What is histoscopy?
Cystoscopy is a diagnostic procedure aimed at the visual exploration of the internal walls of the urethra and bladder, in order to identify any anomalies and take tissue samples for diagnostic and / or therapeutic purposes.
Why is it done?
Cystoscopy is indicated in the presence of urological symptoms such as hematuria (blood in the urine), dysuria and stranguria (difficult and painful urination), inability to empty the bladder (urinary retention) or a sudden and uncontrollable urge to urinate. It is also indicated in the presence of various problems of the urinary tract, such as recurrent infections or urethral strictures due to prostatic hypertrophy, kidney stones or tumors.
In particular, cystoscopy represents the "gold standard" (ie the reference test) in the diagnosis of bladder cancer and as such must be performed whenever - from diagnostic imaging and urinary cytology tests or from other predictive markers - the suspicion of bladder growths.
Operative cystoscopy
During cystoscopy, in addition to examining the internal lumen of the organ, it is possible to take small tissue samples from suspicious lesions and send them to the laboratory for cytological examination (microscopic research of tumor cells).
In many cases, moreover, cystoscopy allows to remove the tumor formation, destroying it by means of an electric current or a high-energy laser beam; after the operation, it is in any case repeated periodically to check for possible relapses.
Also as a minimally invasive interventional procedure, cystoscopy allows to treat other urinary problems, for example by removing stones, diverticula, foreign bodies or abnormal benign or malignant formations.
How it is done
Preventive Anesthesia
Cystoscopy is known, especially in humans, for its annoyance, however attenuated by the use of lubricating gels containing anesthetic; if necessary, should the examination become particularly annoying (for example due to urethral narrowing), the urologist may decide to suspend the procedure or continue it after using anesthetic assistance.
Spinal or general anesthesia is also commonly required when cystoscopy is associated with the surgical procedures described above.
During the Exam
During the examination, a thin, rigid or increasingly flexible instrument (cystoscope) is gently inserted into the bladder through the urethra (the channel that carries urine out).
In the presence of stenosis (narrowing) of the urethra, smaller caliber cystoscopes are available; they can be used to reach the ureters (which convey urine from the kidneys to the bladder), for example when it is necessary to remove obstructive stones. In general, the doctor chooses thinner cystoscopes when the examination is purely diagnostic and larger cystoscopes when it is necessary to pass small surgical instruments through them.
Thanks to a camera and a light source mounted at the apex, the flexible cystoscope transmits images of the urinary tract on the special monitor; in the traditional rigid model, on the other hand, observation is made possible by a system of lenses similar to that of microscopes. In order to improve the vision of the bladder, the urologist introduces a sterile liquid into the lumen of the organ, stretching its walls. The procedure is not painful in itself, but it often results in an annoying urge to urinate.
If necessary, the urologist can introduce some additional instruments through the cystoscope, in order to carry out the aforementioned therapeutic procedures (removal of stones, bladder biopsies, resections of tumors, cauterisations, laser excisions, etc.).
Standard cystoscopy usually lasts a few minutes. However, the execution time can be extended if other procedures are performed, such as the removal of a stone or a biopsy sampling.
Preparation
No special preparations are normally required. For preventive purposes (prophylaxis), antibiotics can be administered to decrease the risk of urinary infections. In the most anxious patients, a sedative can be administered one hour before the test. Any use by the patient of anticoagulants and / or anti-platelet aggregators, such as aspirin or coumadin, must be temporarily suspended according to the instructions. medical, and eventually replaced with low molecular weight heparin.
In the case of general or spinal anesthesia, the patient is explicitly asked not to drink or eat in the four / eight hours preceding the test. In addition, a short hospital stay is foreseen after the operation.
Side effects
The most common side effect of cystoscopy is a temporary urethral swelling, which can make urination difficult; when the obstacle becomes important to the point of preventing normal expulsion of urine, the temporary application of a bladder catheter is necessary.
Small bleeding episodes in the post-surgery period (urethrorrhagia) tend to disappear spontaneously in a short time, while the risk of urinary infections is reduced by the use of antibiotics before and after the procedure. In case these should still occur, the patient may experience symptoms such as pain or burning on urination, urinary incontinence, urge to urinate frequently, associated with a feeling of incomplete bladder emptying, and rusty or foul-smelling urine.
In case of profuse haematuria (bright red urine), emission of clots, fever or major obstacle to long-lasting urination, the patient should contact the specialist. To these possible side effects are added those related to general anesthesia and instrumental maneuvers performed during cystoscopy, which in very rare cases can cause lesions of the urethra or bladder such as to require immediate surgery.
The resolution of small disturbances commonly felt at the end of cystoscopy can be favored by generous hydration and by applying a cloth soaked in warm water to the urethra for about 20 minutes.
