot be seen with ultrasound diagnostics, so according to indications, a more informative procedure in this sense, cystoscopy, can be prescribed. Thus, various neoplasms, stone formations, inflammatory elements, physical damage to the walls of the organ can be detected.

Cystoscopy is performed not only for diagnostic purposes, but also for therapeutic purposes - thanks to the cystoscope device, it is possible to remove a tumor, cauterize an ulcer, introduce the necessary medication into the bladder cavity, crush and remove deposits, etc.

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Indications for cystoscopy

When a doctor prescribes a cystoscopy:

• with interstitial cystitis;
• with frequently exacerbated cystitis;
• when blood appears in the urine;
• in case of enuresis;
• if atypical cellular structures are detected during urine testing (suspicion of a tumor);
• for painful urination, chronic pelvic pain syndrome, chronic cystitis;
• in case of obstructed urine flow as a result of prostate hyperplasia, blockage or narrowing of the ureters;
• in case of urinary stone formation;
• for neoplasms of the urinary system;
• with frequent urination of unknown etiology.

For therapeutic purposes, cystoscopy is used to perform the following manipulations:

• to remove neoplasms in the bladder cavity;
• for crushing and removing stones;
• to relieve blockages and narrowing of the urinary tract;
• for cauterizing bleeding surfaces on the walls of an organ.

Preparation for cystoscopy

Before going to the procedure, it is necessary to familiarize yourself with some points of preparation for the manipulation. What should the patient know?

• If the doctor has warned you that the cystoscopy will be performed under anesthesia, you should abstain from eating before the procedure. For how long - depends on the type of anesthesia, so this point should be clarified directly with the doctor.
• If the doctor prescribed pain relief, you will be prohibited from driving on your own immediately after the procedure – keep this in mind. You may need help from relatives or friends to get home.
• Depending on the diagnosis and individual characteristics of the body, the doctor may voice his preparatory requirements. Listen to them carefully and follow them carefully.

What should you take with you to the procedure and what should you leave at home?

• Remove all valuable jewelry from your body and leave especially valuable items at home.
• Have some comfortable clothes ready to change into.
• Don't forget to bring any medications you need to take throughout the day so you don't miss a dose.
• Collect and take with you all the documentation that relates to your illness (test results, images, conclusions, etc.).
• It is not advisable to use cosmetics when going for a cystoscopy.

Cystoscopy kit

For diagnostic cystoscopy, rigid instruments with a diameter of 16-22 Fr are usually used. In order to fully examine the urethra and bladder cavity, two optical systems are used, allowing examination from different angles. Flexible instruments are easier for patients to accept if cystoscopy is performed without anesthesia. When using rigid instruments, it is recommended to use anesthesia: such instruments allow for a better examination of the pathology, as well as for performing associated manipulations.

Cystoscopy instruments that may be used during the procedure include:

• cystoscope tube with shut-off valves;
• cystoscope tube with bypass valve;
• obturator for tube;
• gripping pliers;
• regular biopsy forceps;
• spoon-shaped biopsy forceps;
• scissors;
• optical stone crushing pliers;
• various adapters;
• flexible biopsy forceps;
• flexible "alligator" for gripping;
• flexible scissors;
• flexible electrodes (simple, needle, loop);
• flexible injection needle;
• Dormia's ureteral basket;
• tool handles;
• loop for removing polyps.

The listed instruments are absolutely non-traumatic. They are made of durable, long-lasting material, due to which they not only serve for a long time, but also will not fail or break during manipulations.

How is a cystoscopy performed?

A cystoscope is a tubular device with a light. It can be flexible or regular. Rigid cystoscopy is performed with a regular cystoscope – it allows for a more thorough examination of the urinary tract and bladder, but it does not cause the patient to feel very comfortable. Therefore, the introduction of a rigid device must be combined with the use of anesthesia.

To examine the internal cavity of the bladder, the device is inserted into the urethra.

Is it painful to do a cystoscopy? Indeed, it can be unpleasant and even a little painful, so patients are often given local, spinal or general anesthesia (narcosis). Flexible cystoscopy (examination using a flexible instrument) is less painful, but also less informative for the doctor. Therefore, the question of which cystoscope to use and whether to use anesthesia is decided on an individual basis.

For local anesthesia, 10 ml of 2% novocaine or lidocaine gel is injected into the urethra. If the procedure is performed on a male patient, a special clamp is placed on the penis, below the head, for approximately 8-10 minutes.

Cystoscopy under general anesthesia is rarely performed, mainly in mentally unstable patients.

During a cystoscopy, the patient lies on a couch, and his genitals are treated with an antiseptic solution. The device is inserted into the urethra, which is filled with liquid for better visibility (for example, sterile isotonic solution - about 200 ml). The doctor conducts the examination, depending on the circumstances, from 2 to 10 minutes. The entire procedure can last about 40-45 minutes. Upon completion, if the patient was given local anesthesia, he can be sent home.

Diagnostic cystoscopy

Since the cystoscope is inserted through the urethra, the doctor has the opportunity to examine all surfaces of the mucous membranes for any lesions, changes, blockages. When the device is inserted into the bladder cavity, the doctor gradually introduces a sterile solution there to examine all the walls well. If necessary, accompanying instruments are inserted through the same cystoscope, for example, for a biopsy, to take a piece of affected or suspicious tissue for diagnostics.

Cystoscopy with biopsy – taking material for histological analysis – is performed simultaneously with examination of the surface of the bladder, if pathological areas or tumors are detected. It is noteworthy that this procedure allows detecting neoplasms of very small sizes (up to 5 mm), which cannot be achieved by any other diagnostic method.

The use of a miniature video camera with illumination located at the end of the cystoscope during the procedure allows for a careful examination of all the internal walls of the bladder with the ability to enlarge the resulting image.

Cystoscopy under anesthesia

This is a procedure in which a doctor uses an instrument called a cystoscope to examine the patient's bladder and urinary tract while the patient is under general anesthesia. This procedure may be performed for a variety of medical reasons, such as examining the bladder, diagnosing or treating various urinary tract diseases.

A cystoscopy procedure under general anesthesia may be recommended in the following cases:

1. Children and some adults: Children and some adults especially may experience significant discomfort or fear when having a cystoscopy without general anesthesia.
2. Pain or discomfort: If the patient has severe pain, cramping, or other problems that may interfere with a painless cystoscopy, general anesthesia may be needed.
3. Complex procedures: In some cases, cystoscopy may be part of a more complex procedure that requires general anesthesia.

It is important to note that performing a cystoscopy under anesthesia is a serious medical procedure and requires special preparation and monitoring of the patient during anesthesia. The decision to perform a cystoscopy under anesthesia is always made by the doctor, taking into account the clinical indications and needs of the patient.

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Cystoscopy in women

All kinds of diseases of the urinary system are a frequent reason for visiting doctors. Women are especially often affected by inflammatory and infectious diseases: cystitis, neoplasms, stone formation and bladder trauma - these are the pathologies that are easiest to recognize thanks to cystoscopy. This procedure can also be prescribed for urinary incontinence, pain in the bladder area, and the detection of blood and other unwanted impurities in a urine test.

It is generally accepted that cystoscope manipulations are easier and slightly less painful for female patients. This is partly true, because the female urethra is significantly shorter than the male one - only 3-5 cm, and also wider - about 1-1.5 cm. However, it should be taken into account that women are more sensitive natures, so they are often initially afraid of the procedure, considering it extremely uncomfortable. To get rid of fears, it is necessary to talk to a doctor before cystoscopy, who will explain all the intricacies of the procedure.

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Cystoscopy in men

Often, a study of the urinary tract in men is carried out if there is a suspicion of inflammation of the prostate gland (prostatitis) or a tumor (adenoma or adenocarcinoma), which are accompanied by a urination disorder.

The urethra in men is quite long (approximately 18-20 cm), it starts from the bladder, then stretches through the prostate gland, the external sphincter and the spongy tissue of the penis, ending with an external opening in the head area. The part of the urethra that passes near the sphincter (pelvic floor muscles) has a physiological narrowing. The average diameter of the male urethra is about 0.8 cm.

Given the parameters of the male urethra, it can be assumed that the cystoscopy procedure in male patients may be accompanied by discomfort, a feeling of pressure and pain. Therefore, manipulations are carried out using anesthesia, most often local or general, depending on the situation.

If flexible instruments are used during the procedure, the sensations are less painful and, at the patient’s request, anesthesia may not be used.

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Cystoscopy in children

In pediatrics, cystoscopy is performed in an absolutely identical manner to adult patients. However, special pediatric instruments and the device itself are used for manipulations. Such instruments have a significantly smaller diameter.

The procedure is usually prescribed to a child only after the written consent of the mother and father. Local anesthesia is usually used, but for emotional and excitable children, general anesthesia may be offered.

The length of the urethra in newborn boys is usually 5-6 cm. With age and with the growth of the genital organ, it lengthens every year by about 5 mm, and by adulthood it is about 17 cm. The mucous tissues of the urethra are smooth, with a small diameter, which makes it somewhat difficult to insert a catheter, but prevents pathogenic microbes from entering the bladder.

The urethra of a newborn girl is 1-1.5 cm. By the age of one year, this size increases to 22 mm, and by adulthood it reaches approximately 3 cm.

The use of a flexible cystoscope and the literacy of the physician reduces to zero the likelihood of damage to the urinary canal in small patients.

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Cystoscopy during pregnancy

During pregnancy, cystoscopy is often performed only for kidney drainage in cases where blood is detected in the urine analysis. This may occur with kidney stones or acute pyelonephritis. In all other situations where the procedure can be avoided, it is not prescribed, since accidental injuries during manipulations can lead to spontaneous termination of pregnancy.

If possible, diagnostics and treatment are postponed until after the birth. Of course, such a decision is made by the doctor, based on the results of the tests, the patient's well-being, the severity of the suspected diagnosis and other circumstances.

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Contraindications to cystoscopy

Cystoscopy is not prescribed or performed on patients in the following situations:

• in the acute stage of the inflammatory process in the bladder;
• for inflammation of the urinary tract;
• for orchitis or prostatitis in the acute stage;
• when blood is released from the urinary tract;
• for fever associated with infectious diseases of the urinary system;
• in severe forms of blood coagulation disorders.

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Cystoscopy results

Since the procedure is performed directly through the urethra, the doctor has the opportunity to carefully examine the walls of the duct, characterize them, detect any changes or violations of integrity. When the instrument reaches the bladder, the doctor gradually begins to introduce sterile liquid or isotonic solution of 0.9% sodium chloride, which makes it possible to better examine the cavity and mucous membranes of the organ. Gradually, millimeter by millimeter, the doctor examines the entire cavity of the bladder, observing the presence of pathologies in it.

What does a cystoscopy show?

• The presence or absence of an inflammatory process in the urethra and bladder.
• Stricture or infiltrate.
• The presence of tumors in the urethra or bladder (including papillomatosis, condylomatosis).
• Formation of stones and diverticula in the urinary organ.
• The presence of damage or traumatic areas in the urethra and bladder.

If necessary, the doctor will insert auxiliary instruments through the device, for example, to take tissue for analysis. In addition, it is possible to simultaneously remove a polyp, cauterize a lesion, administer a medicine, take the required amount of urine for analysis, etc.

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Complications after cystoscopy

Immediately after the procedure, the doctor should inform the patient about the further treatment plan, as well as give advice on possible complications and sensations after cystoscopy.

Usually, specialists recommend that patients drink more fluids after manipulations on the bladder to increase urine output. Frequent urination will help minimize the feeling of discomfort after the procedure - this may be itching, burning during urination.

If you find blood in your urine after a cystoscopy, don't be alarmed: this can be considered a normal condition for 1-2 days after the examination. The following are also considered normal:

• pain after cystoscopy in the lower abdomen;
• burning in the urethra.

However, since this type of examination can cause a number of complications, each patient should be aware of them. The most serious possible, although rare, complication is trauma to the urinary tract, as a result of which an additional passage can form. In such a situation, doctors perform a cystostomy - the removal of urine from the bladder using catheterization, through a special incision above the pubis.

Other possible complications include:

• traumatic injuries of the urethra;
• difficulty urinating;
• prolonged hematuria;
• introduction of infection into the urinary organs;
• bacterial pyelonephritis.

How can a patient understand that complications have begun in order to consult a doctor in a timely manner? One should be wary and pay attention if the following symptoms appear:

• prolonged delay in urination;
• blood clots in urine;
• temperature after cystoscopy (may indicate infection);
• inability to urinate despite the urge to urinate;
• frequent urges, accompanied by a burning sensation and stinging in the urethra;
• sharp pain in the lumbar region.

In all the above cases, it is important to see a doctor without wasting time. If there are no such reasons, the patient will return to his usual rhythm of life in a short time.

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Cystoscopy is one of the most important and informative methods of examination in urological practice. When choosing a specialist who will perform the procedure, pay attention to his reputation, work experience, qualifications, and ability to communicate with patients. A competent doctor is the key to a successful diagnostic examination and effective further treatment of the pathology.