Cystoscopy - Causes, symptoms and treatment. MF.

Cystoscopy is an endoscopic method for examining the bladder and urethra, which consists in examining the mucous membranes of these organs with the help of a special optical system. To date, there are two types of cystoscopes: rigid and mobile. When working with the first urologist directly examines the urinary tract, and during the application of the second image appears on the monitor screen.

Cystoscopy with a rigid

device Cystoscopy with a computer cystoscope

Indications for cystoscopy

Cystoscopy can not be called a routine method of investigation, because it is much more painful, unpleasant and more expensive than, for example, ultrasound examination of the kidneys and bladder. But, despite this, it is widely used in urology and has a considerable list of indications.

In case of hematuria( discharge of blood in the urine), cystoscopy is performed to identify the site of bleeding. If even when the mucosa is examined and the source of bleeding is not revealed, then it can be asserted that it is in the kidney or ureter and, accordingly, perform other methods of investigation.

In the presence of an external body in the bladder cavity, cystoscopy is simply a "gold standard" for diagnosis. The fact is that with the help of this method it is possible not only to accurately determine the size and nature of an extraneous object, but also to solve the problem with the patient's treatment. For example, with small external bodies with smooth contours and edges, they can be removed naturally by using the same cystoscope.

For the same purpose, cystoscopy is performed and if there is a suspicion of the presence of a calculus in the bladder cavity, which in medicine is called urolithiasis. As well as with external bodies, with urolithiasis, cystoscopy can be one of the methods of treatment.

Traumatic injuries of the urethra and bladder are also absolute indications for cystoscopy. With the help of this method, it is possible to diagnose the size and position of ruptures and bruises of the mucous membrane of the urethra and bladder.

Another absolute indication for cystoscopy should be considered oncological diseases of the bladder and urethra. Strictly speaking, in order to diagnose this pathology, this method was developed in due time.

Contraindications to cystoscopy

Contraindications to this diagnostic method are divided into local and general. First of all, local contraindications include inflammatory diseases of the bladder and urethra, such as urethritis and cystitis. When carrying out cystoscopy, the mucous membrane of these organs lends itself to additional traumatization, which leads to an aggravation of the inflammatory process. Therefore, before appointing such a procedure, it is necessary to conduct the entire spectrum of laboratory studies to identify the inflammatory process.

As for general contraindications, these include serious diseases of internal organs in the stage of decompensation. For example, the performance of cystoscopy in renal or hepatic insufficiency threatens to worsen the overall clinical state. This method of research is also not recommended for people in old age who have problems with the cardiovascular system. Categorically contraindicated procedure for patients with myocardial infarction. Since this disease can proceed painlessly, all patients who are scheduled to perform cystoscopy should perform electrocardiography.

In the list of contraindications to cystoscopy, pregnancy also entered. Since the bladder is in close proximity to the uterus, the execution of various manipulations on it threatens to damage the walls of the genital organ, which can result even in miscarriage. Therefore, in pregnancy it is better to use more gentle methods, such as excretory urography or ultrasound.

Preparation for cystoscopy

Cystoscopy threatens to enter a pathogenic infection in the bladder. The probability of this complication directly depends on the purity of the patient's external genitalia and the sterility of medical instruments. If the last patient can not be affected in any way, then it is simply obliged to ensure the purity of his genitals. This he will do useful not only to the doctor, but to himself.

In addition, in everyday life there is an opinion that before carrying out cystoscopy it is necessary to fill your bladder. As medical practice and theory tell us, it is absolutely not necessary to do this. Naturally, for a good cystoscopy, the bladder should be full, but nothing terrible will happen if the patient comes to the procedure before pissing. The fact is that the doctor himself can fill the bladder after inserting a cystoscope into it.

To reduce painful sensations during cystoscopy, a catechol is administered to the urethra. Naturally, a cheap medicine is not provided to patients free of charge, which means that it must be purchased. In order not to carry out unnecessary trips to the pharmacy, buy the drug better before visiting the cystoscopic cabinet.

Cystoscopy with the eyes of the patient

If you look at the procedure performed by the patient, you will not get a very pleasant picture, as often manipulation delivers many unpleasant and even painful sensations.

At the very beginning of the procedure, the patient is placed on the couch and he is treated with the skin of the external genitalia. This is done in order to reduce the risk of infection in the bladder.

After this, in the urethra, with the help of a special pipette, the catechal drug is found. This is done in order to improve the glide of the apparatus through the urethra and reduce the patient's pain.

The next step in the procedure is the introduction of the cystoscope itself. At this moment, the anesthetic effect of the catechism is felt, so the patient does not feel any unpleasant sensations. Further, when manipulations are performed in the cavity of the bladder itself, the patient can feel even severe pains in the lower abdomen, which must be prepared in advance.

The procedure ends with the extraction of a cystoscope from the bladder cavity. As a rule, at this point the patient feels a sharp relief. Approximately two hours later, when the effect of an anesthetic drug passes, the pain can resume. But in this situation, they are already localized in the projection of the urethra, and are not acute, but aching.

Action of the doctor in the conduct of cystoscopy

Cystoscopy is exclusively medical manipulation and carrying out by her nurse is absolutely unacceptable. Depending on the type of cystoscope, after its introduction, the urologist examines the mucosa of the bladder in the opening of the optical device or in the monitor. At this time, he must determine all pathological formations that exist in this anatomical site. It is desirable that this be done as quickly as possible, because, as already mentioned, manipulation of the apparatus in the bladder cavity delivers unpleasant sensations to the patient.

Duration of the procedure and the length of stay in the hospital

The duration of cystoscopy, like many other medical procedures, depends on the disease, the type of apparatus and the qualifications of the specialist. For example, to examine the normal mucosa of the bladder and urethra will take no more than five minutes. If we add to this time another five minutes to prepare for the procedure, it turns out that at best, from the beginning to the end it lasts no more than ten minutes. If the manipulation is performed, say, for the purpose of performing a catheterization of the ureter, it can last about an hour. Even if during this time the planned medical manipulation is not performed to the end, it is not recommended to continue it, as this may result in damage to the urethral mucosa. In addition, it is necessary to remember and about the unpleasant sensations that the patient experiences.

The time spent in the hospital before and after the procedure is determined not by the manipulation itself, but by a disease that obliged the doctor to prescribe the procedure. If the diagnosis does not reveal any pathological condition, the patient can go home on the same day.

Possible complications in cystoscopy

The most frequent complication of cystoscopy is infection in the bladder cavity. As already mentioned, the reason for this is insufficient hygiene of the external genital organs or non-sterile medical instruments. As practice shows, most often against this background develops cystitis, which is manifested by minor pain in the lower abdomen, as well as frequent urge to urinate. In addition, a small amount of blood may appear in the patient's urine, which is caused by erosion of the mucous membrane of the bladder.

Besides, traumatic complications of cystoscopy are often noted. The most difficult place for the introduction of a cystoscope is the urethra section at the level of the prostate gland. Here the urethra makes a physiological bend, so for its normal passage it is necessary to correctly position the cystoscope tube. It is especially difficult to perform cystoscopy in such a disease as prostate adenoma. Therefore, it is in elderly patients that such complications of cystoscopy as traumatic urethral ruptures are most often observed.

Not so frequent, but more dangerous complication at carrying out of a cystoscopy is a perforation of a bladder. It is a puncture of its organ wall with the outflow of urine beyond its limits. As practice shows, this occurs when a biopsy of the mucosa of the bladder is performed. When taking a histological material, the urologist may not calculate the depth of needle insertion and accidentally pierce the wall of the bladder. A particular danger of such a complication is that it can not always be diagnosed at the time of its occurrence. Quite often there are hidden perforations, which are detected only after the suppuration of the adipose tissue of the retroperitoneal space or the cellulose tissue of the pelvic cavity.

With the correct procedure, the risk of complications is minimal.

Rev.the doctor the urologist, the sexologist-andrologist Plotnikov AN