Norm of Cystoscopy
Normal structure and function of the bladder; absence of urethral strictures or abnormalities, tumors, or bladder calculi; and absence of inflammation or purulent secretions.
Usage of Cystoscopy
Diagnosis of bladder cancer (99% Stage Ta grade I), diagnosis of vesicoureteral efflux in children, evaluation and differentiation of urinary tract disorders, method for obtaining bladder and ureteral biopsy specimens, sometimes used for excision of small tumors, evaluation of hematuria and of suspected urinary tract malformation in children.
Description of Cystoscopy
Cystoscopy is the direct, transurethral visualization of the bladder and urethra with the use of a lighted, magnifying cystoscope with a variety of lenses. The cystoscope is a metal instrument with a solid obturator that is placed inside a sheath within the urethra. Flexible cystoscopy is becoming more widely used as an alternative to rigid cystoscopy. Cystoscopy is indicated after other tests (such as cystography) show abnormalities; for evaluation of symptoms such as dysuria, frequency, and incontinence; or for evaluation of hematuria. It is also used as surveillance for recurrent bladder lesions such as transitional cell carcinoma. The procedure may be performed in a hospital or office by a physician or specialist urology nurse.
Professional Considerations of Cystoscopy
Consent form IS required.
Bleeding, infection (7.8% overall and 21.7% in enterocystoplasty clients), urinary tract obstruction.
Acute inflammations of the urethral passage. Sedatives are contraindicated in clients with central nervous system depression.
- See Client and Family Teaching.
- Obtain a cystoscopy tray, disinfectant or surgical scrub solution, a genitourinary irrigant, drapes, sterile gloves, a cystoscope with appropriate lenses, obturator and light source (today video monitoring is common and the appropriate lens connector for camera and cord connection to the video unit is recommended), filiforms and followers, and two or three sterile specimen containers (for possible biopsy, urine for culture and sensitivity, and a urine sample for cytologic testing).
- A sedative may be prescribed.
- Prophylactic antibiotics do not decrease the incidence of urinary tract infection in clients with sterile urine.
- The client should disrobe below the waist or wear a gown.
- Obtain baseline vital signs.
- Pad the lithotomy stirrups.
- Have emergency equipment readily available.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The client is positioned in the supine position on the cystoscopic table for possible administration of general or regional anesthesia.
- The client is then placed in the lithotomy position for external genitalia cleansing and draping and cystoscopic examination.
- After local anesthesia (if used) is instilled into the urethra and bladder and retained for 10–20 minutes, the urethra is progressively dilated (if necessary), and a cystoscope with obturator in place is inserted through the urethra into the bladder. The cystoscope is usually placed with the obturator in place in women and under direct vision with a 0- or 30-degree lens or flexible cystoscope in men. Pain can be significantly reduced by use of 20 mL of 2% lignocaine (lidocaine) gel left in the urethra for 15 minutes.
- Urine specimens for culture or cytologic study may be removed through the cystoscope.
- The bladder is filled with genitourinary irrigant solution, and the lighted cystoscope is used with magnification to directly examine the interior walls, structures, and contents of the bladder and urethra.
- The bladder is inspected for tumors, calculi, diverticula, obstructions, and other lesions. The urethra is inspected for strictures and other lesions.
- A biopsy sample of the bladder or ureters may be taken, and tiny tumors may also be excised through the cystoscope, with bleeding controlled by electrocautery.
- For general anesthesia, monitor vital signs every 15 minutes × 4, then every 30 minutes × 2, and then every 2 hours × 2. Typical postanesthesia monitoring also includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway and neurologic status until the client is lying quietly awake, is breathing independently, and responds appropriately to commands spoken in a normal tone.
- For local anesthesia, assist the client to a chair until strength has returned to baseline value or for at least 15–30 minutes.
- Encourage oral intake of fluids: 125 mL/hour for 24–48 hours when not contraindicated.
- Monitor fluid intake and urine output for 24 hours.
- Observe for urinary retention or symptoms of urinary tract infection (fever, chills, pain [abdominal, suprapubic, or flank], tachypnea, tachycardia, hesitancy and frequency, dysuria, and hematuria). Notify the physician if any of these signs occur.
- Observe for hematuria. Pink urine is normal initially but should clear. Frank hematuria or clotting is abnormal. Dysuria lasting more than 4–6 hours is abnormal.
- Analgesics may be prescribed for bladder spasms, and sitz or tub baths may help decrease generalized genital area discomfort.
- Resume diet.
Client and Family Teaching
- Arrange for someone to drive you home if the procedure was performed using anything other than local anesthesia because you will not be permitted to drive for 24 hours after having general anesthesia. It is also suggested that someone drive you home after local anesthesia in some situations, but this is not absolutely necessary.
- For general anesthesia, fast from food and fluids for 8 hours. For local anesthesia, consume only clear liquids for 8 hours. You may be required to take in a large amount of fluids to promote urine flow during the procedure.
- Clients receiving local anesthesia may feel the urge to void while the cystoscope is in place.
- After the procedure, drink 6–8 glasses of water or other fluids per day for 2 days (unless contraindicated). Watch for warning symptoms of complications (see above). Report chills, fever, dysuria, or frank blood in the urine.
- Do not have sexual relations until the physician confirms healing.
Factors That Affect Results
- Urethroscopy or retrograde pyelogram may also be combined with cystoscopy.
- Cystoscopy may also be used as a therapeutic procedure to crush and remove calculi, perform bladder irrigation, resect tumors, or perform a transurethral resection of the prostate gland.
- The use of intraurethral lidocaine gel has not been shown to decrease client pain during rigid cystoscopy. Anxiety has been shown to positively correlate with pain perception.