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Introduction ⬇

Cystoscopy is the visualization of the urethra and bladder with the use of a cystoscope. It is performed to diagnose and treat disorders of the lower urinary tract.

Cystoscopy is the most common of all urologic diagnostic procedures. It may be indicated in the following conditions:

  1. Unexplained hematuria (gross or microscopic)

  2. Recurrent or chronic urinary tract infection

  3. Infection resistant to medical treatment

  4. Unexplained urinary symptoms such as dysuria, frequency, urgency, hesitancy, intermittency, straining, incontinence, enuresis, or retention

  5. Bladder tumors (benign and malignant)

  6. Pediatric considerations include the above and the following:

    1. Posterior urethral valves, ureteroceles in females, and other congenital anomalies

    2. Complete workup of children with daytime incontinence usually done in conjunction with urodynamic studies

    3. Removal of foreign objects and stents placed in previous surgeries

Because IV pyelography does not allow proper visualization of the area from the neck of the bladder to the end of the urethra, cystoscopy makes it possible to diagnose and to treat abnormalities in this area.

A ureteroscopy procedure visualizes the ureters and kidneys with the use of a ureteroscope, which is longer and thinner than a cystoscope. This procedure may be performed to identify the cause of urine blockage in the ureters, such as a kidney stone, or to evaluate abnormalities in the ureters or kidneys, such as polyps or tumors.

Biopsy specimens can be obtained during either procedure. General anesthesia may be given to perform a cystoscopy or ureteroscopy, although a local anesthetic into the urethra may also be given.

Procedure ⬆ ⬇

  1. The examination can be performed in a special operating room designed for this purpose, in a clinic, or in the urologist’s office. The patient’s age, state of health, and extent of surgical procedure necessary determine the setting. Pediatric cystoscopy is done in the operating room under general anesthesia.

  2. Prep the external genitalia with an antiseptic solution such as povidone-iodine after the patient is properly grounded, padded, and draped.

  3. Instill local anesthetic jelly into the urethra. For males, the anesthetic is retained in the urethra by a clamp applied near the end of the penis. For best results, the local anesthetic should be administered 5–10 minutes before passage of the cystoscope.

  4. The scope is connected to an irrigation system, and fluid is infused into the bladder throughout the procedure. Solutions used are nonconductive and retain clarity during the procedure (e.g., glycine, sterile water). The solution also distends the bladder to allow better visualization. The infusion is stopped and the bladder drained when it becomes filled with 300–500 mL of fluid.

  5. Should blood or other matter be present in the bladder, the fiberoptic cystoscope will not provide as clear a view as a rigid cystoscope because it is more difficult to flush.

  6. During transurethral resection procedures, venous sinuses may be opened, and irrigation fluid may enter the circulatory system, causing water intoxication. Therefore, isotonic solutions such as sorbitol, mannitol, or glycine must be used.

  7. Institutional policies dictate general perioperative care and procedures. Follow guidelines in Chapter 1 regarding safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

Abnormal conditions revealed by cystoscopy may include the following:

  1. Prostatic hyperplasia or hypertrophy

  2. Cancer of the bladder

  3. Bladder stones

  4. Urethral strictures or abnormalities

  5. Prostatitis

  6. Ureteral reflux (shown on cystogram)

  7. Vesicle neck stenosis

  8. Urinary fistulas

  9. Ureterocele

  10. Diverticula

  11. Abnormally small or large bladder capacity

  12. Polyps

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose and procedure of the test. Special sensitivity to concern for cultural, sexual, and modesty issues is an important part of psychological support. Emphasize that there is little pain or discomfort from cystoscopy; however, a strong desire to void may be experienced.

  2. Ensure that bowel preparation and other laboratory and diagnostic tests were completed as ordered if extensive procedures are planned.

  3. Confirm that a properly signed and witnessed consent form is in the patient’s medical record (see Chapter 1).

  4. Liquids may be encouraged until the time of the examination to promote urine formation if the procedure is a simple cystoscopy done under local anesthesia. Fasting guidelines are followed when spinal or general anesthesia is planned.

  5. Start an IV line for the administration of drugs to achieve a state of conscious sedation. Warn the patient that amnesia may be a side effect. Younger men may experience more pain and discomfort than older men. Women usually require less sedation because the female urethra is shorter. Instruct the patient to relax the abdominal muscles to lessen discomfort. See Chapter 1 regarding sedation and analgesia precautions.

  6. Follow guidelines in Chapter 1 regarding safe, effective, informed pretest care.

Posttest Patient Care

  1. After cystoscopy, monitor voiding patterns and bladder emptying, as well as vital signs and pulse oximetry.

  2. Encourage fluid intake once the patient is fully awake.

  3. Report unusual bleeding, clots, or difficult urination to the healthcare provider promptly.

  4. Tell the patient that urinary frequency, dysuria, pink to light-red urine, urethral burning, and posttest bladder spasms are common after cystoscopy.

  5. Warn the patient that the potential for Gram-negative shock is always present with urologic procedures because the urethra is so vascular that any break in the tissues can allow bacteria to enter the bloodstream directly. Explain that the onset of symptoms can be rapid and may actually begin during the procedure if it is fairly lengthy. Observe for and promptly report chills, fever, increasing tachycardia, hypotension, and back pain to the healthcare provider.

  6. Be aware that urethral catheters may be left in place to facilitate urinary drainage, especially if there is concern about edema.

  7. Teach the patient and family about routine catheter care for retention of urethral catheters. Follow institutional protocols.

  8. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient appropriately.

  9. Follow guidelines in Chapter 1 for safe, effective, informed posttest care. Provide written discharge instructions.

Clinical Alert

  1. If urethral dilation has been part of the procedure, the patient is advised to rest and to increase fluid intake.

  2. Monitor patient’s voiding patterns and bladder emptying (or instruct to self-monitor).

  3. Evaluate and instruct the patient to watch for edema. Edema may cause urinary retention, hesitancy, weak urinary stream, or urinary dribbling any time within several days after the procedure. Warm sitz baths and mild analgesic agents may be helpful; however, an indwelling catheter may sometimes be necessary for relief.

Reference Values ⬆

Normal