What is Cystoscopy? How is it Performed?

What is Cystoscopy? How is it Performed?: Cystoscopy is a widely used diagnostic and therapeutic procedure in urology that allows direct visualization of the bladder and urethra using a specialized instrument called a cystoscope. It is an essential tool for detecting various urological conditions, including bladder tumors, urinary tract infections, hematuria, and structural abnormalities.

With advancements in medical technology, cystoscopy has evolved significantly, with flexible and rigid cystoscopes, high-definition imaging, and improved patient comfort. This article provides a detailed overview of cystoscopy, including its indications, procedure, latest advancements, and clinical relevance.

What is Cystoscopy?

Cystoscopy is a minimally invasive endoscopic procedure performed to examine the inner lining of the bladder and urethra. The procedure can be diagnostic or therapeutic and is performed using a thin, tube-like instrument called a cystoscope, which is equipped with a camera and light source.

Depending on the indication, cystoscopy can be:

• Flexible Cystoscopy: Used primarily for diagnostic purposes and performed under local anesthesia.
• Rigid Cystoscopy: Used for therapeutic interventions such as bladder biopsies, stone removal, and tumor resection, typically performed under general or spinal anesthesia.

Indications for Cystoscopy

Cystoscopy is recommended for several urological conditions, including:

• Hematuria (Blood in Urine): To detect underlying causes such as bladder cancer, infections, or stones.
• Recurrent Urinary Tract Infections (UTIs): To identify anatomical abnormalities or chronic infections.
• Bladder Tumors and Polyps: For detection, biopsy, and follow-up of bladder cancer.
• Urinary Incontinence and Retention: To assess bladder function and rule out obstructions.
• Bladder Stones: To visualize and remove stones causing symptoms.
• Urethral Strictures: To diagnose and evaluate narrowing of the urethra.

How is Cystoscopy Performed?

Pre-Procedural Preparation

• Patient Evaluation: A thorough medical history and examination are conducted to assess indications and contraindications.
• Informed Consent: The procedure, risks, and benefits are explained to the patient.
• Pre-Medications: In some cases, antibiotics may be prescribed to prevent infections.
• Anesthesia: Depending on the type of cystoscopy, local, spinal, or general anesthesia is used.

Step-by-Step Procedure

1. Positioning: The patient is placed in a lithotomy position (legs elevated and supported in stirrups).
2. Sterilization: The genital area is cleaned to reduce the risk of infections.
3. Lubrication and Insertion: A lubricating gel containing anesthetic is applied, and the cystoscope is gently inserted through the urethra into the bladder.
4. Visualization: The bladder is filled with sterile saline to expand it, allowing clear visualization.
5. Examination: The urologist examines the bladder lining for abnormalities such as tumors, stones, inflammation, or structural defects.
6. Biopsy or Treatment: If necessary, a biopsy can be taken, or minor treatments (e.g., stone removal, tumor resection) can be performed.
7. Completion: The cystoscope is carefully removed, and the patient is monitored for immediate post-procedure effects.

Post-Procedural Care and Recovery

• Patients undergoing flexible cystoscopy can return home the same day with minimal discomfort.
• Common symptoms post-cystoscopy include mild burning during urination, slight blood in urine, and increased frequency of urination.
• Adequate hydration is encouraged to flush out the bladder.
• In cases of biopsy or therapeutic intervention, follow-up visits are scheduled for further evaluation.

Recent Advances in Cystoscopy

1. High-Definition Digital Cystoscopy: Provides enhanced visualization, improving diagnostic accuracy.
2. Narrow Band Imaging (NBI): A technique that enhances the detection of bladder tumors by improving contrast between normal and abnormal tissues.
3. Blue-Light Cystoscopy (BLC): Uses a photosensitizing agent to enhance the visibility of cancerous lesions.
4. Disposable Cystoscopes: Reduce the risk of infections and cross-contamination.
5. Artificial Intelligence (AI) in Cystoscopy: AI-assisted image analysis is being developed to aid in early cancer detection.

Complications and Risks

While cystoscopy is generally safe, potential risks include:

• Urinary Tract Infections (UTIs): Prophylactic antibiotics may be given to high-risk patients.
• Bleeding: Mild hematuria is common post-procedure but resolves within a few days.
• Pain and Discomfort: Temporary burning sensation while urinating.
• Bladder Perforation (Rare): More common with rigid cystoscopy and extensive interventions.

Conclusion

Cystoscopy remains a vital tool in modern urology, enabling accurate diagnosis and effective treatment of a wide range of bladder and urinary tract conditions. With continuous advancements in technology, the procedure has become safer, more comfortable, and highly precise. Early detection through cystoscopy can significantly improve patient outcomes, especially in conditions like bladder cancer and recurrent urinary issues.

For more details on cystoscopy and its applications, visit Institute of Urology, Jaipur.

References

1. Babjuk, M., et al. (2022). European Association of Urology Guidelines on Non-Muscle-Invasive Bladder Cancer. European Urology.
2. Bryan, R. T., et al. (2021). Advances in Cystoscopic Techniques for Bladder Cancer Detection. Nature Reviews Urology.
3. American Urological Association (AUA). (2023). Best Practices in Cystoscopy for Diagnosis and Management of Bladder Disorders.