Cystoscopy – examination of the bladder and urethra

Ultrasound shows the bladder from the outside, but some changes in its lining – small tumours, areas of inflammation, narrowings of the urethra – remain invisible to it. Cystoscopy is the test in which Dr Penev looks at the inside of the urethra and the bladder with a thin instrument fitted with a camera. It is the main method for investigating blood in the urine and for detecting and monitoring bladder tumours.

The word “cystoscopy” often causes anxiety. In its modern form, however, the test is done with a flexible instrument and anaesthetic gel, takes only minutes, and most patients describe it as unpleasant rather than painful.

When it is recommended

Cystoscopy is arranged for:

• blood in the urine – visible or found on a laboratory test. Painless blood in the urine, especially in smokers and after the age of 40, requires an examination of the bladder to rule out a tumour and should not be left in the hope that it will “go away”;
• a suspected bladder tumour on ultrasound or a CT scan, as well as follow-up after a tumour has been removed;
• a suspected urethral stricture – a narrowing of the urethra with a weak stream;
• bladder stones;
• persistent burning, frequent urges or pain above the pubic bone where urine tests do not find a cause;
• recurring urinary tract infections in men;
• removal of a JJ (double-J) stent after stone treatment – a short procedure through a cystoscope.

How it is done

Flexible cystoscopy is done with you lying down. The area is cleaned with antiseptic and a gel containing local anaesthetic is put into the urethra; it takes effect within a few minutes. Dr Penev then gently passes in the flexible cystoscope – an instrument about as thick as a slim pen, which follows the curves of the urethra. Sterile fluid is run through it into the bladder so that the walls unfold.

The examination covers the urethra (in men, including its prostatic part), the bladder neck, the bladder walls and the two openings of the ureters. You can follow the image on the monitor while Dr Penev explains what he sees. The examination usually takes five to ten minutes; the most common sensations are pressure and a strong urge to pass urine as the bladder fills.

When a procedure is expected in addition to the examination – a biopsy, removal of a tumour by TUR (transurethral resection), breaking up a stone, widening a stricture – the cystoscopy is done in hospital with a rigid instrument under spinal or general anaesthetic.

Preparation

• A few days before the cystoscopy a urine test is done and, if needed, a urine culture. An active infection is a reason to postpone the test.
• Tell Dr Penev about all your medicines, especially anticoagulants and antiplatelet drugs, and about any allergies to medicines and latex.
• You do not need to fast – with local anaesthetic you can eat normally; for an anaesthetic in hospital you will be given separate instructions.
• Pass urine immediately before the test.
• Preventive antibiotics are not needed for everyone; Dr Penev decides individually based on your risk factors.

After the test – results

Dr Penev discusses what he has seen with you straight after the examination. If there is a suspicious growth, the next step is a biopsy or removal by TUR at Kaspela University Hospital (UMBAL Kaspela), Plovdiv, where the histology (tissue analysis) gives the final answer. If there is a stricture or a stone, the appropriate treatment is planned.

For the first one or two days mild burning, passing urine more often and slightly pink urine are normal; drink more fluids to flush out the bladder. You can return to your usual activities the same day.

Seek emergency help if you develop a high temperature with shivering, cannot pass urine with a full and painful bladder, pass a lot of blood with clots or have severe pain that does not go away. In these cases do not wait for an appointment – go to an emergency department or call 112 (the European emergency number).

Where it is done

Diagnostic flexible cystoscopy is done by appointment at Dr Penev’s urology practice at 5 Anri Barbyus St, Plovdiv, depending on the available equipment and the reason for the test. Cystoscopies with a procedure, under anaesthetic or in a child are carried out at the Department of Urology at Kaspela University Hospital, Plovdiv. Patients from Karlovo can check when booking where it is most convenient to have the test done.

Price

An initial consultation is €50 and a follow-up consultation €30. The price of the cystoscopy depends on its type – diagnostic or with a procedure – and is confirmed when you book.

Blood in the urine and unexplained bladder symptoms should not be left without an answer. Book an appointment with Dr Penev – after an examination and ultrasound he will decide whether cystoscopy is needed and explain every step to you.