Cystoscopy of the bladder: indications asmake women, men, training, results, cost

Update: October 2018 Endoscopic examination methods now
firmly entered into the practice of specialists of different profiles. it
safe and very informative for the doctor and patient.

Many people know about colonoscopy (intestinal examination) and
almost everyone is aware of what FGDs are
(fibrogastroduodenoscopy or examination of the stomach with
device that has to swallow).

But not much is known about cystoscopy. However, sometimes
we have to deal with this method of research. Today we
We will talk about this method in more detail, and many of your questions will find
answer.

What is cystoscopy

Cystoscopy is an instrumental examination of the internal
structures of the bladder and urethra. When this happens assessment
the state of its walls, the mouths of the ureters, contractility, capacity,
the presence of pathological foci (inflammation or suspicion of
oncological diseases). When cystoscopy may take
biopsy material (a piece of tissue with the most suspicious
участка слизистой)  для того, чтобы уточнить диагноз, а также
many therapeutic interventions.

The cystoscopy procedure is performed using a cystoscope, this
device from a long tube (tube), a lighting device and
auxiliary parts.

A cystoscope is a standard rigid (rigid) and flexible.

Types of cystoscope

Hard or traditional

The hard cystoscope is a metallic
construction with a long thin tube and magnifying device with
lens.

The tubule (tube) is inserted into the urethra and the doctor,
gradually moving the device into the bladder cavity, stepwise
examines all parts of the mucosa.

Then the device reaches the cavity of the bladder. For full
About 200 ml of sterile is injected into the bladder.
isotonic solution (usually saline).

During the inspection, indications for intervention are determined. AT
In this case, cystoscopy is not only diagnostic
event, but also a medical procedure.

Flexible cystoscope or fibro cystoscope

The flexible cystoscope has a movable tube that can be attached.
any bend, unlike hard metal tube
cystoscope. Flexible cystoscope equipped with a mini-camera at the end.
The image is transmitted to the computer screen.

The image is transmitted to the computer screen.

The advantage of flexible cystoscopy is that images can be
save to digital media and then track the dynamics
diseases.

The procedure itself is the same in both cases, however
with a flexible cystoscope is much more comfortable for patients.

Inspection by a flexible cystoscope has its drawbacks. Often he
less informative than inspecting a hard instrument.

If necessary, additional cystoscope is inserted into the cystoscope tube.
tools for cauterization of ulcers, removal of polyps and stones,
dissection adhesions.

How to prepare for cystoscopy

Conversation with the attending physician

Discusses the issue of anesthesia. Most patients are well
tolerate the procedure using local anesthetics. Other types
pain relief is rarely used. Date and time assigned
carrying out cystoscopy.

Arrive on an empty stomach

ATо-первых, у всех разная реакция на чувство боли и распирания,
which are frequent. If you have not arrived on an empty stomach, then it is possible
nausea, weakness.

ATо-вторых, иногда процедуру начинают на местном обезболивании, а
then you have to do a short general anesthesia. it нужно,
if during the inspection it was necessary to conduct
cauterization or removal of the polyp, removal of stones, and so on.
The procedure is lengthened and the local anesthetic may not be enough.

With general anesthesia, all the muscles in a person are greatly relaxed,
food from the stomach is thrown into the esophagus and can through the larynx
get into the lungs. Food in the stomach is mixed with sour gastric juice,
and if it enters the bronchi and lungs, then the real happens
acid burn. it опасное состояние, требующее госпитализации и
long treatment and observation.

To prevent this, you need to have dinner on the eve no later than 20.00
(light salads, dairy products, cereals) and do not eat in the morning.

Pass tests

  • OAK (complete blood count: hemoglobin, signs of inflammation)
  • OAM (urinalysis)
  • coagulogram or it is also called hemostasiogram (analysis on
    blood clotting).

Sometimes the patient is examined in the clinic and brings tests with
By itself, less often the examination is carried out upon admission.

Hygiene training should be carried out.

A shared shower the night before and in the morning is recommended to everyone. Shaving
crotch shown to those who have active hair.

How to conduct cystoscopy

The patient after preparation and on an empty stomach arrives at the clinic.

The duration of the cystoscopy procedure is from 10 to 60 minutes. ATремя
depends on the complexity of the inspection, the technical capabilities of the equipment and
identified during the inspection of diseases.

The research procedure itself takes place either in a chair,
resembling gynecological, or on the couch.

If you lie down in a chair, then your legs rest on special
coasters with mounts, it helps to create good access for
introduction of the device.

If the diagnosis is carried out on the couch, then you lie on your back,
bend your legs and push your knees apart.

Before the introduction of the cystoscope external genitalia
treated with an antiseptic solution. it необходимо для
prevent pathogen flora from the skin.

After anesthesia, a cystoscope tube is inserted into the urethra,
pre-lubricated with sterile glycerin. Glycerin improves
slip and helps avoid friction and injury to the mucous. To that he
transparent and does not violate the clarity of the picture.

After the tube is inserted, urine is removed from the bladder.
(even its residual amounts). To create a transparent
uniform medium, about 200 ml is injected into the bladder
saline solution. Subject to these conditions, good
visible walls of the bladder, you can appreciate their color, folding,
identify areas of inflammation, sores, polyps and neoplasms
(tumors). AT этот момент пациент может испытать умеренную
bursting or pulling pain in suprapubic region.

The cavity of the bladder is examined by a certain
Algorithm: front wall, left side, then right side
the wall, then the bottom of the bubble, the so-called Leto triangle, and the mouth
ureters. AT дне мочевого пузыря чаще всего локализуются
pathologies (polyps and tumors, including cancer), so this area
looking very carefully. As for the mouth of the ureter,
their location, throughput, symmetry and even
presence and quantity (urinary tract abnormalities are not as rare as
it seems).

Further, if necessary, taking a piece of cloth for
research (biopsy) and therapeutic measures (cauterization, removal
polyps, foreign bodies and stones).

For лечебных манипуляций в трубочку вводят special
Instruments: for removing stones and foreign bodies – cystoscopic
Dormie’s basket, for cauterization of papillomas – electrocoagulator and so
Further.

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For взятия биопсии использую special щипцы, которые также
enter the cystoscope tube and bite off the area from the suspicious
places. Then this fabric is placed in a container with formalin and sent
for histological examination.

After the procedure, the cystoscope is removed and sent to
sterilization.

If local anesthesia was used, the patient is sent.
home. If there was general anesthesia, it will take some time.
observations in the hospital, and then giving up driving.

After the procedure, some unpleasant
sensations:

  • itching and burning in the urethra
  • nagging pains
  • a small amount of blood in the urine
  • painful urination

it следствие внедрения постороннего предмета в такой нежный
organ like a bladder. As a rule, the same complaints can be
about a day, then they pass. If urinating hurts, and urine has
unusual color and for 3-5 days. It should urgently turn to
doctor-urologist to exclude complications.

Cystoscopy in men

In men, the length of the urethra is on average from 15 to 22 cm.
this is observed curvature of the urethra.
Therefore, cystoscopy in men is more technical.
procedure for the doctor and more painful for the patient. Local
pain relief is used in most cases
procedures. The most commonly used flexible cystoscope.

Cystoscopy in women

In women, the length of the urethra ranges from 2.5 to 5 cm, while it
wider than men. it облегчает процесс введения cystoscope.
Diagnosis lasts less, and complications occur much less frequently.
Cystoscopy is sometimes recommended for incontinence.
unclear genesis. it помогает различить урологическая у пациентки
Whether the problem is gynecological. And that means which specialist
should be treated and monitored.

Cystoscopy in children

In children, the procedure is rare. Only in cases where
All types of ultrasound, radiography and MRI give an unclear result. For
children use a special flexible smaller cystoscope
(length and diameter). Boys at birth length
the urethra is about 5 cm, in girls 1.5 cm. As
the growth of the child is calculated approximate the length of the urethra. In children
цистоскопия всегда с обезболиванием, обычно местными
anesthetics. If you are allergic to procaine / lidocaine or baby
still quite small, then held a short total
anesthesia.

Cystoscopy in pregnant women

In pregnant women, cystoscopy is rarely performed, in exceptional
cases. The advantage is given to ultrasonic methods.
diagnostics.

With the purpose of treatment can be performed urinary catheterization.
the bubble.

Pain in the urethra and in the lower abdomen, bursting sensations
due to bladder filling can cause hypertonus
uterus, it threatens miscarriage. On the big terms of pregnancy
the procedure is not so dangerous, but it becomes technically more difficult because
enlarged uterus.

Thus, in terms of examining pregnant women, cystoscopy is not
is a frequent method.

Anesthesia

Cystoscopy with a rigid (standard) cystoscope

it довольно болезненная процедура, все depends on
individual sensitivity, but the use of anesthesia
greatly facilitates the process.

local anesthesia

AT мочеиспускательный канал непосредственно перед введением
The device is administered local decontamination drugs. Used by
Novocain solution 2% about 10 ml or more modern gels on
lidocaine-based (cathedzhel, instillagel).

Several minutes are given for “freezing”, and then the doctor begins
procedure.

clamping

when it comes to cystoscopy and men, it is sometimes used
overlay gentle clip just below the glans penis.
Clamping duration is no more than 10 minutes.

spinal anesthesia

Spinal (spinal, epidural) anesthesia is used
in patients with high sensitivity, in the presence of somatic
diseases (for example, arterial hypertension with crises) or when
a therapeutic and diagnostic procedure is planned (stone removal or
polyp).

general anesthesia

Учитывая небольшую длительность процедуры, general anesthesia
held very rarely: in children, psychiatric patients and in
других редких индивидуальных cases.

As a rule, local anesthesia is sufficient. it самый
frequent type of anesthesia with cystoscopy.

Cystoscopy flexible instrument

The flexible device brings less discomfort, therefore
cystoscopy can be performed without anesthesia.

If the decision was made to anesthetize, then use such
drugs for local anesthesia, as is the case with hard
cystoscope.

Indications

Diagnostics:

  1. interstitial cystitis (deep bladder disease)
    damage to its walls and urination disorders)
  2. chronic cystitis (to clarify the cause and depth of the lesion
    walls of the bladder)
  3. bladder tumors (benign and
    malignant)
  4. diverticula and polyps (pathological processes and protrusions
    inner wall of the bubble)
  5. stones of the urethra, bladder and stones, blocking the mouth
    ureters (in the place where the ureter “falls” into the urinary
    Bubble often occurs wedging small stones)
  6. foreign bodies. Foreign bodies in the bladder – this is not so
    so rare situation. Often in the literature describe the cases
    small objects and parts through the urethra into the bladder. Often this
    associated with the desire to diversify sex life. once
    described the long-term presence of a normal mercury thermometer in
    полости мочевого the bubble.
  7. injuries and consequences of old injuries. The consequences of old injuries and
    Damage to the bladder can be very different. Fistula
    (pathological hole) between the bladder and the vagina
    rectum, in this case, the urine involuntarily flows from
    vagina or from the anus.
  8. structures or pathological constrictions along
    the urethra can be the result of damage,
    inflammation or swelling.
  9. hematuria (blood in the urine) of unknown origin
  10. enuresis in adults and children
  11. diagnostic search for atypical (suspicious
    on cancer cells) in a general urine test
  12. frequent urination and chronic pelvic pains that are not
    managed to cure conservatively and more accurate is needed
    diagnostics.
  13. benign prostatic hyperplasia (BPH) in men

Treatment

Often the diagnostic procedure in the process goes into
therapeutic. With technical capacity and sufficient experience
doctors, the patient can avoid repeating such an unpleasant
procedures and solve two problems in one visit.

  1. removal of foreign bodies and bladder stones and urethra. If a
    stones or foreign bodies are small, accessible to capture, have
    rounded edges and not soldered to the inner wall, i.e. large
    probability of their successful extraction. In the presence of large
    stones you can try to split the stone and extract it by
    parts.
  2. removal of a small tumor or polyp
  3. taking a piece of tissue for histological examination. Any
    remote education and biopsy material anyway
    sent for histological examination to the pathologist. it
    allows you to diagnose cancer, determine its prevalence and
    species, or vice versa confirm that the tumor / polyp is benign
    and nothing to worry about.
  4. stricture dissection. When narrowing the urethra or
    ustiy, urine is defective, lingers and stretches
    urethra it проявляется болью, нарушением мочеиспускания и требует
    лечения.AT этих случаях цистоскопия — это очень щадящий и
    effective method, the places of contractions stretch or intersect and
    urine flow is restored.
  5. stent placement. Stents are cylindrical
    devices that are introduced to expand a certain
    plot. Stenting can be used if dissection adhesions
    it helped for a short time and again there was a narrowing and difficulty of discharge
    urine.

Contraindications

  1. acute inflammatory diseases of the urogenital system (cystitis,
    urethritis, prostatitis, orchitis and others). AT период острого воспаления
    The tissues are friable, painful, swollen and very easily damaged.
  2. тяжелые соматические diseases. Patients with renal,
    hepatic and pulmonary heart disease have a risk
    deterioration на фоне carrying out cystoscopy. With
    the need for the procedure should first be achieved
    stability of a heart or other disease, and
    then start the diagnosis.
  3. coagulation disorders (high risk of bleeding even from
    minor mucosal damage)
  4. early gestation. The uterus and bladder are located
    close. Stretching the bladder solution, tube movement
    cystoscope, pain can trigger hypertonicity of the uterus and even
    cause miscarriage.

Cystoscopy results

AT результате мы должны получить уточнение диагноза, подтвердить
or refute the presence of a tumor and find out its appearance and danger,
remove polyps / stones / foreign bodies, stop bleeding and
find out its source. As we can see, the effectiveness of cystoscopy
very high.

Cystoscopy Complications

  • trauma to the urethra

The mucous membrane of the urethra is very delicate and thin, therefore it is possible
повреждение ее, особенно при использовании жесткого cystoscope.
The risk increases if the patient is restless, moving or trying
impede the process (pulls out the device, trying to get up).

  • wrong move

it очень серьезный вариант травматического повреждения уретры.
With этом цистоскоп создает отверстие в стенке мочеиспускательного
channel and goes into the surrounding tissue. If a цистоскоп проникает в
prostate tissue, then possibly threatening bleeding.

  • cystitis

If a гигиена наружных половых органов была недостаточной и
irregular, then during the procedure with the skin and mucous inside
infection occurs. One treatment with antiseptic solution
It is impossible to remove all kinds of bacteria.

With несвоевременном лечении cystitis может перейти в пиелонефрит,
this is a much more serious kidney disease.
pelvis. With пиелонефрите развиваются боли в пояснице, высокая
лихорадка с ознобом, ухудшаются показатели крови и urine.

  • bladder perforation

Puncture (perforation) of the bladder can happen at
insufficient experience of the doctor, abnormal structure of the bladder or
changes in the location of organs due to adhesions.

Where do cystoscopy

Cystoscopy is carried out in the urological departments of multi-disciplinary
hospitals, day clinics clinics (if available in
clinic urologist) and in private clinics, with appropriate
certification.

Cost of bladder cystoscopy procedure

AT государственных учреждениях процедура выполняется бесплатно по
OMS in the direction of the attending physician, or for paid services. AT
private clinics patient pays all costs.
Prices in different regions vary greatly, the price range is
from 800 rubles to 25,000 rubles.

Цена вопроса также depends on того, первичный это прием или
secondary, need a diagnosis or are already planned medical
activity. The cost increases in accordance with the technical
the complexity and necessity of using additional tools
in the process. Also included in the research price is histological
biopsy of the bladder or urethra.

Conclusion

The method we described is not pleasant and painless, but
He is very informative. If a по УЗИ и МРТ не получается поставить
диагноз, есть подозрение на рак или хронический cystitis, то
agree to cystoscopy, as you recommend
attending doctor. Often a single procedure is enough to
establish the diagnosis and prescribe the most effective treatment.

Removal of the same stones or polyps during cystoscopy is
unique method, all interventions are carried out through natural
holes, no need to cut the belly and enter the small cavity
pelvis. it намного безопаснее открытой операции.

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