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Cystoscopy with a flexible cystoscope (+ possibly an associated procedure)


What does this procedure entail?

The purpose of this procedure is to examine and assess the condition of the mucosa and the interior space of the bladder, the orifice of ureters and the inner orifice of the urethra, as well as the urethra itself – in men also the area of the prostate. The most common reason for this examination is to search for the source of blood in the urine (possibility of a bladder tumour), the cause of unclear urinary disorders or problems with urinary incontinence, recurrent inflammation, etc. During this procedure, it is possible to perform sampling from the bladder and urethra wall, to treat bleeding areas using electrocoagulation (ELCO – high frequency current burns). Similarly, a foreign body, a smaller stone, and a stent can be removed from the bladder. The procedure is performed without general anaesthesia – usually on an outpatient basis. Some procedures are reimbursed by some health insurance companies for women only in special cases, e.g., with significantly limited hip joint mobility.

What are the alternatives to this procedure?

Cystoscopy rigid – in women most commonly under local anaesthesia, in men under general anaesthesia.

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach. Normally, it is not necessary to discontinue these drugs prior to diagnostic flexible cystoscopy.

Remember to inform your physician about the following possible facts before the surgery:

  • artificial heart valve
  • coronary artery stent
  • pacemaker
  • artificial joint
  • artificial vascular graft
  • neurosurgical bypass
  • other implanted foreign body
  • use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton  Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
  • drug and other allergies
  • any abnormalities or eventualities

 It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before your admission for the procedure.

What will happen during the surgery?

You will normally receive an injection or oral antibiotics before the procedure, but any allergies must be checked first.
You will be placed on an examination couch. After disinfecting the outer orifice of the urethra and its surroundings and after applying an anaesthetic gel, a flexible instrument with a diameter of about 5-6 mm is inserted into the bladder through a tube under visual control. The bladder is then filled with sterile fluid. You may feel pressure in your lower abdomen during filling – inform your doctor about these sensations. The doctor will turn the instrument and gradually examine the entire inner wall of the bladder, the ureteral orifices and, finally, the urethra when pulling the instrument out. Special optics and light supplied to the optics with a glass fibre cable is used to this end.

The procedure itself usually takes a few minutes.

What will happen immediately after the procedure?

After the procedure, the doctor will explain the finding and possibly further diagnostic/treatment steps.

You should:

  • ask if the planned outcome was achieved
  • inform the medical staff about any problems
  • ask what you can and cannot do
  • ask all the questions you have for the healthcare professionals and members of the medical team.
  • remember (and understand) why the surgery was performed, how it turned out, and what will follow

After the procedure, you should urinate to excrete the liquid used to fill your bladder. Afterwards, you can wash up and dress.

What are the postoperative risks or complications?

Common (10% of procedures of this type)

  • Slight burning or bleeding when urinating for a short time after the procedure
  • Sampling in case of an abnormal finding on the bladder wall with the need for further management under general anaesthesia

Occasional (2-10% of procedures of this type)

Inflammation of the bladder requiring antibiotic treatment

Rare (may occur in 2% of procedures of this type)

  • Temporary need for a catheter inserted into your bladder
  • Subsequent bleeding requiring clot removal or surgical revision
  • Injury to the urethra, which causes a scarring and narrowing 

Hospital infections

  • MRSA colonisation (0.9% – 1 of 110)
  • Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
  • MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you are discharged from the hospital, you should:

  • Get recommendations on recovery at home
  • Ask when you can return to normal activities such as work, exercise, driving, housework and sexual activities
  • Get a contact number for further questions after returning home or in case of trouble
  • Ask about the date and place of subsequent check-ups (hospital or your doctor)
  • Make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs

At your departure from hospital (sometimes several days later), you will receive a hospitalisation report / report on the performed procedure. The document contains important information about your hospital stay, your surgery and recommended follow-up. If you need to call your attending physician or visit the hospital for any reason, take this document with you so that the physician knows the details of your treatment. This is especially important if you need to consult another doctor or longer after discharge.

After returning home, you should drink 2x more fluids than normal for the next 24-48 hours. When urinating, you may initially experience burning and tingling up to pain, and blood may be present in the urine. These problems will quickly disappear if you have a high fluid intake.

What else should I watch out for?

If you develop a fever, severe pain when urinating, if you are unable to urinate or your bleeding gets worse, contact your doctor.

Important information?

If samples have been collected for histological examination, you will be informed about the result at the next check-up by your doctor/urologist.

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