The cystoscopy is a urological endoscopic examination, which shows the visual appearance of the penile urethra, prostate, and bladder order. A saline solution that distends the urethra and bladder is used. In this way, the lower urinary tract is evaluated, and the bladder can be evaluated in an empty situation and during its total filling. Therefore, vegetative lesions (which grow into the bladder in the form of a tumor), foreign bodies, the presence of bladder stones, inflammatory and edematous processes, etc., can be detected.
Endoscopic visualization has improved over the last 20 years, with the improvement of the lenses of cystoscopy devices, with greater magnification, flexible video cystoscope and the introduction of means for the image to be transferred to a video. This advance allowed the surgeon to see what was happening and the entire operating room team. In this way, it is possible to discuss the findings with other colleagues and even with the patient, according to the type of anesthesia applied, in real-time. Therefore, these advances made it easier to capture images, which nowadays can even be recorded. Thus, it can even be discussed in the office later with the patient and family.
Types Of Cystoscopes
The indication for cystoscopy must be done with care and precision, as it is an invasive exam. In developed countries and with greater availability of endoscopic materials, it can be done in the doctor’s office since it can be done under local anesthesia. Here in our country, flexible cystoscopes are little used since these devices are more expensive. The rigid cystoscope is the most used, as it has greater durability and is purchased for a lower price.
Some more frequent indications, with or without endoscopic biopsy, are:
Assessment of solid bladder injury previously seen by ultrasound, computed tomography, or magnetic resonance imaging. In these cases, they are usually caused by bladder cancer. The biopsy will define the histological type and is also essential to assess the rest of the bladder epithelium. Any altered epithelium should be considered suspicious and, therefore, biopsied separately to search for carcinoma in situ – CIS.
Evaluation of patients with urinary tract infections such as recurrent cystitis in women and less frequently in men.
Some Cases Of Urinary Incontinence, Both In Men And Women
There are rare cases of benign prostatic hyperplasia – BPH due to anatomical changes in the bladder and in the urethra itself.
To see the entrance to the urethral meatus (where urine from the kidneys enters the bladder). Sometimes tests can be done to visualize better the upper urinary tract (ureters and kidneys). An example is ureter pyelography, where contrast is used to assess the upper tract using radiography. Radioscopy can be used, where the doctor follows the filling of the urinary tract during the application of contrast.
Control after treatments with drugs used intravesical and more often with BCG or chemotherapy drugs used for bladder cancer.
In some cases of HPB to estimate the size and internal anatomy of the prostate and investigate bladder conditions. The presence of diverticula, foreign bodies, bladder trabeculation, and aspects of bladder stones can be observed.
Evaluation of macroscopic hematuria is not defined by imaging methods, either for detecting the bleeding site or if it happens to be from the kidneys.