Cystoscopy of the bladder in women, men and children

Examination of the inner walls of the bladder with the help of a specific device of the cystoscope is called the term "cystoscopy". Why is this diagnostic method necessary?

The fact is that certain disorders in the urethra - for example, sores, small polyps - can not be considered for ultrasound diagnosis, therefore, according to the indications, a more informative cystoscopy procedure can be prescribed. Thus, it is possible to detect various neoplasms, stone formation, inflammatory elements, physical damage to the walls of the organ.

Cystoscopy is performed not only for diagnostic purposes, but also for therapeutic purposes. Thanks to the cystoscope instrument, it is possible to remove the tumor, prizhech jazvochku, insert the desired medication into the cavity of the bladder, grind and remove deposits, etc.

[1], [2], [3], [4]

Indications for cystoscopy

When the doctor prescribes a cystoscopic examination:

• with interstitial cystitis;
• with often worsening cystitis;
• when blood appears in the urinary secretions;
• with enuresis;
• when abnormal cellular structures are detected in urine (suspicion of a tumor);
• with painful discharge of urine, with chronic pelvic pain syndrome, chronic cystitis;
• with a complicated outflow of urine as a result of prostatic hyperplasia, obstruction or constriction of ureters;
• with urinary calcification;
• with neoplasms of the urinary system;
• with frequent urination of unknown etiology.

For therapeutic purposes, cystoscopy is used for the following manipulations:

• for removing neoplasms in the cavity of the bladder;
• for grinding and removing stones;
• for getting rid of obstructions and narrowing of the urinary tract;
• cauterization of bleeding surfaces on the walls of the body.

Preparation for cystoscopy

Before you go to the procedure, you need to familiarize yourself with some moments of preparation for manipulation. What should the patient know?

• If the doctor has warned you that cystoscopy will be carried out with anesthesia, then before the procedure should refuse to eat. At what period - depends on the type of anesthesia, so this point needs to be clarified directly from the doctor.
• If the doctor has prescribed anesthesia, then immediately after the manipulation you will be forbidden to drive independently at the wheel - consider this. You may need the help of relatives or friends to return home.
• Depending on the diagnosis and individual characteristics of the organism, the doctor can voice his or her preparatory requirements. Listen carefully and carefully observe them.

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

• Remove all valuables from your body, leave valuable items at home.
• Prepare comfortable clothes to change clothes.
• Do not forget to bring along the medicines that you need to take throughout the day so you do not miss the appointment.
• Collect and take with you all the documentation that relates to your disease (test results, pictures, conclusions, etc.).
• It is undesirable, going to a cystoscopy, to use cosmetics.

Set for cystoscopy

For diagnostic cystoscopy, as a rule, a hard instrument with a diametrical size of 16-22 Fr is used. In order to fully examine the urinary canal and the cavity of the bladder, two optical systems are used, allowing you to inspect from different angles. Flexible instruments are more easily perceived by patients if cystoscopy is performed without anesthesia. When using hard instruments, it is recommended to do anesthesia: such tools allow for better consideration of the pathology, as well as accompanying manipulations.

Instruments for cystoscopy that can be used during the procedure:

• cystoscope tube with shut-off valves;
• cystoscope tube with a bypass valve;
• obturator for the tube;
• gripping forceps;
• biopsy forceps;
• biopsy forceps are spoon-shaped;
• scissors;
• optical forceps for grinding stones;
• various adapters;
• flexible biopsy forceps;
• Flexible "alligator" for the capture;
• flexible scissors;
• flexible electrodes (simple, needle, loop);
• flexible needle for injection;
• ureteral cart of Dormia;
• handles for tools;
• loop for removing polyps.

The listed instruments are absolutely non-traumatic. They are made of a durable, durable material, so they not only serve for a long time, but they can not fail and break during manipulation.

How are cystoscopy done?

A cystoscope is a tubular device with a lighting device. It can be flexible or ordinary. Rigid cystoscopy is performed by a conventional cystoscope - it allows you to more thoroughly examine the urinary tract and bladder, but it does not feel very comfortable for the patient. Therefore, the introduction of a rigid device must be combined with the use of anesthesia.

To inspect the internal cavity of the bladder, the device is injected into the urethra.

Is it painful to do cystoscopy? Indeed, it can be unpleasant and even a little painful, so often patients undergo local, spinal or general anesthesia (anesthesia). Flexible cystoscopy (study with a flexible instrument) is less painful, but less informative for the doctor. Therefore, the question of which cystoscope to use, and whether to apply anesthesia in this case, is solved individually.

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

Cystoscopy under general anesthesia is rarely done, mainly in mentally unbalanced patients.

When carrying out cystoscopy, the patient lies on the couch, his genitals are treated with an antiseptic solution. The device is inserted into the urinary canal, which, for a better view, is filled with a liquid (for example, a sterile isotonic solution - about 200 ml). The doctor examines, depending on the circumstances, from 2 to 10 minutes. The whole procedure can last about 40-45 minutes. At the end, if the patient was given local anesthesia, he could be released home.

Diagnostic cystoscopy

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

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

Use during the procedure of a miniature video camera with a backlight located at the end of the cystoscope, allows you to carefully examine all internal walls of the bladder with the possibility of increasing the image obtained.

[5], [6], [7], [8]

Cystoscopy in women

All sorts of diseases of the urinary system - a frequent reason to seek medical help. Especially often inflammatory and infectious diseases are affected precisely by women: cystitis, neoplasm, formation of stones and traumatization of the bladder - it is precisely such pathologies that are most easily recognized, thanks to cystoscopy. This procedure can also be prescribed for urinary incontinence, pain in the area of the bladder, when blood and other undesirable impurities are detected in the urinalysis.

It is generally accepted that cystoscope manipulation in female patients proceeds more easily and is slightly less painful. In part this is so, because the female urethra is much shorter than the male ñ just 3-5 cm, and also wider - about 1-1.5 cm. However, it should be borne in mind that women in themselves are more sensitive natures, so they are often afraid from the very beginning procedure, considering it extremely uncomfortable. To get rid of fears, you need to talk with the doctor before cystoscopy, which will explain all the subtleties of the procedure.

[9], [10], [11]

Cystoscopy in men

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

The urethra in men is long enough (about 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 hole in the head region. Part of the urethra passing near the sphincter (pelvic floor muscle) has a physiological constriction. 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 procedure for cystoscopy in male patients can be accompanied by discomfort, a feeling of pressure and soreness. Therefore, manipulations are carried out using anesthesia, 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.

[12], [13], [14]

Cystoscopy in children

In pediatrics, cystoscopy is performed in a manner analogous to that of adult patients. However, a special children's instrumentation and the device itself are used for manipulation. Such tools have a much smaller diameter.

The procedure for the child is usually prescribed, only after the written consent of Mom and Dad. Usually, local anesthesia is used, but general and severe anesthesia may be suggested for emotional and excitable children.

The length of the urethra in newborn boys is usually 5-6 cm. With the course of age and with the growth of the genital, it extends every year by about 5 mm, and by the age of majority is about 17 cm. The urethral mucosa is smooth, with a small diameter, which makes it somewhat difficult the introduction of a catheter, but prevents the entry of pathogens into the bladder.

The urethra in the newborn girl is 1-1.5 cm. By the year this size is increased to 22 mm, and by the age of majority it reaches about 3 cm.

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

[15], [16]

Cystoscopy during pregnancy

During pregnancy, cystoscopy is often performed only for the drainage of the kidney in cases where an impurity is found in the urine sample. This can occur with stone formation in the kidneys or acute pyelonephritis. In all other situations, when procedures can be avoided, it is not prescribed, since accidental injuries during manipulation can lead to spontaneous abortion.

If possible, the diagnosis and treatment are postponed for the postnatal period. Of course, this decision is made by the doctor, based on the results of the tests, the patient's state of health, the severity of the alleged diagnosis and other circumstances.

[17], [18], [19]

Contraindications for cystoscopy

Cystoscopy is not prescribed or administered to patients in the following situations:

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

[20], [21], [22]

Cystoscopy results

Since the procedure is carried out directly through the urethra, the doctor has the opportunity to carefully examine the duct walls, give them a characterization, detect any changes or integrity disorders. At the time when the instrument reaches the bladder, the doctor gradually begins to administer a 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 cystoscopy show?

• The presence or absence of an inflammatory process in the urethra and bladder.
• Stricture or infiltration.
• Presence of tumors in the urethra or bladder (including papillomatosis, condylomatosis).
• The formation of stones and diverticulum in the urinary organ.
• The presence of lesions or traumatic areas in the urethra and bladder.

If there is a need, the doctor will introduce auxiliary instruments through the instrument, for example, to take the tissue for analysis. In addition, you can simultaneously remove the polyp, cauterize the damage, inject the medicine, take the necessary amount of urine for analysis, etc.

[23], [24], [25], [26], [27]

Complications after cystoscopy

Immediately after the procedure, the doctor should inform the patient about the further treatment regimen, and also give advice about possible complications and sensations after cystoscopy.

Typically, experts recommend that patients after manipulating the bladder use more fluid to increase the yield of urine. Frequent discharge of urine will help to minimize the feeling of discomfort after the procedure - it can be itching, burning with urination.

If after a cystoscopy you find blood in your urine - do not panic: for 1-2 days after the test, this can be considered a normal condition. The same norm is:

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

However, since this kind of research can cause a number of complications, every patient should know about them. The most serious, although rare complication, is the urinary tract trauma, which can lead to an additional stroke. In such a situation, doctors conduct a cystostomy - excretion of urine from the bladder by catheterization, through a special incision above the pubis.

Among other possible complications, it should be noted:

• traumatic injuries of the urethra;
• difficulty urinating;
• long haematuria;
• infection in the urinary tract;
• bacterial pyelonephritis.

How can a patient understand that complications have begun to call a doctor in a timely manner? Should be alerted and pay attention if the following symptoms have appeared:

• long delay urge to urinate;
• blood clots in the urine;
• temperature after cystoscopy (may signify infection);
• impossibility to urinate in the presence of urge to urinate;
• rapid urges, which are accompanied by sensations of burning and rubbing in the urinary canal;
• sharp pain in the lumbar region.

In all these cases it is important, without wasting time, to see a doctor. If there are no such reasons, then the patient returns to the habitual rhythm of life in a short time.

[28], [29], [30]

Where to make a cystoscopy?

Cystoscopy is performed in almost any outpatient or medical institution. The procedure is carried out either out-patiently (when referring to a urologist in a polyclinic), or permanently (if the patient was taken to the urological department of the hospital).

We bring to your attention several addresses of medical institutions, where professionally and qualitatively they will perform cystoscopy.

Cystoscopy in Kiev:

• Universal Medical Center "Oberig" - Kiev, Zoologicheskaya Street 3, building. B;
• Clinic "Medicom" - Kiev, Prospekt G. Stalingrad 6D;
• "Medical Club" - Kiev, Shevchenkovskiy district, Baggovutovskaya street 14;
• Clinic "Adonis-O" - Left Bank, Kiev, R. Okipnoi street 8B.

Cystoscopy in Moscow:

• Medical Center "Prima Medica" - Moscow, Ak. Chelomey 10B;
• Medical Center "Delta Clinic" - Moscow, Lane Mentor 6;
• Multipurpose center "Medlux" - Moscow, Boulevard Lilacovy 32A;
• Clinic and Diagnostic Center "Medline Service" - Moscow, Khoroshevskoe highway 62;
• "Medincenter" - Moscow, IV lane Dobryninsky 4.

Cystoscopy in St. Petersburg:

• The multi-disciplinary clinic "Be Healthy" - St.Petersburg, Ligovsky Avenue 274A;
• The multidisciplinary clinic "Grange" - Marata street 25А;
• German medical center - St.Petersburg, lane Kovensky 5B;
• Clinic "Medsanast 157" - St. Petersburg, Varshavskaya Street 100A;
• Medical center "Baltzdrav" - St.Petersburg, Dybenko street 25/1.

Cystoscopy in Minsk:

• City clinical oncological dispensary - Minsk, Nezavisimosti avenue 64;
•  Multidisciplinary medical center "Lode" - Minsk, Gikalo street 1, building. 10;
• The medical center "Kravira" - Minsk, Pobediteley Avenue 45, or 11 Skripnikova Street;
• Republican Center of Urology and Andrology - Minsk district, Lesnoy village, regional clinical hospital;
• Medical center "Lekar" - Minsk, Engels street 34А, building 2

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