Cystoscopy

Cystoscopy belongs to the camp of endoscopic diagnostics with high productivity. The technique is used to make a thorough visualization of the bladder on its inner surface.

The method is invasive, which scares many patients who have a low pain threshold. To implement the plan, the physician uses a special optical system, which in professional terminology goes under the term cystoscope. It is inserted into the cavity of the bladder using the urethra as a bypass. The urethra is called the urethra.

Many patients far from medicine believe that the study is only suitable for women. But if the representatives of the stronger sex are suspected of complications regarding the functioning of this internal organ, they can also be prescribed the same in extreme situations. It’s just that men will have a slightly different mechanism for introducing a sensor to study the alleged problem area.

But the effectiveness of the survey still remains at a high level. Even children are looking for bladder pathologies using an identical mechanism, if similar formats for monitoring the state of the organ do not cope with the tasks.

Supporting tools

The standard algorithm for invasive intervention provides for the smooth advancement of the cystoscope into the bladder in order to simultaneously assess the health status of the accompanying mucous membranes. The second point of the study is called ureteroscopy. Usually direct cystoscopy is inseparable from it, which allows you to get more detailed results. They guarantee the possibility not only to detect a possible focus of the inflammatory process, but also to monitor the surrounding tissues at the same time, regardless of the degree of their damage.

Not only those patients who are suspected of having various diseases in terms of destabilization of the indicated internal organ are sent to undergo such complex testing. Sometimes one cannot do without a technique to build a further program of alternative treatment, or restorative therapy after a recent surgical intervention.

Some patients, having learned how to do an examination, are afraid of the prospect of pain and discomfort, looking for alternative diagnostic options. But any substitutes are not able to provide such a detailed picture, even if we are talking about ultrasound or x-rays.

Depending on the format of the procedure prescribed by the attending physician, the tools used for control will vary greatly. But in any case, one cannot do without the cystoscope itself. It is a separate type of modern endoscopic medical equipment.

Outwardly, it resembles an ordinary tube, which has additional illumination. Inside it has a special channel through which the laboratory assistant delivers a special liquid designed to intentionally irrigate the studied mucous membranes of the urethra. The design of the maternal apparatus is designed so that, if necessary, the doctor can use auxiliary instruments.

The basic set includes the following parts:

• forceps for collecting biological material to be sent for subsequent histology;
• diathermoelectrodes, which are necessary for the instant removal of polyps;
• catheters.

The latter will be needed if the condition of the victim turned out to be too severe, and he will need to install artificial parts in the ureters.

If the victim only needs an examination, then usually its price is lower than when additional stages are involved. But here it is necessary to clarify how much manipulation costs in general. Especially in cases where the procedure is carried out within the walls of a private medical center.

Also, the cost will be based on the specifics of the use of anesthesia and the equipment used. To find a place where you can do a cystoscopy with minimal risk of complications, it is better to contact your doctor. It would be useful to read reviews about the work of a private medical institution you like. At the same time, the clinic should not only offer a favorable price list, but also have high-level experts.

Only after a person finds out where the diagnosis is really safe, he can make a final decision. An important point when choosing a medical institution is the type of cystoscope used.

There are only two of them:

• flexible;
• rigid.

The latest version allows you to rely on the examination of the organ cavity through the optical system. But the flexible variation is a kind of tube, which has a fixed video camera at the end. It transmits all graphic information in real time to a computer monitor.

The patient himself cannot choose the type of maternal device, as this must be prescribed by the attending physician who issued the referral.

Basic indications

Most often, a urologist sends to the diagnostic room, who diagnoses pathologies in both women and men. In both sexes, the rating of indications for the appointment of an examination is often the same, representing the following diseases or suspicions of them:

• chronic cystitis, the attacks of exacerbation of which are repeated too often;
• urolithiasis disease;
• problems with urination, the primary sources of which cannot be recognized by other solutions;
• urinary incontinence;
• blood in the urine;
• atypical cells in the urine found during a prophylactic clinical trial;
• pain syndrome in the pelvic area;
• high activity of the bladder;
• noninfectious cystitis.

Sometimes testing is carried out in order to clarify the results of standard types of diagnostics such as ultrasound, x-rays, computed tomography. If a stage with a biopsy is needed, then this indicates a suspicion of tumor formation.

The neoplasm can be benign or malignant. To understand whether the tumor is a focus with metastases and a procedure is performed.

Based on the collected indications, it turns out to carry out a number of therapeutic measures, most of which involve the use of the resulting visualization as a kind of map for the subsequent operation. Especially important results of the study will be, if necessary, to perform surgical interventions to remove tumors.

Also, the list of information use during cystoscopy includes the following manipulations:

• stopping bleeding;
• crushing and extraction of stones;
• dissection of the stricture, which implies the expansion of the resulting internal lumen of the ureter;
• removal of obstruction.

Rarely, an invasive approach is necessary to confirm congenital pathology.

Despite the numerous benefits that the procedure can bring, it has a number of important contraindications. Ignoring them threatens with serious complications up to the development of anaphylactic shock.

The main prohibitions cover:

• inflammatory process of the mucous membranes of the canal at the acute stage of the course;
• exacerbation of chronic diseases not only of the urethra itself, but also of the prostate with testicles among men;
• infectious lesions, which are accompanied by fever and intoxication;
• recent trauma of any type affecting the functionality of the urethra;
• bleeding of unknown origin;
• traffic problems.

Separately, situations are considered when the victim simultaneously suffers from some rare genetic or acquired disease.

Preparatory stage

After the specialist decides to send his ward to undergo cystoscopy, he must conduct an explanatory conversation. During the consultation, the doctor will explain why it is impossible to do without an examination, and how it will be possible to avoid discomfort.

Also, the preparation provides for a discussion of the need to refuse the use of previously prescribed pharmacological agents. But this should be done only after the full approval of the attending doctor. At the same time, the expert may prescribe new drugs, redesigning the alternative treatment regimen.

Separately, it is worth checking with the doctor whether it is necessary to take an antibacterial drug the day before. If such a decision is made, then the attending physician, based on the results of other tests, the individual characteristics of the organism of the ward, will decide on the dosage and treatment regimen.

When the examination is carried out under anesthesia, then in the morning on the day of the examination it is forbidden to eat. Also, to eliminate the risks of individual intolerance to drugs, additional tests are carried out: urine (general); urine (biochemical); blood for clotting.

They are handed over a couple of days before the appointment. And before the direct cystoscopy, you will need to wash the external genital organs to comply with the rules of personal hygiene. You will also need to get rid of the surrounding hairline, because getting even one hair into the maternal apparatus threatens to complicate the testing.

How is the procedure performed

The exact duration of the manipulation depends entirely on the stage of the disease in the victim. Also, the type of cystoscope, the qualifications of medical personnel affect the timing of execution. Sometimes ten minutes is enough, but with the development of the most complex scenario, it will take about an hour.

For the convenience of the patient, he is first seated in a special chair, which outwardly resembles a gynecological analogue. The patient is placed on his back, and the legs are slightly raised and bent at the knees. To spend more than half an hour in a not too comfortable position, the medical staff fixes the lower limbs of the victim on special supports.

If an ordinary examination is provided, then usually the diagnostician involves only local anesthesia, which became possible thanks to special “freezing” solutions or gels. But if you have a long monitoring, it is better to use general anesthesia.

Before the direct introduction of the maternal device, the nurse treats the external genital organs of the patient with an antiseptic. The tube must be lubricated with sterile glycerin, which does not shift the transparency of optical media.

After the device reaches the end point, urine remains are removed from the bladder, and only then the internal organ is washed with heated Furacilin.

To control the capacity of the bladder, it is filled with a clear solution until the person experiences a clear urge to urinate. Usually the average dosage of liquid is about 200 milliliters.

Upon completion of the preparatory stage, the stage of studying the organ begins, which begins with the anterior wall. Later, the diagnostician shifts to the left side surface, gradually moving to the back, and completes work on the right side wall.

The Lieto triangle deserves special attention. So in medical terminology they call the bottom of the bladder. It deserves increased vigilance due to the fact that in percentage terms it is here that most of the diagnosed abnormalities are localized.

Under the close attention of the expert are the mouths of the ureters, where you need to study them:

• location;
• form;
• quantity;
• symmetry.

After the cystoscope is removed, the patient can go home if he was given local anesthesia. But with spinal or general anesthesia, the patient first remains in the hospital in order to be under vigilant supervision.

Nuances for men, women and children

The fairer sex was a little more fortunate than the men. Due to the anatomical features of the urethra, which is short, local anesthesia is often used for the examination. It is believed that it is less harmful to cardiovascular activity than the general extensive analogue.

The latter is resorted to only when, along with monitoring, it is planned to carry out several other additions.

But the strong half of humanity, regardless of the specific purpose of the analysis, is prescribed spinal or general anesthesia without options. This is due to their long length of the urethra. Also, during the start of the introduction of the tube, the nurse first raises the penis, and then lowers it to straighten it as much as possible.

A well-thought-out algorithm can significantly reduce the risks of accidental mechanical damage to the urethral mucosa.

Often, to simplify the procedure and reduce time costs, patients, along with classical cystoscopy, are simultaneously prescribed chromocystoscopy. It aims to evaluate renal activity.

To implement the plan, you will need to first enter a contrast agent intravenously. It is also checked for a possible allergic response of the body in advance.

After the introduction of a contrast agent, the diagnostician must trace which particular ureter it comes out of, how soon this happens, and when exactly urine begins to be released to pass its path further.

The normal indicator is the appearance of urine along with contrast approximately 3-5 minutes after it enters the bloodstream. But if the delay is ten minutes or more, then this indicates a very likely violation of renal activity.

Modern technologies have allowed physicians to create cystoscopes with various parameters without losing their effectiveness in transmitting the collected data. This has been key to attracting the smallest models to test urethral bladder health in children.

The size of the device is selected based on the anatomical features of the baby, as well as the age of the young patient. Today, some medical centers can even boast of such equipment for newborns. Infants are given general anesthesia, but teenage girls, in the absence of serious indications, can get by with local anesthesia.

Side effects

Sometimes even a highly qualified doctor is not able to protect the ward from a number of related complications. The most likely side effect caused by mechanical intervention is blood in the urine. But the inconvenience passes in two days.

The next couple of days that haunt a person, burning, pain, or just discomfort when urinating is a normal condition. These symptoms almost always disappear on their own.

Among the more serious variants of events is the development of cystitis. The source of this kind of problem is not always medical carelessness or error. The reason for the development of the inflammatory process is the uncleanliness of the victim himself, who did not adhere to the rules of hygiene of the external genital organs.

But with cystitis it turns out to cope relatively quickly if you prescribe the right medications and strictly follow the established instructions for taking them. But the puncture of the bladder is a more complicated situation, which is caused by the inexperience of the diagnostician. In this situation, the victim will experience severe pain, which is unlikely to leave him in the near future. Along the way, the amount of urine excreted decreases and a blood admixture appears. The patient will be tormented by chills and fever. In such difficult circumstances, only emergency surgical intervention will help.

To avoid this, you should trust your body only to recognized professionals who have a good reputation in medical circles.