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What is a Cystoscopy

Cystoscopy is a diagnostic procedure that enables doctors to examine the internal surfaces of the bladder and urethra. It involves the use of a cystoscope, a thin, tube-like instrument fitted with a lens and a light source. The cystoscope is carefully inserted into the urethra and then advanced into the bladder. This tool provides a detailed view of the bladder and urethral lining, which is not possible through standard imaging techniques.

Indications for Cystoscopy

Cystoscopy is used for a range of symptoms and conditions related to the bladder and urethra. The primary indications for undergoing a cystoscopy may include:

Hematuria (Blood in Urine)

The presence of blood in the urine is a symptom that warrants investigation through cystoscopy to determine its cause.

Painful Urination (Dysuria)

This symptom can be an indicator of various urinary tract problems, which cystoscopy can help diagnose.

Bladder Stones

These are hard masses of minerals that can form in the bladder and cause various urinary symptoms.

Bladder Control Issues

This encompasses a spectrum of problems such as urinary retention, where the bladder cannot be completely emptied, and incontinence, which is the inability to control urine flow.

Frequent Urinary Tract Infections (UTIs)

Persistent or recurrent UTIs might require a cystoscopy to identify underlying issues that could be contributing to the infections.

Cystoscopy Procedure

The cystoscopy procedure involves several steps to ensure both accuracy in diagnosis and patient comfort.

  1. Anaesthesia: Local anaesthetic gel is often used to numb the urethra. In more invasive procedures, sedation or general anaesthesia may be administered.
  2. Insertion of the Cystoscope: The patient is positioned on a table, usually with feet in stirrups. A lubricated cystoscope is gently inserted through the urethra into the bladder.
  3. Examination: The bladder and urethra are examined for abnormalities. If necessary, small instruments can be passed through the cystoscope to take tissue samples (biopsies) or perform minor treatments.
  4. Completion of the Procedure: The cystoscope is carefully withdrawn. Patients are usually encouraged to empty their bladder after the procedure.

The duration of the cystoscopy varies, generally lasting about five minutes for a diagnostic procedure. It may take longer if biopsies or treatments are performed during the cystoscopy.

Understanding Cystoscopy Results

The results from a cystoscopy can provide insights into the health of the bladder and urethra.

Observation of the Bladder and Urethra

The cystoscopy allows for direct visualisation of the bladder and urethral lining, helping to identify any abnormalities such as inflammation, stones, tumours, or structural issues.

Diagnosis of Specific Conditions

Conditions like bladder cancer, bladder stones, cystitis (bladder inflammation), and benign prostatic hyperplasia (enlarged prostate) can be identified. Urethral strictures (narrowing) and urinary fistulas (abnormal connections) are also diagnosable through cystoscopy.

Analysis of Biopsy Samples

If tissue samples are taken during the procedure, they are sent to a laboratory for further analysis. This can confirm or rule out the presence of cancerous cells or other pathological conditions.

Benefits of a Cystoscopy

A cystoscopy offers several benefits in the diagnosis and management of urinary tract conditions.

Accurate Diagnosis

  • Provides a direct visual inspection of the bladder and urethra, allowing for the accurate identification of abnormalities that may not be visible on imaging tests.

Immediate Treatment Opportunities

  • In some cases, minor issues like small bladder tumours or bladder stones can be treated immediately during the cystoscopy procedure.

Minimally Invasive

  • Compared to other surgical procedures, cystoscopy is less invasive, often requiring only local anaesthesia and involving minimal recovery time.

Biopsy Capability

  • Enables the retrieval of tissue samples for biopsy, which is needed to diagnose conditions like bladder cancer.

Monitoring Treatment Effectiveness

  • Useful in the ongoing monitoring of conditions affecting the urinary tract, particularly after treatment for bladder cancer or other urological conditions.

Reduced Risk of Complications

  • Generally carries a lower risk of complications compared to more invasive diagnostic and treatment methods.

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Risks and Complications of Cystoscopy

While cystoscopy is a generally safe procedure, it is not without potential risks and complications.

  • Urinary Tract Infections (UTIs): In rare cases, cystoscopy can introduce bacteria into the urinary tract, leading to infection.
  • Bleeding: Some blood in the urine is common after a cystoscopy, but heavy bleeding is rare.
  • Pain and Discomfort: Patients may experience mild abdominal pain and a burning sensation during urination after the procedure. These symptoms generally improve gradually.
  • Bladder Spasms: Occasional bladder spasms may occur, resulting in discomfort and urine leakage.
  • Urethral Scarring: Repeated cystoscopies can lead to scarring or narrowing of the urethra.
  • Perforation: Although very rare, there is a small risk of bladder or urethra perforation during the procedure.
  • Anesthesia-Related Risks: For procedures requiring sedation or general anesthesia, there are associated risks, though these are typically low.

Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK

Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

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    Frequently Asked Questions

    How accurate is cystoscopy in diagnosing bladder conditions?

    Cystoscopy is highly accurate in diagnosing various conditions affecting the bladder and urethra. It can identify abnormalities, such as tumours, stones, or inflammation, that may not be detectable through other imaging methods. The accuracy depends on the specific condition being investigated and, in some cases, may need to be supplemented with other diagnostic tests, such as biopsies or imaging studies, for a definitive diagnosis.

    How should I prepare for a cystoscopy?

    You may need to provide a urine sample before the procedure, avoid certain medications, and follow specific instructions if sedation or anaesthesia is involved. Fasting might be required for several hours before the procedure.

    Is the procedure painful?

    Cystoscopy might cause some discomfort but is generally not painful due to the use of local anaesthetic or sedation. Some patients might feel pressure or a sensation similar to needing to urinate.

    What should I expect after the procedure?

    It’s common to experience mild abdominal pain, a burning sensation during urination, and blood-tinged urine for a day or two. These symptoms usually resolve within 48 hours.

    Are there any post-procedure care tips?

    Drinking plenty of water to flush out the bladder, applying a warm cloth over the urethral opening, and taking over-the-counter pain relievers can help ease discomfort.

    When can I resume normal activities?

    Most patients can return to their normal activities soon after the procedure, Make sure to follow any specific guidelines given by your doctor.