A cystoscopy is used when a patient’s symptoms suggest something is wrong in the bladder, and also to monitor progress of treatment. The commonest symptom requiring cystoscopy is bleeding in the urine. Other symptoms include pain in the bladder, problems with urinary control and certain infections. The thing we are looking for is often a bladder tumour. In spite of the great advances in medical imaging a cystoscopy is still the best way of looking for bladder tumours.
Cystoscopy is also used to access the bladder for a number of other types of treatment (eg kidney stones, tumours) but it is not usually charged for separately in these cases.
When patients notice bleeding in the urine their doctor will often suspect that it is coming from a bladder tumour. Tests will be ordered, including scans. There are many other causes of bleeding, but cystoscopy is almost always done, mainly to be sure that there is no tumour present. Bladder tumours occasionally cause other voiding difficulties also.
If a bladder tumour is found an attempt will usually be made to remove it through the cystoscope, without major surgery. The tumour will be sent to the Pathologist and his report is very important in determining what further treatment is required. If the tumour is advanced or aggressive further treatment is needed, possibly even removal of the bladder.
If a tumour has been removed through a cystoscope, followup is essential. Recurrences are common, particularly if the patient continues smoking. There is often a checkup in six weeks with a further biopsy, and then regular checkups for at least five years to ensure there is no recurrence of the tumour. These followups will involve further tumour removals if they arise.
As time goes on, if there have not been further recurrences, the checkups get less of a hassle for the patient, they may not need a general anaesthetic and it takes only a half day in hospital.
Admission is usually on the day of surgery, you will be checked in by the nursing staff who will record your medical details for the hospital’s records and help you change into theatre dress. You will usually seethe anaesthetist before the start of the operating list. He/she will take a brief medical history and do an examination to make sure you are fit for the anaesthetic and may order a premed – usually a mild sedative. You can expect to be wheeled into the operating theatre on a trolley.
After the operation you will wake up in the recovery room. You will have a tube in your arm, the “drip” and another in your bladder, the catheter. You will often feel as if you want to pass urine. If this happens, tell the nurse. He/she will check to ensure that the catheter is not blocked and reassure you.
Usually the catheter is removed the next day and you will be discharged.
The Urologist, the Anaesthetist and the Pathologist will all submit a bill. There is usually no need for an assistant or other medical consultants. Depending on the amount charged and your Insurance details, you may not even see these bills. There should not be other equipment or supply costs.
Sometimes there will be a separate charge from the hospital, this depends on your level of insurance cover and the arrangements between the hospital and your Health Fund.
Cystoscopy used to always involve a rigid instrument, this was pretty uncomfortable so a general anaesthetic was usually needed. In recent years it has often been done with a flexible instrument, which doesn’t need a general anaesthetic. The drawback of flexible cystoscopy is that if something is found that needs to be treated it often can’t be managed through the flexible cystoscope. The patient then needs to have a general anaesthetic, usually on another day. A flexible cystoscopy is best used when the procedure is a checkup and there is not a high likehood of finding something nasty.