Cystoscopy, Cystoscopy with Biopsy, and Cystoscopy with Removal of Stent

Definition

Cystoscopy, except in special circumstances, is an office-based procedure. Simply put, it is the placement of a small telescope into the bladder by way of the urethra (the tube through which you urinate). Because the urethra is fully visualized as well, it is sometimes referred to as cystourethroscopy. The scope provides lighting and magnification so that we may carefully examine the anatomy inside. With this minor procedure we are able to see tumors, areas of inflammation, abnormal variations in anatomy, stones, drainage of urine from the kidneys into the bladder, etc. The procedure takes just a few minutes and can be done using only numbing jelly to minimize discomfort.

Through the cystoscope, we can pass instruments to take biopsies (tissue samples) of areas that we believe are abnormal. Small biopsies can sometimes be done in the office. An area that we biopsy can also be cauterized (burned) if there is any bleeding. Cauterization can also be used to kill cells that we perceive to be abnormal. Patients who undergo hospital procedures for kidney stones often have a stent placed during the procedure. This is a plastic tube that goes from the kidney down to the bladder. Except for unusual circumstances, we can remove a stent in the office while doing a cystoscopy.

Occasionally, patients request sedation (relaxing medication) for biopsy procedures or stent removals. If you are anxious, please let us know during the consultation so that we may consider sedation if we feel it is appropriate.

Preparation

There is no particular preparation for a cystoscopy. While it is not absolutely necessary, we would prefer that you have someone to drive you home. Some patients unexpectedly feel light-headed or uncomfortable after any procedure. If you do not have anyone available, we may ask that you relax for a while in our waiting room after the procedure before going home.

*If you had any sedation given, you must have somebody drive you home. For your own
safety, we will make few exceptions.

*For women of child-bearing age, it is important that you are not pregnant. Please let us know if there is any suspicion that you may be. While cystoscopy itself is not contraindicated in pregnancy, we would prefer to know prior to the procedure. We may decide to give you a dose of an antibiotic tablet. We may check a urine pregnancy test prior to the procedure.

Procedure

To review the basics of what we discussed in the office: The actual procedure typically takes a few minutes for a plain cystoscopy. Removal of a stent may add a bit more time. Biopsy(s) and possible cauterization can add more time.

We may decide to give you an antibiotic tablet just before or after the procedure. We will have you lie on your back with your legs in stirrups (holsters). Your urethra will be cleaned with an antiseptic to create a sterile field. Numbing jelly may be placed in your urethra and allowed to remain for a short time. Next, the scope is guided through the urethra (under direct vision) and into the bladder. Some urologists will look directly into the end of the scope. In other cases, a camera will project the image onto a small television screen. In a simple cystoscopy, we would remove the scope once we visualized all of the important areas. If a biopsy is to be taken, you might feel a little pinch when the tissue is grabbed. After the tissue is removed, we may cauterize (burn) the area with a special instrument. Again, you may feel a little sting. When a stent is removed, you may feel a twinge of discomfort in the area of the kidney. The stent typically comes out in just seconds.

Post Procedure

After the procedure, you might have a little stinging in the urethra until the next time you urinate. In some patients, it may last a bit longer. While it is quite unusual to see any blood in a female patient (except in some cases of stent removal), we occasionally see blood after cystoscopy in men. This is more common in men with large and obstructing prostates, in situations where the urethra contains a stricture (narrowing due to scar tissue), or again in cases of stent removal.

You have no restrictions after a cystoscopy and may even return to work if you choose. Ideally, we would prefer that you take it easy at home for the remainder of the day or evening.

If you received sedation, we insist that you return home with your family member or friend and relax for the remainder of the day or evening.

Expectations of Outcome

If a biopsy is performed, the specimens are sent to a pathology laboratory for evaluation by a trained pathologist. We understand that you are anxious to have the results and ask for your patience. We will call you as soon as they are available to us.

Possible Complications of the Procedure

ALL procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned. It is important that every patient be made aware of all possible outcomes which may include, but are not limited to: l Urinary Tract Infection or Urosepsis (Bloodstream Infection): Even from a minor and sterile procedure, it is possible for you to get an infection with bacteria that typically cause urinary tract infections (UTIs). It may be a simple bladder infection that presents with symptoms of burning urination, urinary frequency and a strong urge to urinate.

This will usually resolve with a few days of antibiotics. If the infection enters the bloodstream, you may feel very ill.

This type of infection often presents with the urinary symptoms and any combination of the following: fevers, shaking chills, weakness or dizziness, nausea and vomiting. You may need a short hospitalization for intravenous antibiotics, fluids, and observation.

This scenario is more common in diabetics, patients on long-term steroids, or patients with any disorder of the immune system.

If you have symptoms of any of the above, you must contact us immediately or go to the nearest emergency room.

• Blood Clots in the Urine: Rarely, the scope can traumatize a blood vessel on the surface of the prostate or less commonly in the bladder. In this instance, you may develop hematuria (blood in the urine). In patients having a biopsy, we rarely have any significant bleeding because we only take small samples. There are instances where a scab (from the cauterization) can fall off and a patient subsequently develops hematuria one or a few days later. In almost all instances, the urine clears on its own over the next few days. Ongoing bleeding with the development o clots is uncommon. If the clots block the bladder, a catheter may need to be inserted to flush out the clots. If bleeding persists, we may have to look back in the bladder to control or cauterize the bleeding.
• Urinary Retention: In men, pressure from the scope can occasionally cause swelling of the prostate. It may block the flow of urine and cause “retention”. This is more common in men with a prior history of an enlarged prostate (BPH) or difficulty urinating. In most circumstances, it resolves with a catheter over the next few days. Less commonly aremedications or a prostate procedure required.
• Perforation: The wall of the bladder can be perforated from a biopsy. In most cases, all we need to do is leave the catheter in for an extra few days to allow self-healing. If the perforation occurs in a specific area of the bladder, we may need to perform a formal bladder repair through an incision in the abdomen, or place a drainage tube in the lower abdomen to evacuate this fluid.
• Inability to Pass the Scope: Occasionally, a severe stricture (scar in the urethra) or bladder neck contracture (full circumference scar at the neck of the bladder) may prevent safe passage of a scope into the bladder. In these instances, we would remove the scope and perhaps suggest a cystoscopy procedure in the hospital using anesthesia.
• Inability to Remove a Stent: It is quite unusual that we cannot easily remove a stent. In patients that have had a stent in place for a long time, or in patients that have made stones that stick to the stent, it can quickly become difficult to remove in the office. If we notice resistance to removal of the stent, we will remove the scope and recommend that the procedure be done under anesthesia in the hospital. Sometimes, other procedures are necessary. In rare instances, the ureter (tube that transports urine from the kidney to the bladder) can be injured during a difficult stent removal. Treatments may include replacement of a new stent, placement of a tube or stent through the back and into the kidney, or even open surgery to repair the injury if it is severe.

We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).

The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While UUANJ endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. UUANJ cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.

UUANJ, P.C.