“Cystoscopy: What to Expect Before, During, and After the Procedure??”

 

In simple words, Cystoscopy is an endoscopy of the urinary bladder.

Why Do We Need Cystoscopy?

Cystoscopy serves several crucial purposes. It’s often used to diagnose problems with the bladder.

· UTIs

· Bladder cancer

· Urethral cancer

· Bladder stone

· Bladder control problem

· Ureteral fistula.

Types of Cystoscopy:

There are two types of Cystoscopy: flexible and rigid.

1. FLEXIBLE CYSTOSCOPY: 

· This technique is usually carried out in both genders, male and female.

· Flexible Cystoscopy is performed under local anesthesia, normally lidocaine gel.

· The gel is introduced into the external urinary meatus 5 to 10 minutes before the procedure begins.

2. RIGID CYSTOSCOPY:

· Rigid Cystoscopy is performed under general anesthesia or spinal anesthesia due to pain caused by the cystoscope probe.

· It is mostly performed in males.

· Sometimes, it is used to remove tumors.

Preparation for Cystoscopy:

· Before getting a cystoscopy, patients need to follow some important steps.

· Doctors require complete information regarding disease history and a list of medications that patients take currently.

· The doctor will prohibit liquids and solids 5 to 6 hours before the procedure starts.

· A urine sample is collected before the procedure to ensure any evidence of UTIs.

· Stop blood thinning medications like aspirin and warfarin.

· Complete gestational history regarding pregnant patients.

· Make sure the bladder is empty before the procedure starts.

In the medical room, everything needs to be super clean and safe. Doctors and nurses take special care to ensure the equipment is sterile to avoid infections.

The Cystoscopy Procedure:

· Patients lie on the table on their backs, ensuring their legs are slightly parted. Sometimes, it is necessary to raise their knees.

· The doctor will give the patient general or local anesthesia depending upon the type of Cystoscopy used. In the case of rigid Cystoscopy, general anesthesia is administered, making the patient sleepy or unable to sense.

· In the case of flexible Cystoscopy, local anesthesia, which is numbing jelly, is administered with the help of a needleless sterile syringe or thin tube into the urinary tract, which is helpful to minimize the discomfort as a consequence of the cystoscope.

· The external urethral opening is cleaned by chlorhexidine, an antiseptic that helps minimize the chance of bacteria exposure before the instrument insertion.

· Wait for a while till the effect of anesthesia commences. The doctor slowly and gently pushes the cystoscope into the urethra.

· Cystoscope has a camera on its bladder-oriented side, which works like a telescope, along with a video recording specialty, which is helpful to magnify the histological structures of the urinary bladder and urethra and record these all.

· During the procedure, a sterile solution (water, saline, or glycine) is introduced into the bladder, making the bladder beneficial for a better view of the inside.

· The fullness of the bladder triggers the patient to pee, but the patient will wait until the procedure finishes.

· The duration of Cystoscopy from insertion to removal is a few seconds. However, the duration is a little longer in case there is removal of any stone or tissue removal.

· A little tissue sample is removed from the bladder and preserved for later examination.

BLUE LIGHT CYSTOSCOPY:

Blue light Cystoscopy has a photosensitizing agent (hexyl aminolevulinate hydrochloride). This photosensitizing agent specifically collects the porphyrin in the malignant cells. Under a specific wavelength of blue light illumination, neoplastic clusters appear red, helping to distinguish them from non-neoplastic cells. This technique is specially used for the tumor diagnosis of the bladder.

What are the possible side effects of Cystoscopy?

It takes some time to recover. However, patients may experience some side effects, including:

· Frequent urination

· Bleeding from the urethra

· Burning sensation in urination after a few days.

· Urethral trauma

Some points that aid in early relief:

· Increase water intake as it is helpful to flush out the irritants.

· Used painkillers to relieve the discomfort on the advice of a doctor.

· Take a warm bath as per the doctor’s advice

. Take rest until the pain is gone.

Advancements in Cystoscopy:

· The contribution of blue light Cystoscopy in diagnosing non-invasive bladder cancer is considerably encouraged. It is good to know that various findings show that a significant proportion of non-invasive tumors are diagnosed through blue light cystoscopy, along with a better approach to treating these invasive bladder lesions.

· It is also proven that the blue light cystoscopy (BLC) enhances the apprehension of non-invasive bladder cancer and declines the frequency rates.

· In this scenario, blue light flexible cystoscopy (BLFC) was certified by the FDA (US Food and Drugs Administration) for its utilization in the observational setting and an exhibit to upgrade diagnosis. Results of the multicentre show that 20.6% of malignancies are only recognized through BLFC. So, the scientists will predict the enhanced clinical outcomes by minimizing future reappearance and a rapid understanding of the tumors unresponsive to past therapies.

· Another study concluded that the relevancy, sensitivity, and oncologic consequences of photodynamic diagnosis (PDD) fluorescence and narrow-band imaging (NBI) with conventional white light cystoscopy (WLC) are greatly comparable.

· PDD AND NBI show lower frequency rates and higher characteristic sensitivity than conventional white light cystoscopy.

· Cystoscopy is an important diagnostic tool in the oncological aspect of the urinary bladder. With the advancement in medical sciences, there is also a need to improve this technology. Cystoscopy Artificial Intelligence Diagnostic System (CAIDS) provides several clinical outcomes, a high accuracy rate for bladder cancer, minimizing the cystoscopy procedure time duration, and correctly identifying different carcinomas.

· CAIDS is also beneficial in identifying flat cancerous tissues and very small tumors.

Conclusion:

Cystoscopy sounds intimidating, but it’s a valuable tool in the world of urology. It helps doctors diagnose and treat issues related to the bladder and urethra. So, don’t worry too much if your doctor recommends a cystoscopy. It’s a crucial step toward understanding and improving your health. Remember, staying informed and caring for your body is a powerful way to stay healthy.