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'[[Image:Cystoscope-med-20050425.jpg|thumb|250px|A sterile flexible cystoscope in an [[operating theatre]]]] <!-- unusually, this article seems to adopt British English (viz anaesthesia) --> '''cystoscopy''' (si-ˈstäs-kə-pē) is [[endoscopy]] of the [[urinary bladder]] via the [[urethra]]. It is carried out with a '''cystoscope'''. Diagnostic cystoscopy is usually carried out with [[local anaesthesia]]. [[General anaesthesia]] is sometimes used for operative cystoscopic procedures. The [[urethra]] is the tube that carries [[urine]] from the bladder to the outside of the body. The cystoscope has lenses like a [[telescope]] or [[microscope]]. These lenses let the doctor focus on the inner surfaces of the [[urinary tract]]. Some cystoscopes use [[optical fiber|optical fibres]] (flexible glass fibres) that carry an image from the tip of the instrument to a viewing piece at the other end. Cystoscopes range from between the thickness of a pencil, up to approximately 9mm and have a light at the tip. Many cystoscopes have extra tubes to guide other instruments for [[surgical procedures]] to treat urinary problems. There are two main types of cystoscopy - [[flexible]] and [[rigid]] - differing in the flexibility of the cystoscope. Flexible cystoscopy is carried out without the use of local anaesthesia on both sexes. Typically, [[lidocaine|xylocaine]] gel (such as the brand name Instillagel) is used as an anaesthetic, instilled in the urethra. Rigid cystoscopy can be performed under the same conditions, but is generally carried out under general anaesthesia, particularly in male subjects, due to the pain caused by the probe. A doctor may recommend cystoscopy for any of the following conditions:<ref>[http://www.doctorslounge.com/urology/procedures/cystoscopy.htm Cystoscopy and Ureteroscopy - The Doctors Lounge(TM)<!-- Bot generated title -->]</ref> * Frequent [[urinary tract infection]]s * [[Blood]] in the urine ([[hematuria]]) * Loss of bladder control ([[Urinary incontinence|incontinence]]) or overactive bladder * Unusual cells found in urine sample * Need for a bladder [[catheter]] * Painful urination, [[chronic pelvic pain]], or [[interstitial cystitis]] * Urinary blockage such as from [[prostate]] enlargement, stricture, or narrowing of the urinary tract * [[Kidney stone|Stone]] in the urinary tract * Unusual growth, [[Polyp (medicine)|polyp]], [[tumor]], or [[cancer]] == Male and female urinary tracts == [[Image:Cystoscopy-im-20050425.jpg|thumb|250px|Images from a cystoscopy. The top two images show the interior of the [[urinary bladder|bladder]] of a male patient. In the top-right image, the cystoscope has been bent within the bladder to look back on itself. The bottom two images show an [[Inflammation|inflamed]] [[urethra]]]] If a patient has a stone lodged higher in the urinary tract, the doctor may use a much finer calibre scope called a [[ureteroscope]] through the bladder and up into the [[ureter]]. (The ureter is the tube that carries urine from the kidney to the bladder). The doctor can then see the stone and remove it with a small basket at the end of a wire which is inserted through an extra tube in the ureteroscope. For larger stones, the doctor may also use the extra tube in the ureteroscope to extend a flexible fiber that carries a [[laser]] beam to break the stone into smaller pieces that can then pass out of the body in the urine. == Test Procedures == Doctors may have special instructions, but in most cases, patients are able to eat normally and return to normal activities after the test. Patients are sometimes asked to give a urine sample before the test to check for infection. These patients should ensure that they do not urinate for a sufficient period time, such that they are able to urinate prior to this part of the test. Patients will have to remove their clothing covering the lower part of the body, although some doctors may prefer if the patient wears a [[hospital gown]] for the examination and covers the lower part of the body with a sterile drape. In most cases, patients lie on their backs with their knees slightly parted. Occasionally, a patient may also need to have their knees raised. This is particularly when undergoing a Rigid Cystoscopy examination. For flexible cystoscopy procedures the patient is almost always alert and a local anesthetic is applied to reduce discomfort. In cases requiring a rigid cystoscopy it is not unusual for the patient to be given a general anesthetic, as these can be more uncomfortable, particularly for men. A doctor, nurse or technician will clean the area around the urethral opening and apply a local anesthetic. The local anesthetic is applied direct from a tube or needleless syringe into the urinary tract. Often, skin preparation is performed with [[Hibitane]]<ref>http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20H)/HIBITANE.html</ref> Patients receiving a ureteroscopy may receive a [[spinal anaesthesia|spinal]] or [[general anaesthetic]]. The doctor will gently insert the tip of the cystoscope into the urethra and slowly glide it up into the bladder. The procedure is more painful for men than for women due to the length and narrow diameter of the [[male urethra]]. Relaxing the [[pelvic muscles]] helps make this part of the test easier. A [[Sterilization (microbiology)|sterile]] liquid (water, [[saline (medicine)|saline]], or [[glycine]] solution) will flow through the cystoscope to slowly fill the bladder and stretch it so that the doctor has a better view of the bladder wall. As the bladder reaches capacity, patients typically feel some mild discomfort and the urge to urinate. The time from insertion of the cystoscope to removal may be only a few minutes, or it may be longer if the doctor finds a stone and decides to remove it, or in cases where a [[biopsy]] is required. Taking a [[biopsy]] (a small tissue sample for examination under a microscope) will also make the procedure last longer. In most cases, the entire examination, including preparation, will take about 15 to 20 minutes. After the test, patients often have some burning feeling when they urinate and often see small amounts of blood in their urine. Procedures using rigid instrumentation often result in urinary incontinence and leakage from idiopathic causes to urethral damage. Occasionally, patients may feel some [[lower abdominal pain]]s, reflecting bladder [[muscle spasms]], but these are not common. Common prescriptions to relieve discomfort after the test include: * Drinking 32 fluid ounces (1 L) of water over 2 hours. * Taking a warm bath to relieve the burning feeling. * Holding a warm, damp washcloth over the urethral opening. Some doctors will prescribe an [[antibiotic]] to take for 1 or 2 days to prevent an [[infection]]. However, recent trends have been to discourage this kind of [[prophylaxis|prophylactic]] treatment (prescribing antibiotics as a preventative when there is no other evidence of infection) because it tends to increase the rate at which bacteria develop [[resistance]] to the antibiotic drug. Physicians may also prescribe an oral urinary analgesic [[Phenazopyridine]] or a combination (urinary) analgesic/anti-infective/anti-spasmodic medication containing [[Methylene Blue]], [[Methanamine]], [[Hyoscyamine Sulfate]] and [[Phenyl Salicylate]] for irritation and/or dysuria patients may experience after the procedure. Patients receiving [[Tetracycline]]-class antibiotics are advised to '''avoid''' taking [[Phenazopyridine]] concurrently, for reasons of drug interaction. == Notes == <references/> == References == * [http://kidney.niddk.nih.gov/kudiseases/pubs/cystoscopy/ Cystoscopy and Ureteroscopy on the ''National Institute of Diabetes and Digestive and Kidney Diseases'' website] * IMAJ Study into the Adverse Effects of Cystoscopy and its impact on patients quality of life and sexual performance (Vol 6, August 2004) http://www.ima.org.il/imaj/ar04aug-7.pdf * ''An earlier version of this article was adapted from the [[public domain]] NIH Publication No. 01-4800, at http://www.niddk.nih.gov/health/kidney/pubs/cystoscopy/cystoscopy.htm which says, "This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired."'' {{Urologic surgical and other procedures}} [[Category:Endoscopy]] [[Category:Urology]] [[de:Zystoskopie]] [[es:Cistoscopia]] [[fr:Cystoscopie]] [[it:Cistoscopia]] [[nl:Cystoscopie]] [[ja:膀胱鏡]] [[pl:Cystoskopia]] [[pt:Cistoscopia]] [[ru:Цистоскопия]] [[fi:Kystoskopia]] [[sv:Cystoskopi]] [[zh:膀胱镜]]'