Editing Cystoscopy (section)

== Test procedures ==

Physicians may have special instructions, but in most cases, patients are able to eat normally and return to normal activities after the test.  Patients are sometimes asked to give a urine sample before the test to check for infection.  These patients should ensure that they do not urinate for a sufficient period of time, such that they are able to urinate prior to this part of the test.

Patients will have to remove their clothing covering the lower part of the body, although some physicians may prefer if the patient wears a [[hospital gown]] for the examination and covers the lower part of the body with a sterile drape.  In most cases, patients lie on their backs with their knees slightly parted. Occasionally, a patient may also need to have his or her knees raised. This is particularly true when undergoing a Rigid Cystoscopy examination. For flexible cystoscopy procedures the patient is almost always alert and a local anesthetic is applied to reduce discomfort. In cases requiring a rigid cystoscopy it is not unusual for the patient to be given a general anesthetic, as these can be more uncomfortable, particularly for men.  A physician, nurse, or technician will clean the area around the [[urinary meatus|urethral opening]] and apply a local anesthetic. The local anesthetic is applied direct from a tube or needleless syringe into the urinary tract. Often, skin preparation is performed with [[chlorhexidine]].<ref>{{cite web |url=http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20H)/HIBITANE.html |title=Pharmaceutical Information – Hibitane |publisher=RxMed |access-date=2013-06-09 |url-status=dead |archive-url=https://web.archive.org/web/20140203163920/http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20%28General%20Monographs-%20H%29/HIBITANE.html |archive-date=2014-02-03 }}</ref>

Patients receiving a ureteroscopy may receive a [[spinal anaesthesia|spinal]] or [[general anaesthetic]].

The physician will gently insert the tip of the cystoscope into the urethra and slowly glide it up into the bladder. The procedure is more painful for men than for women due to the length and narrow diameter of the [[male urethra]], and results of a 2019 systematic review of the literature found that intraurethral lidocaine greatly reduces this painful procedure in men.<ref>{{Cite journal |last1=Raskolnikov |first1=Dima |last2=Brown |first2=Benjamin |last3=Holt |first3=Sarah K. |last4=Ball |first4=Andrea L. |last5=Lotan |first5=Yair |last6=Strope |first6=Seth |last7=Schroeck |first7=Florian |last8=Ullman |first8=Ralph |last9=Lipman |first9=Robert |last10=Smith |first10=Angela B. |last11=Gore |first11=John L. |date=2019 |title=Reduction of Pain during Flexible Cystoscopy: A Systematic Review and Meta-Analysis |url=http://www.auajournals.org/doi/10.1097/JU.0000000000000399 |journal=Journal of Urology |language=en |volume=202 |issue=6 |pages=1136–1142 |doi=10.1097/JU.0000000000000399 |pmid=31219763 |s2cid=195192577 |issn=0022-5347}}</ref> Relaxing the [[pelvic muscles]] helps make this part of the test easier.  A [[Sterilization (microbiology)|sterile]] liquid (water, [[saline (medicine)|saline]], or [[glycine]] solution) will flow through the cystoscope to slowly fill the bladder and stretch it so that the physician has a better view of the bladder wall.

As the bladder reaches capacity, patients typically feel some mild discomfort and the urge to urinate.{{cn|date=February 2022}}

The time from insertion of the cystoscope to removal may be only a few minutes, or it may be longer if the physician finds a stone and decides to remove it, or in cases where a [[biopsy]] is required.  Taking a biopsy (a small tissue sample for examination under a microscope) will also make the procedure last longer. In most cases, the entire examination, including preparation, will take about 15 to 20 minutes.{{cn|date=February 2022}}

=== Blue light ===

In blue light cystoscopy [[hexyl aminolevulinate hydrochloride]] is instilling a photosensitizing agent, into the bladder. The blue light cystoscopy contains a light source and light is transmitted through a fluid light cable connected to an endoscope to light up the area to be observed. The photosensitizing agent preferentially accumulates [[porphyrin]]s in malignant cells as opposed to nonmalignant cells of urothelial origin. Under subsequent blue light illumination, [[neoplasm|neoplastic lesions]] fluoresce red, enabling visualization of tumors. The blue light cystoscopy is used to detect non-muscle invasive papillary cancer of the bladder.<ref>{{cite web | url = https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm215427.htm | archive-url = https://web.archive.org/web/20170118090751/https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm215427.htm | archive-date = 18 January 2017 | publisher = FDA | title = Photodynamic Diagnostic D-Light C (PDD) System – P050027 }}</ref><ref name="pmid22512972">{{cite journal | vauthors = Mark JR, Gelpi-Hammerschmidt F, Trabulsi EJ, Gomella LG | title = Blue light cystoscopy for detection and treatment of non-muscle invasive bladder cancer | journal = The Canadian Journal of Urology | volume = 19 | issue = 2 | pages = 6227–31 | date = April 2012 | pmid = 22512972 | doi = | url = http://www.canjurol.com/pdfs/HOW/HOW-DrMark.pdf }}</ref>