Performed in both males and females, cystoscopy involves placing a thin tube through the urethra to look for narrowing, as well as polyps or other abnormal growths.
Depending on the reason for the exam, the doctor will use either a rigid cystoscope or a flexible tube.
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A standard rigid cystoscope delivers a comparatively better image and higher irrigant flow and it has a wider diameter. However, a rigid scope only allows the patient to assume one position: lying on their back with their knees apart and elevated.
Flexible cystourethroscopes allow the doctor to place the patient in different positions, including prone cystoscopy. The prone position is the method of choice for female patients who are undergoing retrograde ureteral catheterization. Prone cystoscopy is faster and more sterile. With a flexible scope, it is easier to pass the instrument smoothly over an elevated bladder neck or median lobe. It has a movable tip that permits full inspection of the bladder and, most significantly, improves patient comfort.
This method is commonly used by urologists to examine patients suspected who display hematuria, dysfunctional voiding symptoms, require foreign body removal, or surveillance of urothelial carcinoma. Retrograde ureteral catheterization is a quick, routine procedure used by doctors in women with cervical cancer in its early stages.
Cystoscopy is also performed in patients with pain in the urinary tract in an effort to determine the cause. It is one of the diagnostic methods used to investigate cancers of the urethra and the bladder.
Having a cystoscopy feels a little uncomfortable, although every effort is made to make the patient as comfortable as possible. Once the tube is in place, water is placed through it to fill the bladder. This gives the doctor a better view of the entire wall of the bladder.
If necessary, the doctor may take a biopsy of the tissue. Unless a general anesthetic is indicated, the entire procedure should not take more than around 20 minutes. Usually, an anesthetic lubricating gel is used to coat the cystoscope to make it easier to pass through the urethra. Sometimes, in addition to using lubricating gel, an intra-rectal suppository containing diclofenac may be inserted one hour before the procedure to provide pain relief.
Because the bladder is filled with water, patients often feel the need to urinate. There is no need to feel anxious about losing bladder control; the urologist is able to manage the urine stream. There may be a pinching sensation if a biopsy is performed.
In August 2016, scientists in Connecticut reported using the urological analgesic phenazopyridine to confirm the absence of injury to the bladder or the ureter following cystoscopic examinations performed in the course of surgical operations. The drug was well tolerated and reduced the amount of anesthetic time.
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