Cystoscopy is a medical procedure that involves the use of an endoscope to observe the urinary tract system, primarily used for diagnosing and treating abnormalities of the urethra, bladder, and upper urinary tract. The physician inserts a slender endoscope through the urethra, directly visualizing the mucosal condition via an optical system, and can perform tissue sampling or minor surgeries simultaneously. This procedure is widely employed for precise assessment of symptoms such as hematuria, frequent urination, and urinary difficulty, enabling immediate detection of tumors, stones, strictures, and other issues.
Based on the purpose of the examination, cystoscopies are categorized into diagnostic and therapeutic types. Diagnostic procedures focus on visual assessment and cytology sampling, while therapeutic procedures may include lesion removal, stone fragmentation, or catheter placement. Modern equipment integrates imaging systems and laser technology, significantly enhancing operational accuracy and patient comfort.
There are mainly two types: "rigid cystoscope" and "flexible cystoscope." Rigid cystoscopes use a metal tube structure suitable for tissue biopsies or stone removal. Flexible cystoscopes utilize bendable fiber optics, reducing urethral irritation and suitable for initial examinations or female patients. Both transmit real-time images to a display screen via high-resolution cameras.
The examination mechanism involves three stages: first, local or general anesthesia ensures patient comfort; second, the endoscope is slowly inserted into the urethra; third, the interior of the bladder is illuminated with cold light. During treatment, miniature tools such as laser devices or graspers can be inserted through the endoscope channel to directly address lesions.
Common indications include unexplained hematuria, recurrent cystitis, tumor screening suspected of bladder cancer, and urinary tract stone localization. When ultrasound or X-ray results are inconclusive, cystoscopy provides precise diagnosis through direct visualization. Additionally, this procedure is used to evaluate causes of urinary incontinence and the degree of urethral stricture.
Special indications include monitoring postoperative recurrence of bladder cancer, assessing mucosal changes in interstitial cystitis, and confirming anatomical abnormalities caused by urethral trauma. Children with congenital urinary tract anomalies may require examination under general anesthesia.
The procedure is usually performed on an outpatient basis. Patients are required to void before the procedure and lie in the lithotomy position. Topical anesthetic gel is applied to the urethral opening to reduce discomfort. Rigid cystoscopy typically takes about 15-30 minutes, while flexible cystoscopy, due to its greater flexibility, may be shorter, around 10 minutes. Anesthesia choice depends on patient tolerance; elderly or sensitive patients may consider intravenous sedation.
Therapeutic operations such as tissue biopsy or stone fragmentation may require deeper anesthesia and longer procedure time. Post-procedure, antibiotics may be prescribed to prevent infection depending on the scope of the examination, and urination is monitored. Most patients can resume normal activities within a few hours.
The real-time imaging capability allows immediate detection of minute lesions, which is especially critical for early diagnosis of bladder cancer. Compared to imaging studies, it can clearly differentiate mucosal lesions from deeper tissue issues and provides immediate histopathological analysis.
Common short-term discomforts include urethral irritation (such as burning sensation during urination), mild hematuria, and lower abdominal discomfort, occurring in about 15-20% of patients, usually resolving within 2-3 days. Serious complications such as urethral perforation, severe bleeding, or infection are rare, with an incidence below 1%, but patients with diabetes or immunocompromised states are at higher risk.
Emergency warning symptoms include:
These conditions require immediate medical attention for urethral dilation or antibiotic treatment.
Fasting for 4-6 hours before the procedure is recommended (for general anesthesia), and it should be avoided during acute urinary tract infections. Women are advised to postpone the procedure during menstruation. Contraindications include severe urethral stricture preventing scope insertion, uncontrolled acute urinary tract infection, and uncorrected coagulation disorders.
Special populations such as patients with pacemakers should choose equipment unaffected by radio waves. Patients with benign prostatic hyperplasia may need to undergo alpha-blocker therapy to dilate the urethra beforehand. After the procedure, strenuous exercise and sexual activity should be avoided for 24 hours to reduce infection risk.
Biopsy procedures may interact with anticoagulant medications; it is recommended to stop drugs like aspirin 7 days prior. If combined with bladder dilation, the endoscope diameter should be adjusted to prevent tissue injury. For cancer patients undergoing immunotherapy or chemotherapy, treatment plans should be reassessed after the procedure.
Compared to imaging, cystoscopy allows direct observation of mucosal micro-lesions but cannot evaluate issues in the kidneys or upper ureters. It is often combined with ultrasound or CT urography for diagnosis confirmation.
The detection rate of lesions in hematuria patients reaches 80-90%, with early bladder cancer diagnosis accuracy surpassing imaging. Systematic evaluations show that combining endoscopy with histopathology yields a sensitivity of 95% and specificity over 90%. The American Urological Association considers it the gold standard for hematuria assessment.
Clinical studies confirm that therapeutic cystoscopy has an effectiveness rate of up to 98% for removing stones smaller than 0.5cm and reduces hospitalization needs by 70% compared to extracorporeal shock wave lithotripsy. For recurrent urinary tract infection patients, it can identify anatomical abnormalities and facilitate immediate repair.
Ultrasound can non-invasively assess bladder morphology but cannot visualize mucosal changes; urine cytology is low-cost but has only 60% sensitivity. Urethroscopy focuses on the lower urinary tract, while retrograde pyelography offers superior diagnosis of upper urinary tract obstructions but is invasive.
If patients cannot undergo endoscopy, urine cytology and tumor marker tests may be performed initially, but these methods have clear diagnostic limitations. For high-risk patients, most medical guidelines still recommend cystoscopy as the primary assessment tool.
What preparations are needed before the examination? Is fasting or bladder emptying required?
Before cystoscopy, fasting for 4 to 6 hours and abstaining from fluids are generally required, though specific regulations vary by medical facility. Patients should void before the procedure. Some may need to take antibiotics to prevent infection or undergo urine tests to confirm no signs of inflammation. Wearing loose clothing is recommended for ease of procedure, and a list of current medications and allergies should be prepared.
Is blood in the urine or pain during urination normal after the procedure? How can it be alleviated?
Minor hematuria or burning sensation during urination are common and usually improve within 1-2 days. Drinking plenty of water after the procedure helps promote metabolism, and avoiding irritant foods (such as spicy foods and alcohol) is advised. If hematuria persists beyond 48 hours, worsens, or if fever develops, immediate medical attention is necessary to rule out infection or mucosal injury.
Can I resume normal activities immediately after the procedure? What precautions should I take?
Most patients can resume light activities within 2-4 hours post-procedure, but it is recommended to avoid heavy lifting or prolonged sitting on the same day. Sexual activity, hot baths, or use of enema products should be avoided for 24 hours to prevent infection. Patients whose work involves high concentration (such as driving or operating machinery) should rest for half a day and observe their condition.
Why is tissue biopsy sometimes performed after the examination? Does it increase risks?
If abnormal lesions (such as tumors or irregular tissue) are observed, the physician may perform a biopsy immediately to confirm the nature of the lesion, shortening diagnosis time. Although biopsies may slightly increase the risk of bleeding or perforation, modern endoscopic equipment is highly precise, and risks are controlled below 1%. Postoperative follow-up effectively monitors wound healing.
When abnormal results are found, how long until follow-up or subsequent treatment is scheduled?
If stones, tumors, or other lesions are detected, follow-up appointments are typically scheduled within 1-2 weeks after the report is issued to discuss treatment plans. For example, bladder cancer patients may need imaging or surgical evaluation within 4-6 weeks. Asymptomatic patients with minor inflammation will have follow-up schedules based on individual circumstances, usually 6-8 weeks later.
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