Cystoscopy is a medical procedure that uses 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 into the urethra, directly observing the mucosal condition through an optical system, and can simultaneously perform tissue sampling or minor surgeries. This procedure is widely used for precise assessment of symptoms such as hematuria, frequent urination, and difficulty urinating, allowing for immediate detection of tumors, stones, strictures, and other issues.
Depending on the purpose, cystoscopes are classified into diagnostic and therapeutic types. Diagnostic cystoscopy focuses on visual assessment and cell sampling, while therapeutic procedures can include lesion removal, stone fragmentation, or catheter placement. Modern equipment integrates imaging systems and laser technology, greatly enhancing procedural 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 employ 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 a cold light source. 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 for suspected bladder cancer, and urinary tract stone localization. When ultrasound or X-ray results are inconclusive, cystoscopy provides precise diagnosis under direct vision. Additionally, it is used to evaluate the 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 should empty their bladder and assume the lithotomy position. Topical anesthetic gel is applied to the urethral opening to reduce discomfort. Rigid cystoscopy typically takes 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 procedures such as tissue biopsies or stone fragmentation may require deeper anesthesia and longer procedure times. Post-procedure, antibiotics may be used to prevent infection depending on the scope of examination, and urination should be monitored. Most patients can resume normal activities within a few hours.
The real-time imaging capability allows immediate detection of minute lesions, which is crucial for early diagnosis of bladder cancer. Compared to imaging studies, it can clearly distinguish mucosal lesions from deeper tissue issues and provides immediate histopathological analysis.
Common short-term discomforts include urethral irritation (such as burning during urination), minor 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 immunosuppression are at higher risk.
Emergency warning symptoms include:
These symptoms require immediate medical attention for urethral dilation or antibiotic treatment.
Fasting for 4-6 hours before the procedure (for general anesthesia) is recommended, and it should be avoided during acute urinary tract infections. Female patients are advised to postpone the examination during menstruation. Contraindications include severe urethral stricture preventing scope insertion, uncontrolled acute urinary tract infection, and uncorrected coagulopathy.
Special populations such as patients with cardiac pacemakers should choose equipment unaffected by radio waves. Patients with benign prostatic hyperplasia may need to take alpha-blockers beforehand to dilate the urethra. After the procedure, strenuous activity and sexual intercourse 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 damage. 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 to confirm diagnoses.
Detection rates for lesions in hematuria patients reach 80-90%, with early bladder cancer diagnosis accuracy surpassing imaging studies. Systematic evaluations show that combining endoscopy and histopathology has 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 98% success rate in removing stones smaller than 0.5cm and reduces hospitalization 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 observe 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 can be performed initially, but these methods have diagnostic blind spots. 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 4-6 hours and voiding the bladder are generally required, though specific protocols vary by medical facility. Patients should empty their bladder on the day of the procedure. Some may need to take antibiotics beforehand to prevent infection or undergo urine tests to confirm no signs of inflammation. Wearing loose clothing is recommended for ease of procedure, and bringing a list of current medications and allergies is advised.
Is it normal to see blood in urine or experience pain during urination 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 can help promote metabolism, and avoiding irritant foods (such as spicy foods and alcohol) is recommended. If hematuria persists beyond 48 hours, pain worsens, or fever develops, medical attention should be sought to rule out infection or mucosal injury.
Can I resume daily 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 advised 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 reduce infection risk. 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 tissues 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 has high precision, and risks are controlled below 1%. Postoperative follow-up can effectively monitor 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 is typically arranged within 1-2 weeks after the report is issued. For example, bladder cancer patients may need imaging or surgical evaluation within 4-6 weeks. For asymptomatic patients with minor inflammation, doctors will set a follow-up schedule 6-8 weeks later based on individual conditions.
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