Cystoscopy

What is it?
The tests you have had so far point to your bladder as the cause of your trouble. Your bladder is like a soft rubber balloon which has an opening into the penis or the front of the vagina. You can feel it in the lower part of you tummy when it is full of urine. It is necessary to look inside the bladder to find out what is going on. A special telescope called a cystoscope is used. It is about half an inch in diameter. The examination is called a cystoscopy. At the same time, X-rays of the kidneys can be taken, narrow parts can be widened, stones can be taken out, pieces of the bladder lining can be taken out, and diseased parts can be burned out as needed.
The Operation
You may have a general anaesthetic and be completely asleep. It is quite common however, for patients to be numbed from the waist down with an injection in the back. If this is the case, you would be awake during the operation, but feel no pain. The operation takes about 40 minutes. If the cystoscopy is being done so that the surgeon can have a thorough look in your bladder and possibly take two or three pieces of tissue from the lining of the bladder (biopsies) to see them under the microscope to help clarify the problem, you might not need a general anaesthetic or an anaesthetic injection in the back.
As an alternative, the surgeon can flush some anaesthetic jelly into your urethra (the tube that connects your bladder with you penis or the area in the front of your vagina) so that you will have only minimal discomfort when he passes the cystoscope up into you. The procedure takes 5 to 10 minutes. The cystoscope is passed through the penis or through the opening of the bladder in the front of the vagina, for a look around inside. Other instruments may be passed up the cystoscope to do the other things as needed. Finally all the equipment is taken out. Sometimes, afterwards, it is necessary to pass a tube, a catheter, back up into the bladder.
This will allow urine to drain freely into a bag for a time. The operation can usually be done as a day case. This means you come into hospital on the day of the operation and go home the same day. You may come into hospital the day before the operation and stay overnight if you are elderly, or have other illnesses, or if there is no-one at home to look after you.
Any Alternatives
If you leave things as they are, any problems with the bladder are likely to get worse. You may be missing the chance of receiving early treatment and this can be extremely important particularly if it is something like a developing cancer which if diagnosed at an early stage could be treated. . Scans and X-rays will not help any further. It is generally not a good idea to start any treatment without knowing what is wrong.
Before the operation
Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. For women, check the hospital’s advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you after the operation. Bring all your tablets and medicines with you to the hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After – In Hospital
You may have some discomfort in the penis or front passage for a day or so. This will settle down. You need to pass urine before you leave the ward. If you have any difficulty, tell the doctors or the nurses. If there is a catheter in the bladder, you will be informed how long it should stay there. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during this time. You will be able to drink and eat some light food on the day of your operation. Drink plenty of fluid if you do not feel like eating. You should be eating normally after a day or two. You will be able to take a bath or shower as often as you want. You should plan to leave the hospital the day of your operation. The nurses will talk to you about your home arrangements to arrange a time for you to leave hospital. Please ask the nurses about sick notes, certificates etc. Some hospitals arrange a check-up about one month after you leave hospital. By that time the results of any biopsies taken from your bladder should be available. Others leave check-ups to the general practitioner.
After – At Home
You may feel very tired for a day or two. You will be back to normal after a week or so. You can start driving again after 24 hours. You can start sexual relations any time you feel comfortable enough. You should be able to return to a light job after about two weeks.
Possible Complications
If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
If you have an anaesthetic injection in the back, there is a very small chance of a blood clot forming on top of your spine which can lead to a feeling of numbness or pins and needles in your legs. Most of the time the clot dissolves on its own and this solves the problem. Extremely rarely, the injections can cause permanent damage to your spine.
Complications are very rare. If any of the lining of the bladder is taken out or burned away, there may be some blood-staining in the urine. If you are passing clots of blood in the urine, or the blood-staining lasts more than two days, phone the ward. You might need to have a catheter put back in the bladder if the clots don’t allow you to pass urine freely. The catheter is removed as soon as your urine is getting clearer. Sometimes the cyctoscopy stirs up an infection, causing scalding and tummy pains. Antibiotics will help to control this.
Extremely rarely (especially if many biopsies are taken or there is a lot of burning in the bladder) the cystoscope or the other instruments used during the cystoscopy can create a hole (perforation) or an extensive scratch in the urethra or, more frequently, the bladder. This problem is usually corrected by putting a catheter back in for one or two weeks to decompress the bladder and drain the urine until the hole or the scratch has healed. Only in extreme circumstances will you need another operation to fix the problem.