Endoscopic research methods are now firmly established in the practice of specialists of different profiles. It is safe and very informative for the doctor and patient.
Many people know about colonoscopy (intestinal examination) and almost everyone is aware of what is FGDs (fibrogastroduodenoscopy or examination of the stomach with the help of a device that has to be swallowed).
But not much is known about cystoscopy. However, sometimes you have to deal with this method of research. Today we will tell about this method in more detail, and many of your questions will find the answer.
What is cystoscopy
Cystoscopy is an instrumental examination of the internal structure of the bladder and urethra. When this occurs, an assessment of the state of its walls, mouths of the ureters, contractility, capacity, the presence of pathological foci (inflammation or suspicion of cancer) occurs. With cystoscopy, it is possible to take a biopsy material (a piece of tissue from the most suspicious part of the mucous membrane) in order to clarify the diagnosis, as well as many therapeutic measures.
The cystoscopy procedure is performed using a cystoscope, it is a device from a long tube (tube), a lighting device and auxiliary parts.
A cystoscope is a standard rigid (rigid) and flexible.
Hard or traditional
Hard cystoscope is a metal structure with a long thin tube and magnifying device with a lens.
The tubule (tube) is inserted into the urethra and the doctor, gradually moving the device into the cavity of the bladder, stepwise examines all parts of the mucous membrane.
Then the device reaches the cavity of the bladder. For a complete examination, about 200 ml of sterile isotonic solution (usually saline) is injected into the bladder.
During the inspection, the indications for intervention are determined. In this case, cystoscopy becomes not only a diagnostic measure, but also a medical procedure.
Flexible Cystoscope or Fibrocystoscope
A flexible cystoscope has a movable tube, which can be given any bend, unlike the metal tube of a rigid cystoscope. Flexible cystoscope equipped with a mini-camera at the end. The image is transmitted to the computer screen.
The image is transmitted to the computer screen.
The advantage of flexible cystoscopy is that images can be saved on a digital carrier and then the disease dynamics can be tracked.
The procedure itself is the same in both cases, but the procedure with a flexible cystoscope is much more comfortable for patients.
Inspection by a flexible cystoscope has its drawbacks. It is often less informative than a rigid instrument inspection.
If necessary, additional tools are inserted into the cystoscope tube for cauterization of ulcers, removal of polyps and stones, and dissection of adhesions.
Arrive on an empty stomach
First, everyone has a different reaction to the feeling of pain and pain that often happens. If you have not arrived on an empty stomach, then nausea, weakness is possible.
Secondly, sometimes the procedure begins at the local anesthesia, and then you have to do short-term general anesthesia. This is necessary if during the inspection it became necessary to cauterize or remove a polyp, remove stones, and so on. The procedure is lengthened and the local anesthetic may not be enough.
With general anesthesia, all the muscles in a person are greatly relaxed, food from the stomach is thrown into the esophagus and can get into the lungs through the larynx. Food in the stomach is mixed with sour gastric juice, and if it enters the bronchi and lungs, then there is a real acid burn. This is a dangerous condition requiring hospitalization and long treatment and observation.
To prevent this, you need to have dinner on the eve of no later than 20.00 (light salads, dairy products, cereals) and do not eat in the morning.
- OAK (complete blood count: hemoglobin, signs of inflammation)
- OAM (urinalysis)
- a coagulogram or it is also called a hemostasiogram (blood clotting test).
Sometimes the patient is examined in the clinic and brings tests with him, less often the examination is carried out upon admission.
How to conduct cystoscopy
The patient after preparation and on an empty stomach arrives at the clinic.
The duration of the cystoscopy procedure is from 10 to 60 minutes. Time depends on the complexity of the inspection, the technical capabilities of the equipment and the diseases identified during the inspection.
The research procedure itself takes place either in a gynecological-like chair or on a couch.
If you lie down in a chair, then the legs rest on special supports with fasteners, this helps to create a good access for the introduction of the device.
If the diagnosis is carried out on the couch, then you lie on your back, bend your legs and move your knees apart.
Before the introduction of the cystoscope, the external genitalia are treated with an antiseptic solution. This is necessary to prevent the introduction of pathogenic flora from the skin.
After anesthesia, a cystoscope tube is inserted into the urethra and is pre-lubricated with sterile glycerin. Glycerin improves gliding and helps avoid friction and injury to the mucous. In addition, it is transparent and does not violate the clarity of the picture.
After the tube is inserted, urine is removed from the bladder (even its residual amounts). To create a transparent, uniform medium, about 200 ml of saline is injected into the bladder. If these conditions are observed, the walls of the bladder are clearly visible, you can evaluate their color, folding, identify areas of inflammation, ulcers, polyps and neoplasms (tumors). At this point, the patient may experience mild tearing or pulling pain in the suprapubic area.
The cavity of the bladder is examined according to a certain algorithm: the front wall, the left side, then the right side wall, then the bottom of the bladder, the so-called Leto triangle, and the mouth of the ureters. In the bottom of the bladder, pathologies (polyps and tumors, including cancer) are most often localized, so this area is examined very carefully. As for the mouths of the ureter, their location, patency, symmetry, and even the presence and quantity are assessed (urinary tract anomalies are not as rare as they seem).
Then, if necessary, taking a piece of tissue for research (biopsy) and therapeutic measures (cauterization, removal of polyps, foreign bodies and stones) are carried out.
For therapeutic manipulations, special tools are introduced into the tube: for removing stones and foreign bodies, Dormy's cystoscopic basket, for electrocautery for burning papillomas, an electrocoagulator, and so on.
To take a biopsy, I use special forceps, which also insert into the cystoscope tube and bite off the area from the suspicious site. Then this tissue is placed in a container with formalin and sent for histological examination.
After the procedure, the cystoscope is removed and sent for sterilization.
If local anesthesia was used, the patient is sent home. If there was a general anesthesia, it would take some time of observation in the hospital, and then giving up driving.
After the procedure, some discomfort may persist:
- itching and burning in the urethra
- nagging pains
- a small amount of blood in the urine
- painful urination
This is a consequence of the introduction of a foreign object in such a tender organ as the bladder. As a rule, the same complaints can be about a day, then they pass. If you urinate it hurts, and urine has an unusual color for 3-5 days. Then you should immediately consult a doctor-urologist to rule out complications.
Cystoscopy in men
In men, the length of the urethra is on average from 15 to 22 cm. At the same time, the course of the urethra is observed. Therefore, cystoscopy in men is a more technically difficult procedure for the doctor and more painful for the patient. Local anesthesia is used in most cases of the procedure. The most commonly used flexible cystoscope.
Cystoscopy in women
In women, the length of the urethra ranges from 2.5 to 5 cm, while it is wider than in men. This facilitates the introduction of the cystoscope. Diagnosis lasts less, and complications occur much less frequently. Cystoscopy is sometimes recommended for urinary incontinence of unknown origin. This helps to distinguish whether the patient has a gynecological problem. And this also means which specialist should be treated and monitored.
Cystoscopy in children
In children, the procedure is rare. Only in cases where all types of ultrasound, radiography and MRI give an unclear result. For children, a special flexible smaller cystoscope is used (length and diameter). In boys at birth, the length of the urethra is about 5 cm, in girls 1.5 cm. As the child grows, the approximate length of the urethra is calculated. In children cystoscopy always with anesthesia usually by local anesthetics. If there is an allergy to Novocain / lidocaine or the child is still very small, then a brief general anesthesia is performed.
Cystoscopy in pregnant women
In pregnant women, cystoscopy is performed rarely, in exceptional cases. The advantage is given to methods of ultrasound diagnostics.
With the purpose of treatment can be carried out catheterization of the bladder.
Pain in the urethra and in the lower abdomen, arching sensations due to the filling of the bladder can cause hypertonicity of the uterus, it threatens miscarriage. For longer periods of pregnancy, the procedure is not so dangerous, but it becomes technically more difficult due to the enlarged uterus.
Thus, in terms of examining pregnant women, cystoscopy is not a frequent method.
Local untreated drugs are injected into the urethra just before the device is inserted. A solution of novocaine 2% about 10 ml or more modern gels based on lidocaine (cathedzhel, instillagel) are used.
Several minutes are given for “freezing”, and then the doctor starts the procedure.
Cystoscopy with a flexible instrument
The flexible device brings less discomfort, so cystoscopy can be performed without anesthesia.
If the decision was made to anesthetize, then use the same drugs for local anesthesia as in the case of a rigid cystoscope.
- interstitial cystitis (a disease of the bladder with a deep lesion of its walls and a violation of urination)
- chronic cystitis (to clarify the cause and depth of the bladder wall lesions)
- bladder tumors (benign and malignant)
- diverticula and polyps (pathological processes and protrusions of the inner wall of the bladder)
- stones of the urethra, bladder and stones, blocking the mouth of the ureter (in the place where the ureter "falls" into the bladder often small stones penetrate into the bladder)
- foreign bodies. Foreign bodies in the bladder - this is not such a rare situation. Often in the literature describe cases of ingress of small objects and parts through the urethra into the bladder. Often this is due to the desire to diversify the sex life. Once described the long-term presence of the usual mercury thermometer in the cavity of the bladder.
- injuries and consequences of old injuries. The consequences of old injuries and damage to the bladder can be very different. Fistula (pathological opening) between the bladder and the vagina or rectum, in this case, the urine involuntarily flows out of the vagina or from the anus.
- structures or pathological contractions along the urethra can be the result of damage, inflammation, or a tumor.
- hematuria (blood in the urine) of unknown origin
- enuresis in adults and children
- diagnostic search for detection of atypical (suspicious for cancer) cells in the general analysis of urine
- frequent urination and chronic pelvic pains that could not be cured conservatively, and more accurate diagnosis is needed.
- benign prostatic hyperplasia (BPH) in men
Often, the diagnostic procedure in the process goes to the treatment. With the technical capacity and sufficient experience of the doctor, the patient can avoid repeating such an unpleasant procedure and solve two problems in one visit.
- removal of foreign bodies and bladder stones and urethra. If the stones or foreign bodies are small, accessible to capture, have rounded edges and are not soldered to the inner wall, then there is a high probability of their safe extraction. If you have large stones, you can try to divide the stone and remove it in parts.
- removal of a small tumor or polyp
- taking a piece of tissue for histological examination. Any remote education and biopsy material in any case are sent for a histological examination by a pathologist. This allows you to diagnose cancer, determine its prevalence and type, or vice versa, to confirm that the tumor / polyp is benign and there is nothing to worry about.
- stricture dissection. When a narrowing of the urethra or orifices, urine is defective, it is delayed and stretches the urethra. This is manifested by pain, impaired urination, and requires treatment. In these cases, cystoscopy is a very gentle and effective method, the areas of constriction stretch or intersect and the urine flow is restored.
- stent placement. Stents are cylindrical devices that are inserted to expand a specific area. Stenting can be used if the dissection of adhesions helped for a short time and the contraction and difficulty of urine discharge appeared again.
- acute inflammatory diseases of the urogenital system (cystitis, urethritis, prostatitis, orchitis, and others). During the period of acute inflammation, the tissues are friable, painful, swollen and very easily damaged.
- severe somatic diseases. Patients with renal, hepatic and pulmonary heart disease have a risk of deterioration against the background of cystoscopy. If necessary, the procedure should first achieve a stable state of heart or other disease, and then start the diagnosis.
- blood coagulation disorders (high risk of bleeding, even from minor damage to the mucous membrane)
- early gestation. The uterus and bladder are close. Stretching the bladder with a solution, movement of the cystoscope tube, pain can provoke uterine hypertonus and even lead to miscarriage.
- trauma to the urethra
The mucous membrane of the urethra is very delicate and thin, so damage to it is possible, especially when using a rigid cystoscope. The risk increases if the patient is restless, moves, or tries to interfere with the process (pulls out the device, tries to get up).
This is a very serious version of traumatic injury to the urethra. In this case, the cystoscope creates a hole in the wall of the urethra and goes into the surrounding tissue. If the cystoscope penetrates the prostate tissue, then there may be threatening bleeding.
If the hygiene of the external genital organs was insufficient and irregular, then during the procedure the infection from the skin and mucous membrane is ingested. One treatment with an antiseptic solution cannot remove all types of bacteria.
If late treatment of cystitis can turn into pyelonephritis, and this is a much more serious disease affecting the renal pelvis. When pyelonephritis develops back pain, high fever with chills, worsening blood and urine.
- bladder perforation
Puncture (perforation) of the bladder can occur with insufficient experience of the doctor, an abnormal structure of the bladder or a change in the location of organs due to adhesions.
Cost of bladder cystoscopy procedure
In public institutions, the procedure is carried out free of charge according to the direction of the attending physician, or paid services. In private clinics, the patient pays all costs. Prices in different regions vary greatly, the range of prices ranges from 800 rubles to 25,000 rubles.
The price of the question also depends on whether this is a primary technique or a secondary one, whether diagnostics are needed or therapeutic measures are already planned. The cost increases in accordance with the technical complexity and the need to use additional tools in the process. The price also includes a histological examination of a biopsy of the tissues of the bladder or urethra.
The method described by us is not pleasant and painless, but it is very informative. If an ultrasound and MRI scan fails to make a diagnosis, there is a suspicion of cancer or chronic cystitis, then agree to have a cystoscopy, as recommended by your doctor. Often, a single procedure is enough to establish the diagnosis and prescribe the most effective treatment.
The removal of stones or polyps during cystoscopy is a unique method; all interventions are carried out through natural openings; there is no need to cut the stomach and enter the pelvic cavity. It is much safer than open surgery.
Preparing for cystoscopy in women
- A woman must understand the essence of the procedure. Мотивация к проведению манипуляции помогает женщинам избежать страха цистоскопии. Поэтому при предварительной консультации женщина не должна стесняться и задавать уточняющие вопросы.This includes how to prepare for cystoscopy and whether it is possible to take medications that are usually taken (with concomitant diseases)
- There is no definite diet. But on the day of the study, breakfast should be light.
- Special preparation for cystoscopy is not required. A woman should be thoroughly washed away, having hygiene not only the urethra, but also the anus.
- Specially emptying the bladder is not necessary. It must be filled with at least 100 ml, otherwise the doctor will fill the bladder with a special liquid.
- If surgery is performed under the control of cystoscopy, then the patient is prepared in accordance with the preoperative preparation protocol.
- It is desirable that there should be attendants who will help the woman to return home.
How is cystoscopy done in women?
A cystocopy is performed in the endoscopy room on an outpatient basis or in a hospital. How do cystoscopy of the bladder in women?
- A woman during the survey offer to lie on your back in a special chair. The legs are fixed and slightly raised on special supports. The lower body is covered with a sterile sheet.
- The urethra is treated with a special anesthetic (if anesthesia is indicated, it is administered intravenously).
- An assembled cystoscope is inserted into the bladder through the urethra, then an optical instrument is taken out and the bladder is emptied.
- The bladder is filled with a specific fluid (usually sterile saline).
- The optical system is inserted into the cystoscope and the bladder is examined.
- After inspecting the mucous membrane, the doctor carefully removes the cystoscope.
How long does a cystoscopy procedure take in women?
The duration of the manipulation depends on the purpose of the procedure, the type of cystoscope and the experience of the doctor. The procedure can be packed in a short time (from 2 to 10 minutes) with a diagnostic cystoscopy, and if this is a medical manipulation, then the time can increase. More than an hour the study is not conducted, as it is possible to damage the urethral mucosa.
Consequences of cystoscopy in women
Cystoscopy is one of the most commonly used methods for examining women with urological diseases. Complications and consequences are rare. Occasionally, women may have a burning sensation after an examination during a bladder emptying or when blood appears in the urine. But, as a rule, these phenomena pass quickly. A doctor should be consulted after the manipulation if the patient cannot empty the bladder, if the blood in the urine does not pass after 3 days, if nausea and vomiting are concerned, chills and fever appear.
Questions most frequently asked by women before cystoscopy.
1. Can an infection join after cystoscopy?
Yes, women have a greater predisposition to the accession of the infection, due to the peculiarities of the anatomical structure. But the study is conducted under sterile conditions, so the accession of the infection is very rare.
2. Is it possible to pierce the bladder?
Bladder perforation is a severe complication of cystoscopy. Urine, appearing in the retroperitoneal space, causes peritonitis. A puncture is possible when tissue samples are taken during a biopsy, if the doctor has inserted the needle too deep. But such a complication is extremely rare.
3. Is cystoscopy possible during pregnancy?
During pregnancy, cystoscopy is performed if it is necessary to drain the kidneys. This procedure is performed only in extreme situations, as there is a threat of miscarriage. The procedure in the second half of pregnancy is not particularly recommended due to the displacement of the bladder wall by the head of the fetus.
Indications and contraindications
Cystoscopy of the bladder is used if there are problems with urine excretion, kidney pathologies and suspicion of the presence of foreign objects in these organs:
- in chronic inflammation of the mucous organs,
- stones in the kidneys and ureters,
- kidney problems
- with polyposis and bladder tumors,
- in violation of the outflow of urine against the background of prostate diseases.
The main indications for cystoscopy are not limited to overt symptomatology, such as blood in the urine, pain and pain during urination. The urologist prescribes this type of diagnosis in the following situations:
- if red blood cells appear in the urine, but the blood in it is not visible visually,
- if the urine contains white blood cells, proteins and calcinates,
- if there are suspicions of kidney disease, which are accompanied by a violation of diuresis,
- if the pathology of the bladder is urinary incontinence, increased activity of the bladder and other forms of organ dysfunction,
- if there is prolonged pelvic pain.
Can also be referred to cystoscopy by patients who have already been diagnosed and need treatment: stop bleeding, remove a foreign object, remove neoplasms from the organ mucosa.
Contraindications to the procedure consider the following pathologies:
- exacerbation of inflammatory and infectious processes in the urinary organs,
- exacerbation of chronic diseases of the pelvic organs (uterus and appendages in women, prostate, urethra and testicles in men),
- feverish conditions with fever and intoxication,
- obstruction of the urethra.
It is not recommended to re-examine, while on the mucous membrane of the urethra there are signs of injuries and irritation, obtained during the previous inspection.
Types of cystoscopy
In medicine, there are several types of cystoscopy, depending on the method of carrying out the procedure and its objectives. Thus, cystoscopy can be flexible or rigid, depending on the type of cystoscope. With regard to the objectives of the procedure, distinguish between therapeutic and diagnostic cystoscopy.
If the method is used for diagnostic purposes, during the procedure, the doctor will examine the cavity of the organ and the mucous membranes of the urethra, assess their condition and functionality, and record the changes. In some cases, viewing cystourethroscopy is accompanied by a biopsy.
Therapeutic cystoscopy involves not only the inspection, but also the elimination of pathologies:
- removal of polyps
- coagulation of bleeding vessels
- extraction of foreign objects (stones),
- removal of other pathological foci.
In the course of diagnostic and therapeutic cystoscopy, various methods of straightening the walls of the bladder can be used for better visualization. In some cases, the body is filled with sterile saline, and sometimes carbon dioxide or oxygen is used.
How to prepare
It is recommended to start preparing for cystoscopy of the bladder several days before the examination. The patient passes the necessary tests:
- general urine analysis,
- urine biochemical analysis,
- blood test for clotting.
These studies will help prevent possible negative consequences: the spread of infection, bleeding, and others.
Further, the preparation algorithm includes dieting, which implies the rejection of products that can cause irritation of the mucous membranes of the organ. The menu excludes spicy seasonings, alcohol, carbonated drinks and drinks with dyes. During the preparation of the patient for cystourethroscopy, it will be necessary to revise the regimen of taking certain drugs. Doctors recommend at the time to abandon analgesics, NSAIDs, aspirin and drugs with anticoagulants and insulin.
Basic preparation for cystoscopy begins on the day before the examination. For the prevention of inflammation and infection after the examination, doctors recommend taking the drug Monural in the evening. Women are advised to remove hair from the pubis and perineum.
When planning a procedure under general anesthesia, patients should refrain from eating and drinking 12-16 hours before the start of cystoscopy. This will help avoid nausea and vomiting during the period of anesthesia and during the awakening period. On the day of cystoscopy, thorough perineal hygiene using fragrance-free soap is recommended.
How do cystoscopy men and women
An algorithm for doing bladder cystoscopy is developed and approved in official medical standards. The technique is the same for men and women. The procedure is carried out in a special chair that resembles a gynecological. The patient fits on his back and puts his feet on the stand. If necessary, they are fixed with straps. The doctor treats the opening of the urethra with antiseptics and, if necessary, uses anesthesia.
Good to know! With diagnostic cystoscopy, doctors prefer to use local anesthetics. If therapeutic intervention is planned, general or spinal anesthesia is used.
Before insertion into the urethra, the cystoscope tube is lubricated with sterilized glycerin and injected into the urethra and then into the bladder. Using special tubes (catheters), the removal of urine residues from the organ cavity and washing with sterile saline or furatsilina solution is carried out. After washing, the organ cavity is filled with air or sterile saline to improve visibility.
To inspect the mucous membranes of the bladder is made according to the following algorithm:
- first, the front wall of the organ is inspected, then the side walls (left and then right) and the back wall,
- the next stage is the examination of the bottom of the bladder (Leto triangle),
- at least the doctor examines the mouth of the ureters.
This sequence allows you to identify pathologies, regardless of their location. During the examination, the doctor records the detected changes and, if necessary, carry out the removal of polyps (if they are small and single). When all manipulations are completed, the doctor removes the cystoscope and re-treats the opening of the urethra with antiseptics.
When using local anesthesia, the patient can leave the clinic immediately after the procedure. If general anesthesia was used, he should remain under observation from several hours to days. Therefore, the doctor warns in advance that you need to take with you personal hygiene items, slippers and pajamas.
Hard cystoscopy of the bladder is quite a painful procedure, so the doctor always uses a local anesthetic before inserting the device into the urethra. In addition, during the manipulation, depending on the individual sensitivity of the patient, general anesthesia is often used. The algorithm of actions is standard, visualization is performed using an eyepiece embedded in a cystoscopic fiber-optic tube. Inspection takes from 5 to 25 minutes.
When conducting a flexible cystoscopy, the sensations are less uncomfortable, since the tube of the device is thinner and softer. The device is more gently and gently inserted into the urethra, without provoking painful sensations. However, the doctor uses local anesthetic if necessary. This type of examination lasts no more than half an hour.
When performing cystourethroscopy with a bladder biopsy, in addition to the cystoscope tube, additional devices are used: loops or forceps to separate and extract biopsy tissues. The doctor also uses a coagulator to cauterize the resulting wound.
This procedure can be more painful enough, because many nerve receptors are located on the mucous membrane of the organ. Therefore, cystoscopy with biopsy requires the use of general or spinal anesthesia. The procedure lasts from 20 to 45 minutes.
Cystourethroscopy using anesthesia
The use of anesthesia for cystoscopy is justified in many cases. Diagnostic manipulations are less painful, so during them local anesthesia is used. To do this, before the introduction of the cystoscope, the doctor treats the urethra with a local anesthetic in the form of a solution or gel.
General or spinal anesthesia is indicated in case of patient's hypersensitivity, as well as when planning therapeutic and surgical procedures:
- removal of a bladder tumor,
- stone removal
- coagulation of the source of bleeding.
The use of this kind of anesthesia requires special preparation of the patient and the presence of an anesthesiologist during the entire examination.
Does cystoscopy hurt?
Often, patients before the procedure experience psychological discomfort about whether cystoscopy is painful, and whether a local anesthetic can relieve discomfort. Experts say that the procedure can be painful only in the absence of anesthesia during hard cystoscopy. When using a flexible cystoscope, the discomfort is less pronounced even without the “freezing” of the mucous membranes with the solution and gel with anesthetics.
Important! If the patient is very worried about the likelihood of pain, the doctor suggests using general anesthesia.
In some cases, when, in addition to assessing the condition of the bladder, it is required to evaluate the functionality of the kidneys, cystourethroscopy is combined with chromocytoscopy. Before the diagnosis, the doctor injects the patient with an intravenous special preparation containing dyes, which are eliminated from the body through the kidneys.
After the drug is injected into the bladder, a cystoscope is injected and it is recorded how many minutes after the injection the colored urine will begin to flow into the lower urinary tract. They also fix the ureter from which the colored solution appears earlier, and with what speed it goes. Such a study helps to identify renal dysfunction and detect obstruction of the ureters.
Features of the children
Examination of the urogenital system of children is carried out according to the standard scheme. The only difference is that they use special children's cystoscopes, which have a smaller tube diameter than for adults. The size is selected individually depending on the characteristics of the anatomical structure of the genitourinary system of children.
Since young patients rarely control their behavior when discomfort appears, they undergo cystoscopy using general anesthesia. Local anesthesia is used only in adolescents during diagnostic procedures.
How is bladder cystoscopy in pregnant women
During pregnancy, cystoscopy is restricted. In the early stages of the method is not used because of the high risk of abortion. In the last trimester, the examination becomes difficult due to the fact that the uterus squeezes the bladder and limits the review. Therefore, cystoscopy in pregnant women is used extremely rarely. In most cases, it is transferred to the postpartum period.
What can replace the procedure
Before using cystoscopy, the doctor always assesses the risks and considers the options of whether this procedure should be done or whether it is worth making a choice in favor of other methods. In situations where the patient has contraindications to cystoscopy, the study of the urinary system is carried out by non-invasive methods: ultrasound, CT, MRI of the bladder and pelvic organs. They are combined with laboratory tests of urine and blood, which allows for a more complete picture.
Unfortunately, when diagnosing with other methods of research it is impossible to obtain data that is available to the doctor during cystoscopy. For example, none of the previously mentioned procedures allows for biopsy of tumors in the organ. Therefore, doctors refuse cystoscopy in extreme cases when it is really dangerous for the patient's health.
What cystoscopy shows
The doctor after cystoscopy is the conclusion of the survey, which describes all the violations found. Among them may be:
- benign and malignant tumors of the bladder,
- diverticula and other pathologies of the organ walls (scars, strictures, holes),
- the presence in the urine of sand, stones, foreign objects,
- inflammatory, purulent, erosive changes of the mucous membranes of the organ,
- bladder fistula
- sphincter dysfunction,
- congenital or acquired anatomical pathologies.
The diagnosis will depend on what the survey shows. However, it will not be final until the doctor receives a conclusion of laboratory biopsy tests, if any.
Patients of any gender and age after cystoscopy, there are some painful phenomena. The most common of them is discomfort during urination, due to which it is unpleasant for a patient to go to the toilet. Along with this, blood drops can be released from the urethra in the first 1-2 days. Such effects of cystoscopy in the absence of high temperature are not considered dangerous.
If, after cystourenoscopy, it is painful to go to the toilet for several days, and the symptoms are complicated by fever, discharge from the urethra, general weakness, there is a possibility that there may be potential complications in the form of urinary tract infection. In most cases, they occur due to non-compliance with personal hygiene or ignoring the rules of preparation for the procedure.
More dangerous complications after cystorenoscopy is the perforation of the walls of the organ and urethra. In this case, the patient requires surgery. In rare cases, after the examination, side effects from the use of anesthetics appear. Such effects are eliminated by medical effects.
Показания для проведения цистоскопии
Показаниями для цистоскопии мочевого пузыря у женщин могут быть следующие патологии:
- часто рецидивирующий хронический цистит,
- difficulty and soreness during urine outflow
- prolonged pain in the lower abdomen,
- blood impurities, pus in the urine,
- frequent urination of unexplained etiology,
- urinary incontinence,
- atypical urine cells found during analysis,
- constricted or blocked ureter,
- foreign objects in the urea cavity,
- urolithiasis disease.
How to prepare for cystoscopy?
In order for the diagnostic procedure to be carried out qualitatively and without complications, you need to prepare for it in advance, for which you need:
- get tested and tested,
- start taking medication (by prescription)
- switch to diet food,
- clean the intestines.
In preparation for the study, the patient is recommended to perform a number of medical manipulations, including the need to pass a urinalysis test, blood for a coagulogram. For the prevention of inflammatory diseases and infection, the doctor may recommend taking uroseptics (Nitroxolin, Furamag).
On the eve of the study, preparation for cystoscopy consists of cleansing the intestines with enema or laxatives.
In order for the survey to produce accurate results, 2-3 days before it is necessary to adhere to certain dietary rules. A light dinner is allowed in the evening before the procedure, but not later than 8 hours. Endoscopy breakfast is not recommended.
- give up alcoholic beverages,
- do not eat spicy food and gas-generating products (legumes, cabbage, kvass, soda),
- drink plenty of water, juice, tea.
If it is decided to perform a cystoscopy under general anesthesia, it is forbidden to eat food 6-12 hours before the procedure, and you cannot even drink water on the day of the study.
How is the procedure?
Cystoscopy without anesthesia is performed on an outpatient basis. If the procedure is done under general anesthesia, or additional medical manipulations with the introduction of a cystoscope are necessary - the patient is hospitalized. The doctor selects the type of device that will be used, hard or flexible.
Simple viewing endoscopy is done 20-30 minutes. After the end of the study, it is recommended to lie for 2-3 hours before leaving. When using anesthesia, patients spend in the clinic a day under the supervision of physicians.
Use of anesthesia
The hard type is best performed with spinal anesthesia, when the pelvic region and lower limbs are not sensitive, but the patient remains conscious. For cystoscopy with a flexible tube, local anesthesia with the introduction of novocaine solution into the urethra or using special gels with anesthetics is sufficient.
General anesthesia is rarely used, for examination of children or, if necessary, surgical procedures.
Cystoscopic examination is performed according to the following algorithm:
- The patient is placed in the gynecological chair, spreads her legs bent at the knees.
- If an anesthetic drug is chosen, then it is administered in exactly the calculated dose.
- The doctor treats the genital and perineal region with an antiseptic.
- The tip of the cystoscope is lubricated with petroleum jelly and gently advances towards the bladder.
- Saline or furatsilin solution is poured into the urea cavity, or air is started to straighten the organ.
- After washing, the liquid is pumped out.
- Inspection of the mucous layer and taking the material for biopsy.
- The cystoscope is pulled out and the urethra is treated with an antiseptic.
Can I do cystoscopy during pregnancy?
The procedure for cystoscopy is not recommended for pregnant women, only in cases of critical need to identify any pathology. The doctor examines the woman and decides whether the procedure is threatened by the health of the baby.
The danger is that with pain the uterus comes to tone, which can lead to miscarriage in the early stages. In the last months of carrying a child, the diagnosis is complicated by an enlarged uterus.
If cystoscopy is to be performed, an antiseptic gel with a lubricating effect is necessarily used. After the procedure, the woman is under medical supervision.
Is cystoscopy painful?
The female urethra is short and access to the urea is not difficult, so the pain is negligible. However, particularly sensitive patients require anesthesia, because the involuntary movements of patients make it difficult to examine and lead to injury to the walls of the organ.
On the video of the Daria Zhmur channel, the patient talks about her own experience of cystoscopy.
What shows: the results of cystoscopy?
- inner layer of the bladder,
- condition of the mouths of the ureters,
- early stage neoplasms,
Signs of healthy organ walls:
- pink tint
- homogeneous structure
- pronounced red vessels.
Manifestations of pathological changes:
- severe hyperemia of the mucous cover - inflammation,
- pallor without vascular network - atrophy,
- scars, polyps, tumors on the walls of the bladder,
- swelling of the mouth indicates a blockage of the ureter stone,
- exudate secretion - purulent inflammation of the kidneys.
What complications can occur?
The list of possible complications after the procedure:
- trauma to the mucous membrane of the bladder,
- puncture of the urethra and the formation of a false stroke,
- bladder perforation,
The unpleasant consequences are:
- hard tools
- inexperience of doctors
- poor antiseptic treatment of the opening of the urinary canal.
Symptoms of complications after cystoscopy:
- temperature rise
- difficulty urinating
- plenty of blood in the urine
- frequent urges to urinate
- burning in the urinary canal,
- back pain.
After cystoscopy, a pulling pain in the lower abdomen may occur. The first urination will be painful, blood may appear in the urine. After 3-7 days, all the unpleasant consequences pass, otherwise help is needed.
Preparation for the procedure
Special preparation for cystoscopy is not required, but some rules should be followed. Before the procedure, it is necessary to wash the external genitalia, as well as remove pubic hair and in the crotch area.
The study is conducted on an empty stomach, filling the bladder does not matter. The patient must be psychologically prepared, that cystoscopy causes discomfort, but the procedure itself is painless, because in most cases anesthesia is used. After surgery, you may experience discomfort when urinating, but they pass during the day.
The duration of the procedure is about 5-10 minutes in the event of an examination, and not more than an hour during additional medical procedures. Depending on the device used, there are two variants of the operation.
Hard cystoscopy is performed using a cystoscope with a solid tube about 30 cm long, equipped with a large number of optical fibers and lenses, which make it possible to obtain very accurate data on the condition of the organs of the urinary system. The doctor examines the mucous membranes of the bladder through the optical system, that is, the eye. The procedure causes painful sensations and is always performed under anesthesia.
Recently, flexible cystoscopy displaces hard. The curvature of the instrument tube helps to perform the operation more gently and carefully. Although the results are less clear, the mobility of the head of the device, which contains a video camera, allows you to make a detailed study of the bladder and display the image on the monitor.
Anesthesia is carried out necessarily in men, and optionally in women. The most commonly used local anesthetic - novocaine (2% solution) or gel with lidocaine. General anesthesia is applicable to children, patients with mental disabilities, and unconscious people.
Before the procedure begins, the doctor tells about upcoming events, asks to sign a consent for cystoscopy. The patient lies on his back, slightly bent and legs apart. After that, hygienic treatment of the urethra with an antiseptic agent is carried out.
If necessary, the urologist introduces an anesthetic, and then a cystoscope, pre-lubricated with petroleum jelly or glycerin. The bladder is artificially emptied, washed with furatsilinom, then filled with a special saline solution in a volume of 200 ml, smoothing folds and allowing more detailed study of the mucous membranes.
During the study, the doctor pays special attention to the color and the absence of tumors, ulcers, redness. In normal color mucous yellowish-pink upon close examination and grayish in the shadows. Particular attention is paid to the triangle Lietho, it contains the internal openings of the urethra and both ureters, which contributes to its frequent inflammation.
The technique of performing the procedure in which the cystoscope is inserted through the urethra also allows an examination of the ureters and kidneys. After the examination, the device is carefully removed, in the case of local anesthesia, the patient goes home immediately, if anesthesia was used, the person goes to the postoperative ward until consciousness is restored. Recommended bed rest, plenty of drink.
This procedure is often combined with chromocystoscopy. For this intravenous solution is administered 0.4% indigo carmine. The doctor monitors the time and intensity of the dye in the urine. Normal staining occurs within 3-5 minutes, deviations from time indicate a violation of the kidneys.
Features of the flow in different categories
The differences in the anatomical structure of the urethra, the age and objectives of the study reveal the features of the operation in different categories of citizens.
In women, the urethra is 3-5 centimeters, which allows the infection to easily pass directly to the bladder, ureters, kidneys. Therefore, cystoscopy in women is carried out more often, it makes it possible to identify cystitis, nephrolithiasis or tumors. Researches practically do not cause discomfort and in most cases are carried out without anesthesia.
The urethra of men is 15-18 centimeters, so during the procedure painful sensations are tested and anesthesia is necessary. Cystoscopy of the bladder in men is more difficult because the path of the cystoscope passes through the prostatic section. In case of improper examination, there is a risk of injury to the mucous membranes, inflammations of the seed tubercle, impaired potency. This procedure allows you to identify inflammatory processes, tumors, stones, prostate enlargement.
Cystoscopy of the bladder in children is carried out using a flexible cystoscope, which is smaller than normal in size, parents need an agreement in writing. Cystoscopy during pregnancy is possible, but it is recommended to wait for the birth of the child. The bladder is located near the uterus, so there is a risk of damage to the wall of the reproductive organ, which can lead to premature birth or miscarriage.
Equipment for manipulation
There is a special set of tools for cystoscopy, in particular - a cystoscope. There are several types of such devices, they are used depending on the purpose of diagnosis, they include: a cystoscope device for inspection, catheterization and an operational cystoscope. The size of the cystoscope is sized and suitable for all.
A special group are children, for them there are reduced forms of equipment for cystoscopy. A cystoscope is a long tube-shaped disposable device, incorporating a special material. Its design allows free penetration into the urethra and prevents injury to the inner membranes. At the end of this device is an eyepiece with optical microfibers - they allow the doctor to consider possible pathologies. Uroscopy is reflected on electronic devices - a computer and recorded on special media for further study of the problem.
Indications for the procedure
Cystoscopy is used both to identify the disease and to treat it. This type of diagnosis is suitable for such cases as:
- painful urination
- detection of alien formations (stones, oncology, urology, diverticula),
- study of the size and nature of cancer cells in diseases of the genitourinary system,
- the study of dislocation abnormalities in renal diseases or during fainting of the patient,
- removal of papillomas, stones and polyps from the bladder;
- study of damage to the walls of the bladder,
- determining the location of vaginal and intestinal cystic fistulas,
- cystoscopy with biopsy, etc.
Diagnostic bladder cystography
Diagnostic cystography is designed for internal study of the bladder, it helps to identify many pathologies in the pelvic organs. How is the operation done? The examination process takes place by introducing a cystoscope through the canal into the bladder, all data is transmitted to electronic carriers, which makes it possible to carefully study the deviations present. On the tube are special lenses for optical observation, they have the ability to adjust the size of the resulting image - bringing it closer and removing it. With the help of a cystoscope make the introduction into the body of additional devices necessary for surgical intervention. These are forceps or loops to remove various kinds of formations. Such diagnostics is conventionally divided into two types.
If there is a suspicion of a possible development of cancer, the patient is undergoing cystoscopy with a biopsy. This process is characterized by taking samples for histological examination. Biopsy of the bladder in women and men is performed simultaneously with the inspection of the internal surface of the organ. Materials for the study are taken immediately, when finding the affected lesions. This type of cystoscopy allows to detect tumors with a size of less than 5 mm.
If it is necessary to identify oncological formations in a patient, a special type of cystoscopy is often used - fluorescent. This process is aimed at studying the amount of a special substance contained in cancer cells - protoporphyrin. To do this, the patient is injected with a special solution of aminolevulinic acid, which provides a red glow during cystoscopy with the use of violet illumination during diagnosis. The use of this technique proves that traditional cystography is not able to reveal oncological formation, especially at the initial stages. Fluorescent cystoscopy is more sensitive, it helps to explore smaller formations. Thus, it is possible to prevent the spread of the disease and avoid its reappearance.
Cystoscopy of the bladder is often carried out under general anesthesia - it is local and general. For local anesthesia, drugs are injected directly into the ureter. To do this, use "Novocain". General anesthesia is used for the procedure for children and unconscious patients. In other cases, local anesthesia is more acceptable.
Always done cystoscopy in compliance with three rules:
- urinary canal of sufficient width to enter the cystoscope,
- the bladder is filled no less than half,
- urine in the urinary is not muddy, it is possible to study the internal state of the organ.
When the patient is prepared for cystoscopy: all the conditions are met, preliminary tests are passed and the consent to the procedure is signed - they are placed on a prepared table and covered with a sterile sheet, which has a cutout in the groin area. Then the genitalia are treated with an antibacterial solution and the cystoscope is lubricated with glycerin or petroleum jelly. However, petrolatum is not very convenient to use, as it promotes turbidity of urine, which can interfere with the process of diagnosis. After that, anesthesia is performed - “Lidocaine” or “Novocain” is introduced into the urinary canal.
Examination in women
They make cystoscopy of the bladder easier for women than for men. This is because the female body is arranged differently and the female urethra has a larger volume in diameter and is not so long. Thus, cystoscopy of the bladder in women is easier and faster. The process of examination, when oncology was diagnosed, as well as during childbirth (if the gestation period exceeds 3 months) is problematic.
Uroscopy for men
Cystoscopy of the bladder in men is more difficult than in the beautiful half. For this, a specific algorithm is observed. Before the diagnosis, men undergo a rectal examination to rule out the possibility of prostate pathologies. The study of the bladder in men is as follows: the penis is lifted and the end of the apparatus tube is inserted into the urinary canal. The tube turns the curved part to the front wall of the urethra. The device must be held at this time, due to its own mass, it will enter the ureter to the mouth of the urinary canal.
After that, his movement will stop in front of the sphincter. Фиксируя эндоскоп рукой, половой орган опускают. Такой маневр дает возможность перейти к задней уретре.If a patient has been diagnosed with prostate gland diseases, at the time when cystoscopy is performed in men, it is necessary to carry out the cystoscope gradually and carefully further. The movement of the apparatus must take place naturally; force cannot be used when inserting the tube.
Examination of the children's urogenital system
Cystoscopy in children is almost the same as in adults, with one difference - children make general anesthesia. In addition, the tube itself and the auxiliary devices have other sizes, due to the peculiarities of the anatomical structure. Permission to conduct cystoscopy in children is given by parents. The size of the urinary canal in a boy is about 50–60 mm; the older the child, the more the length of the ureter increases (in a teenager, 170 mm). The internal structure of the channel has a smooth structure, and its volume is small, so it can be difficult to insert a catheter. However, this feature does not allow pathogens to penetrate into the cavity of the bladder. The length of the urinary canal in a girl is 10−15 mm. Later it grows to 22−30 mm. Does it hurt to make a diagnosis? With a qualified approach of a specialist, there is no pain during the procedure, and there is practically no danger of undesirable deviations.
Examination during pregnancy
During pregnancy, cystoscopy is undesirable in women. This type of examination is used in rare cases. Basically, this procedure should be carried out for kidney drainage, when blood is found in the urine. Such symptoms may indicate the presence of acute pyelonephritis and stones in the urogenital system. If it is possible not to resort to cystoscopy, it is better not to do it during the period of gestation. Such a process is dangerous and provokes a miscarriage. What is suitable in a particular case - ultrasound or cystoscopy - is selected and conducted by the attending physician. It all depends on the condition, the complexity of the disease and other individual indicators.
To evaluate the results, the specialist needs to obtain data on the state of the walls of the ureter, on the presence or absence of pathological changes, to characterize the general well-being of the patient. Using cystoscopy determine:
- development of inflammation in the bladder and urinary canal,
- the presence of oncology, papillomas or warts in the pelvic organs,
- stones and diverticula in the bladder,
- injuries and damage to the integrity of the membrane in the bladder and urethra.
Who is this procedure indicated and contraindicated?
Assessment of the internal walls of the bladder is carried out using a medical device-cystoscope, which is why they called the procedure. It is applicable in situations where alternative diagnostic methods are not able to detect small tumors, their prevalence and nature. For example, a previously performed ultrasound scan of the bladder may not visualize small ulcers or polyps. In this case, cystoscopy is used, this method is more detailed, accurate and informative. It allows you to identify tumors of any shape and size, evaluate their benignity or malignancy, as well as the strength to find stone formation, inflammation sites or injured areas of mucous membranes.
- It is prescribed for previously diagnosed interstitial cystitis.
- Recommended for patients with cystitis in a chronic form, the treatment of which, although it gives results, does not completely exclude periodic exacerbations of the disease.
- Indispensable if blood was detected in the urine, even in small quantities.
- Cystoscopy in children and adults is often prescribed for enuresis, especially if the treatment has so far been unsuccessful.
- If atypical cellular structures were detected during laboratory examination of urine. Most often this indicates the development of tumors.
- This study is always carried out when urination is difficult, the person is painful to move, and the pain is localized in the pelvic region.
- Such an examination is necessary for a patient who was diagnosed with prostate hyperplasia, and an obstruction or narrowing of the ureters was detected.
- The cystoscopy method is used when choosing a stone formation treatment regimen.
- Conducted with frequent urination, the causes of which have not previously been identified.
Most diagnostic methods, whether ultrasound or x-ray, can only detect the disease and determine its nature, but are not applicable to its treatment. Cystoscopic examination, unlike most diagnostic methods, can relieve a patient of certain ailments. For the purposes of treatment, this method is used to remove neoplasms, to remove or crush stones, to get rid of blockages and narrowing of the paths, to cauterize ulcers.
For this survey, choose a standard cystoscope, this tube will allow more detailed and more accurately examine the tissues of the urinary tract and the bladder itself. But It is worth noting that it is quite painful, a person may experience simple discomfort in the area of research, and a rather noticeable pain may appear. That is why before the introduction of the device, the patient is first anesthetized, it can be local, spinal or general.
Cystoscopy for men
It is worth noting that the urethra, where the device is inserted, in men is several times longer than in women, so the procedure is less painful for women. So that the patient does not suffer from pain, it is recommended for men to use anesthesia or give preference to the flexible tube of the device. Cystoscopy of the urinary bladder in men is prescribed for suspected inflammatory processes, including prostatitis. She also visualizes a tumor, including adenoma or adenocarcinoma, which disrupt the function of the urinary system.
Effects of the procedure
After the procedure, doctors advise to drink more water. It is an increased urine output that will help reduce unpleasant symptoms that may occur after an examination:
- After insertion, itching, discomfort, or burning sensation may occur during urination.
- Also, after this method of diagnosis, the patient may be disturbed by the frequent urge to go to the toilet, to reveal veins or blood drops in the urine.
- There may be pain in the lower abdomen.
All these manifestations are a variant of the norm, but if they do not pass within a week, you should contact a specialist to prevent the development of an infection or an inflammatory process.