A

flexible cystoscopy is a test in which a urologist inserts a device called a cystoscope into the urethra (tip of the penis in men) and evaluates what we call the entire lower urinary tract. This includes the entire urethra, prostate, bladder neck, the interior of the entire bladder and urinary meatus.

The urologist normally visualizes the entire scanned area on a screen. The urinary bladder is usually assessed at different filling levels. Only after complete distension of the bladder, characteristic diseases of this organ can be visualized.

What is a cystoscope?

A cystoscope is an endoscopic visualization device for the lower urinary tract that requires irrigation, illumination (fibre optics), and an optical system. The modern flexible cystoscopes that began to be used systematically in consultation more than 10 years ago, are here to stay since their ease of use and good tolerance with minimal discomfort on the patient during the test mean that today there is no discussion about its majority use and choice compared to the old rigid cystoscopes.

When is a cystoscopy performed?

Any urologist considers requesting a cystoscopy in the following cases:

– Patients with microhematuria (microscopic blood in urine analysis), not visible in the patient’s urine with the naked eye.
– Macroscopic hematuria: blood in the urine seen during urination.
– Evaluation of possible strictures of the urethra.
– Evaluation of possible urinary fistulas.
– Persistent irritative syndromes.
– Suspected foreign body in the bladder (stone, etc.).
– As the most important technique in the follow-up of a patient diagnosed and treated for bladder cancer.
– For the removal of double J type catheters in patients who have previously undergone surgery.

How is a flexible cystoscopy performed?

Flexible cystoscopy for any adequately trained urologist is a simple, effective, reliable, and non-aggressive procedure that is quick to perform and can be performed under local anaesthesia in most cases.

The procedure begins with the patient lying down and the urinary meatus area is cleaned with a disinfecting solution; then intraurethral local anaesthetic (1% lidocaine) is put in the form of a gel whose effect is immediate and in 2 minutes the test can be started without problems.

The patient will notice the manipulation but never pain and the cystoscope will be introduced little by little until reaching the bladder, visualizing each and every one of the anatomical areas through which it passes. After a careful inspection of the entire interior of the bladder, we remove the cystoscope, always with direct vision, to finish evaluating the rest of the anatomy of the lower urinary tract.

What complications can occur if I have a cystoscopy?

Virtually none. Although it is an invasive test, since it is entered through the urethra into the bladder, the incidence of urinary infection after the test does not reach 10% of cases and is practically null if taking antibiotic prophylaxis before or after it.

Is this test absolutely reliable?

Yes, although it is true that its diagnostic reliability and security do not reach 100%, since it may not be able to identify small tumour implants in areas of difficult visualization (anterior face of the bladder, intradiverticular tumours, poor vision in cases of prostatic hypertrophy, etc.), as well as areas of carcinoma in situ.

To cover the apparent gaps in cystoscopy and improve diagnostic performance, it is generally associated with certain analytical urine studies.