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Cystoscopy

Cystoscopy is used to examine the urethra and bladder. In a female animal, it is also used to examine the vaginal area. It is used to further evaluate patients with recurrent or persistent urinary tract infections; kidney, ureteral or bladder stones; urinary incontinence; or bladder masses. Cystoscopy is often performed after radiographs (X-rays), abdominal ultrasound and other imaging studies to evaluate anatomy and structure. In cases with urinary incontinence or difficulty urinating, special studies of bladder and urethral function, cystometrogram and urethral pressure profile, may be indicated prior to or in coordination with cystoscopy. A cystometrogram evaluates bladder filling and contraction, whereas urethral pressure studies and electromyographic studies evaluate the strength and length of the urethra.

Uses of Cystoscopy

In addition to allowing visual examination of urinary tract, cystoscopy can be used to:

  1. Diagnose the cause of urinary tract signs such as hematuria (bloody urine), urinary incontinence, urinary retention, and persistent or recurrent urinary tract infections.
  2. Obtain tissue samples (biopsy) for cytologic and histologic evaluation. Samples are evaluated for inflammation, infection, fibrosis and cancer. This generally takes three to five days.
  3. Removal of stones (directly or via laser lithotripsy) or growths.
  4. Correct ectopic ureters through laser resection.
  5. Place ureteral or urethral catheters (stents) to aid urine flow past obstructions.

Procedure

The patient is generally fasted for 12 hours prior to cystoscopy to decrease the risk of aspiration of stomach contents into the lungs. After being anesthetized, the patient is placed on its side and anesthetic monitoring equipment is attached. The patientís heart rate and rhythm, respiratory rate, blood pressure, carbon dioxide level and oxygen saturation level are closely monitored while under anesthesia to prevent and minimize anesthesia-associated complications.

The tip of cystoscope is lubricated and gently advanced through the urethra into the bladder. As the cystoscope is advanced, the luminal surface is closely examined for abnormalities including inflammation, stones, and masses. When the tip of the cystoscope reaches the bladder, the bladder is filled with saline to improve examination of the bladder wall for abnormalities. Photos and videos may be collected of normal and abnormal structures and motility for documentation and further study. If stones are found, the stones can be removed using grasping forceps, a snare or a basket retrieval device. Large stones may be broken down into smaller pieces using a laser to facilitate removal. A number of biopsy samples may be collected from the bladder wall, regardless of appearance, for histopathology and culture. This is because tissues may be diseased even if they appear normal visually.

Cystoscopy generally takes between 20 minutes and one hour depending on gross findings, number of biopsies taken or the amount of stones found. At the end of the procedure, the sterile saline is removed from the bladder and the scope is slowly removed. The patient is recovered from anesthesia. Most patients can go home on the day of the procedure.

Risks and Limitations

Cystoscopy is generally considered a safe procedure. In addition to risks or limitations of endoscopy in general, some blood may be seen in the urine that should stop by itself. The patient may exhibit signs of difficulty urinating due to swelling of urethra. Urinary tract infection is a possible risk after the procedure. A rare complication is perforation of the urethra or bladder with the cystoscope.

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