Is cystoscopy a panacea? What are the risks of the examination?

Author: Xu Tao, Chief Physician, Peking University People's Hospital

Reviewer: Song Gang, Chief Physician, Cancer Hospital, Chinese Academy of Medical Sciences

The bladder is an organ inside the body, but fortunately, it is connected to the outside of the body through the urethra. Therefore, we can use a device like a cystoscope to smoothly enter the body through the natural opening of the urethra and clearly observe the situation inside the bladder, which plays an irreplaceable role in the diagnosis and treatment of many bladder diseases.

Figure 1 Original copyright image, no permission to reprint

The main structure of the cystoscope consists of three parts: the channel, the mirror and the light source. We put the mirror into the body through the channel, and with the light source, we can see some related problems inside.

For example, bladder stones, tumors, inflammation, etc., or structural changes such as bladder capacity being too large or too small can all be seen.

To reach the bladder, it has to pass through a very important channel, the urethra. Therefore, some diseases of the urethra, such as urethral stenosis, tumors, inflammation, stones, obstruction, etc., can also be checked out.

For men, when the cystoscope passes through the urethra, the center will also pass through the prostate, so certain problems with the prostate can be observed at the same time.

Since the bladder is connected to the kidneys through the ureter, the bladder and urethra can also serve as channels for ureteroscopes and pyeloscopes. When there are tumors, stones, inflammation, stenosis, etc. in the ureter and renal pelvis, we need to get a clear diagnosis or treatment. The bladder is still a very important transit station, just like when we climb the Himalayas, there is a very important transit station in the middle, some equipment needs to be transferred here, some important operations need to be adjusted here, etc. Therefore, the function of cystoscopy is very powerful.

Of course, for many diseases, in addition to cystoscopy, there are many imaging methods, such as B-ultrasound, CT, MRI, etc., which can also make very clear and even very accurate diagnoses of some organs in the body.

However, "seeing is believing". For some diseases in the bladder, no matter how clear CT and B-ultrasound are, they cannot replace the accuracy and comprehensiveness of what we see with our naked eyes. Moreover, biopsy tissue can be obtained under direct vision, which is something that imaging cannot do. Therefore, for many diseases in the bladder, ureter and renal pelvis, cystoscopy, ureteroscopy and pyeloscopy are the gold standard, which is irreplaceable and the most accurate.

However, no single procedure or device is omnipotent. The clinical operation manual clearly states that in the case of acute infection, that is, acute inflammation of the urethra or bladder, if cystoscopy is performed forcibly, it will aggravate the infection, as cystoscopy is an external interference and external damage. Unless in special circumstances, cystoscopy is generally prohibited.

For example, if you want to observe in the bladder, you must ensure that the bladder has a certain capacity. Otherwise, if the bladder capacity is too small, such as a contracted bladder, it is easy to cause accidental injury when operating the cystoscope inside. Therefore, it is generally recommended to use less or avoid using the cystoscope as much as possible.

Figure 2 Original copyright image, no permission to reprint

In addition, in clinical practice, inserting a cystoscope into the male urethra actually requires a learning process from the initial training to the final proficiency of the doctor. If the operation is improper, it will not only cause more pain to the patient, but also cause unnecessary damage to the urethra. If the damage is serious, it may even leave some sequelae.

During standard operations, the cystoscope is inside the urethra and can follow the curvature of the urethra to enter the bladder smoothly and gently without causing damage to the urethra or bladder.

If the operation is rough, or if the patient is not familiar with the curvature and structure of the urethra, it is easy to fail to follow the natural lumen. If the urethral wall is subjected to great force, it is easy to cause perforation, which can cause serious damage to the urethra. Moreover, if the damage is serious and accompanied by infection, the scar will heal over time and cause urethral stenosis, which will cause long-lasting and difficult-to-treat sequelae to the patient.

Therefore, cystoscopy is a double-edged sword. Patients should not blindly "worship" it. Whether to undergo cystoscopy should be decided under the guidance of a professional doctor.