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Cystoscopy – Female
Cystoscopy in women is done for various reasons. Blood in the urine, irritative voiding symptoms, certain other conditions such as frequent and/or urgent voiding, and incontinence are just a few of the reasons Cystoscopy may be needed. Cystoscopy in the female is somewhat easier than that for men since the urethra in women is substantially shorter (5 cm vs.
27 cm). Cystoscopy is done in the office with local anesthesia (lidocaine gel). We can no longer prescribe or provide you with Valium or any other sedatives to be used during the procedure due to Texas State Law prohibiting the administration of "Conscious Sedation" in our office with our level of medical licensure (this is a recent change -- sorry for any inconvenience). The patient need not refrain from eating the day of the procedure, and in fact, we recommend eating a
hearty breakfast that day. Upon arrival to the office, the patient may be asked to give a voided urine specimen (arrive with a full bladder, please) and then will be escorted to the procedure room, and be asked to undress from the waist down. The nurse will then assist the patient in preparing. The patient will lay flat with legs up in stirrups, and the nurse will prep the vaginal/urethral area with a surgical scrub soap. Drapes will be placed to ensure sterility of the area (to avoid infection) and
a cotton tipped swab coated with 4% lidocaine gel will be instilled in the urethra to provide local anesthesia to the area. After all the equipment is prepared, the nurse will call in the doctor for the office cysto.
First of all, a urinary cytology may be obtained if indicated (this is a test of the urinary bladder to test for cancerous cells that may not be visible to the naked eye.) This is done by the doctor who inserts a rubber or latex catheter into the bladder through the urethra after removing the numbing swab. This catheter allows a "wash" of the bladder with about 2 ounces of sterile saline that is then retrieved and sent to the lab for cytologic evaluation. The results are usually back in about a
week. Immediately following the cytology (bladder wash) the Cystoscopy will proceed.
The doctor will insert the "sheath" of the Cystoscopy, which is the last instrument that will go into your urethra. The sheath is a rigid steel tube especially designed to be inserted in the urethra. All of the other instruments will go through this first
instrument. The doctor will then look with a narrow angle and a wide angle lens, and in this way will be able to visualize your entire bladder lining including the ureteral openings (where the urine comes in from the kidneys) and the urethra. The bladder will be emptied through the rigid cystoscope prior to completion of the procedure. The entire procedure typically lasts 10 minutes or so.
If something was detected on the Cystoscopy, this will be discussed with the patient, and further follow-up treatment outlined right away. If the cytology returns suspicious after a week or so (the lab takes a while to process these specimens)
then further testing may be necessary in the operating room.
Occasionally, a "urethral dilation" may be done in a female at the same setting as Cystoscopy. This is done to enlarge the urethral opening to aid voiding. This is rarely necessary, but helpful in some who really require it.
The patient will then be able to depart the office after being given a short course of antibiotic samples to make sure no infection develops. Anti-spasmodics can be given on a case-by-case basis for those who may need it.
Patients having Cystoscopy can expect to have some blood in their urine for a few days or even up to a week or so, and may have a slight bloody urethral discharge. This is all normal and should improve rapidly. Some patients experience spasms, or a frequent/urgent need to void. All this is normal and should also go away soon. Serious infections or other complications are exceedingly rare after office Cystoscopy, although very infrequently infections and bleeding can be serious. Other potential dangers such as development of scar tissue are theoretically possible, but highly unlikely after a simple office cysto.
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