Types of Cystoscopy

Cystoscopy is a vital diagnostic and treatment procedure in urology, allowing doctors to directly view the inside of the bladder and urethra. It is commonly used to diagnose urinary tract problems, such as frequent infections, blood in the urine (hematuria), or difficulty urinating. However, not all cystoscopies are the same. There are different types of cystoscopy, and understanding them can help patients prepare better and make informed decisions.

Despite being a single procedure in name, there are different types of cystoscopy depending on the instruments used, the purpose of the examination, and the level of detail required. Some types are quick and minimally invasive, done right in the doctor’s office, while others are more detailed and require anesthesia in a hospital setting.

What is Cystoscopy?

Cystoscopy is a medical procedure that involves inserting a thin tube called a cystoscope into the urethra to examine the bladder. The cystoscope is equipped with a light and camera, which transmits images to a monitor, allowing the doctor to closely inspect the urinary tract.

Cystoscopy is typically performed by a urologist and can help identify issues such as bladder tumors, urinary stones, inflammation, structural abnormalities, and even early signs of bladder cancer.

Why is Cystoscopy Performed?

Doctors may recommend cystoscopy for various reasons, including :-

1. Investigating causes of blood in the urine

2. Frequent urinary tract infections

3. Chronic pelvic pain or bladder pain

4. Blockages in the urinary tract

5. Enlarged prostate symptoms

6. Removal of bladder stones or foreign objects

7. Evaluation of abnormal urine cytology results

Depending on the purpose and complexity, the type of cystoscopy used may vary.

Main Types of Cystoscopy

Cystoscopy can be broadly divided into two main types based on the instrument used and the setting in which it’s performed :-

1. Flexible Cystoscopy :- Flexible cystoscopy uses a thin, bendable (flexible) cystoscope that can easily navigate the natural curves of the urethra. It is most commonly performed in an outpatient clinic and does not typically require general anesthesia.

   Key Features of Flexible Cystoscopy :-

   • Usually done under local anesthesia or mild sedation.

   • Less discomfort compared to rigid cystoscopy.

   • Primarily used for diagnostic purposes like visual inspection of the bladder and urethra.

   • Often completed in less than 10-15 minutes.

   Common Uses :- Flexible cystoscopy is ideal for routine checks and follow-ups, especially for :-

   • Checking for bladder cancer recurrence

   • Investigating hematuria

   • Monitoring known conditions like interstitial cystitis

   Recovery :- Since it’s minimally invasive, patients can usually return to their normal routine the same day. Mild burning or frequency of urination may be experienced for a day or two.

2. Rigid Cystoscopy :- Rigid cystoscopy involves a straight, firm tube that provides a clearer view and allows for the insertion of surgical instruments. This type is often done in a hospital setting and may require regional or general anesthesia.

   Key Features of Rigid Cystoscopy :-

   • Offers high definition images for more precise diagnosis or treatment.

   • Allows for surgical procedures like biopsy, stone removal, or tumor resection.

   • Can be uncomfortable, hence often performed under anesthesia.

   • Takes a little longer than flexible cystoscopy.

   Common Uses :- Rigid cystoscopy is preferred when treatment is involved, such as :-

   • Removing bladder tumors or stones

   • Taking tissue biopsies

   • Placing ureteral stents

   • Performing transurethral resection procedures

   Recovery :- Recovery might take slightly longer due to anesthesia. Temporary urinary discomfort, blood in the urine, or a sensation of bladder fullness is common post procedure.

Specialized Cystoscopy Procedures

Apart from the standard flexible and rigid cystoscopy, there are specialized types of cystoscopy tailored for specific conditions.

1. Blue Light Cystoscopy (Photodynamic Diagnosis) :- This is an advanced form of cystoscopy used to detect bladder cancer. A special dye (hexaminolevulinate) is instilled into the bladder, which is absorbed by cancerous cells. Under blue light, these cells glow, making them easier to detect and remove.
2. Cystoscopy with Biopsy :- In cases where abnormal tissue is found during the procedure, a biopsy may be performed during the same session. This is usually done with rigid cystoscopy and allows for histological analysis of suspicious growths.
3. Pediatric Cystoscopy :- Cystoscopy can also be performed in children for evaluating congenital abnormalities, urinary reflux, or unexplained urinary tract infections. Smaller, pediatric-friendly instruments are used in such cases.

Preparing for a Cystoscopy

Regardless of the type, patients are usually advised to :-

1. Empty their bladder before the procedure.

2. Inform the doctor of any medications or allergies.

3. Avoid blood thinners if instructed.

4. Arrange for someone to drive them home, especially if sedation is used.

Post Cystoscopy Care and Risks

Most patients experience minor side effects like :-

1. Burning sensation while urinating

2. Increased urge to urinate

3. Small amount of blood in the urine

These typically resolve within 24–48 hours. Drinking plenty of water helps flush the bladder and reduce irritation. However, if symptoms persist or worsen (e.g., fever, severe pain, heavy bleeding), immediate medical attention is needed.

Conclusion

Cystoscopy is a highly valuable procedure that aids in diagnosing and managing various urological conditions. Understanding the types of cystoscopy flexible, rigid, and specialized forms helps demystify the process for patients and guides expectations for diagnosis, treatment, and recovery.