Thursday, April 30, 2015

What is the cystoscopy? | Medical tests

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Technique to visualize the inside of the bladder and make a diagnosis, take a biopsy, or practicing certain treatments.

Cystoscopy

Cystoscopy is a technique that allows to visualize the inside of the bladder to make a diagnosis, and also to guide certain treatments if necessary. This is a special type of Endoscope, a tube of about 40 cm long and 0.5 cm in diameter, containing a camera. The tube can be of two types:
Flexible: more comfortable for the patient, allows to visualize the inside of the bladder in a quick way for a first analysis.
Rigid: much more bothersome to the patient; in fact, local anesthesia is almost obligatory. Its main advantage is that it allows to visualize the inside of the bladder with much more clarity, because your camera's higher resolution. In addition, the rigid tube has several recesses by which instruments (forceps, rubber bands, scalpels, etc) can be entered.
The cystoscope was invented in 1877 by the German doctor Maximilian Nitze. At first it was a tube simple hollow which enabled viewing stones inside the bladder and gross alterations of the urethra, but soon added you a light and crevices, allowing you to manipulate the inside of the urinary tract. That is how emerged the first endoscopic interventions in history, long before Arthroscopy or laparoscopy. Dr. Nitze, in addition, used that same device to visualize the inside of the esophagus, stomach and larynx, although it was not as useful as when used to view the inside of the urethra.
Cystoscopy, therefore, is part of the minimally invasive techniques which save major surgery and complications associated with this, such as infections of surgical wounds.

When doing a cystoscopy

A cystoscopy is performed when you want to visualize the inside of the urinary bladder and urethra path to confirm a specific diagnosis. It also allows to take biopsies of the walls of the urethra and bladder and, if necessary, diseases can be treated. The most frequent indications of cystoscopy are:
Check if there is cancer in the walls of the urinary tract, and take biopsies to observe suspicious alterations.
Direct sampling of urine to analyze if there is infection, thus preventing contamination of the sample passes through the urethra and go outside.
Diagnose urinary tract malformations and repair them if possible.
Diagnosis and, occasionally, treatment of the benign prostate hypertrophy, which close the urethra, preventing the passage of urine.
Solve the urethral stenosis by Transurethral resections (TUR), which widen the inside of the urethra.
Remove urinary bladder in or impacted stones in the urethra.
Diagnose the presence of cysts, polyps, diverticula, and other pathological formations of the wall of the bladder. Sometimes they can be solved through cystoscopy.
Study in depth chronic cystitis which have not been resolved with antibiotics.
Identify ulcers in the urinary mucosa and take samples thereof if necessary.
Study the presence of blood in the urine, if its origin is a hemorrhage of the lower urinary tract.

Preparation for cystoscopy

If you will perform a cystoscopy, these are the issues that you must take into account in preparation prior to the test:
Duration: cystoscopy has a variable duration according to the technique that will be used. It can last a few minutes (if it is only necessary for the diagnosis or biopsy), or more than half hour (if any surgical treatment should be performed).
Income: cystoscopy can be done on an outpatient basis. You can put yourself to the test and go your home a little while. However, if it is necessary to carry out any surgical intervention is usually done in an operating room to take extra hygiene measures and regional anesthesia, and so can keep in observation longer.
Is it necessary to be accompanied?: Yes, it is recommended to carry a passenger when performing any surgical intervention during cystoscopy. However, it is not necessary to be accompanied when it comes to timely diagnostic cystoscopy.
Drugs: is not necessary to take any prior medication. Should be communicated to the doctor all the medicines taken regularly, and will decide which suspend or maintain. You should avoid taking medications that hamper the clotting of blood two weeks prior to the cystoscopy if you perform any surgery, such as aspirin, ibuprofen and other NSAIDs.
Food: is not necessary to stay in fasting prior to testing. Yes it is recommended to drink plenty of water the days after the test.
Clothing: can go to the appointment with the urologist with the same clothes every day. If the cystoscopy is performed in the operating room they will give you a comfortable bathrobe to change it by the street clothes.
Documents: is advisable to take the medical history that details the urologic diseases, if you have them, although the doctor will already have it with him. Before you undergo surgery you will sign the informed consent, which you agree to make yourself the technique and you will know the potential risks. If the test is only diagnostic simply an oral consent.
Pregnancy and lactation: cystoscopy is not contraindicated in these situations, but if it is a risk pregnancy is best to do it only if we face a serious situation.
Contraindications: does not have any specific contraindication.

How cystoscopy

Firstly they will ask you if you're agree with you undergo cystoscopy, and testing can be done with a flexible cystoscope in consultation at the same time, if what we want is just to observe the inside of the bladder a few minutes or even take a biopsy. But if you want to perform any surgical technique you will have to sign a written consent and is performed in the operating room anesthesia, so you don't feel any pain throughout the procedure.
The anesthesia can be of three types: general, regional or local. The most frequent is to perform with regional anaesthesia wherever possible. For this practice you a small puncture in his back to anesthetize the nerve roots in the spinal cord directly. Thus, UTI to intervene will not have sensitivity and you'll be awake all the time, although you can sedate yourself so that you are more relaxed. Local anesthesia is not useful in this type of testing, but general anesthesia Yes can be used occasionally.
Before inserting the cystoscope, inlet of the urethra and genitals are disinfected. You will cover with a surgical sheet to limit the area. Usually wash the inside of the urethra with a liquid antiseptic, which also takes a little anesthesia to numb so the walls of the urethra.
It is then when the urologist inserted through the urethra the cystoscope. It can be very annoying and even painful at first. The camera allows to visualize the inside of the bladder and at the same time, introduces normal saline into the bladder to defuse it. When the bladder is filled with serum it is normal that you feel urge to urinate.
The instruments that are inserted into the bladder are very varied: forceps, scissors, handles of coagulation, etc. With them the urologist will get solve the problem that exists. Throughout the procedure is recorded on video so that it can be displayed later by the physician or by yourself. If the test is a biopsy will be sufficient to use tweezers that caught a piece of the internal lining of the bladder, and you can feel a brief prick at that time.
When the intervention is completed the cystoscope is removed. It is normal that the urethra remains distressed for a few hours, and even make you urinate blood for a few days.

Complications of cystoscopy

In general, if they have a cystoscopy you not presentarás no complications and is only recommended to drink between 4 and 6 glasses of water per day to maintain a proper flow of urine. You must see a doctor when you notice fever, chills, pain, or decrease in the amount of urine.
Complications in cystoscopy are not very frequent. Some that occur occasionally are:
The urethra or bladder wall damage. It may be from a small wound to a total rupture of the wall. They may be due to an error of the urologist or by anatomical abnormalities of the patient.
Urine infection after a cystoscopy. When it happens, antibiotic treatment is necessary. If the infection rises to the kidneys causing pyelonephritis treatment antibiotic should be provided intravenously.
Infection of the prostate, i.e., prostatitis. In this case the infection should be treated with an intravenous antibiotic.
Complications of anesthesia (respiratory depression, sedation allergies, nerve paralysis, etc).

Results of cystoscopy

When a diagnostic cystoscopy is performed in consultation, the urologist can get the test results at the same time. So then you can propose a solution or treatment if there is a problem.
If a biopsy performed during cystoscopy or takes samples to cultivate microbes, results may take several weeks.
In case of performing any treatment via cystoscopic, the results are very positive. After undergoing the technique is needed very little time to recover, and can go home the same day if all has gone well.
Published for educational purposes
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