Cystoscopy Health Dictionary

Cystoscopy: From 2 Different Sources


The examination of the urethra and bladder using a cystoscope inserted up the urethra. A cystoscope is a rigid metal or flexible fibre-optic viewing instrument, sometimes with a camera at the tip (see endoscopy). Cystoscopy is used to inspect the bladder for calculi, bladder tumours, and sites of bleeding and infection, and to obtain urine samples from the ureters to look for infection or tumour cells. Radiopaque dye may be injected into the ureters via the cystoscope during the X-ray procedure of retrograde pyelography (see urography).

Treatment, including removal of bladder tumours or calculi and insertion of stents (narrow tubes) into a ureter to relieve an obstruction, can all be performed via the cystoscope.

Health Source: BMA Medical Dictionary
Author: The British Medical Association
n. examination of the bladder by means of an instrument (cystoscope) inserted via the urethra. The cystoscope consists of either a metal sheath surrounding a telescope and light-conducting bundles or a flexible tube with built-in optical fibres for viewing and illumination. Irrigating fluid is conducted through a channel into the bladder. When using the rigid instrument, additional channels are available for the insertion of guidewires, ureteric catheters, diathermy electrodes, or biopsy forceps for taking specimens of tumours or other growths. When using the flexible cystoscope, only small instruments can be passed through the additional channel, such as biopsy forceps, diathermy electrodes, or laser fibres for the destruction of tumours or stones.
Health Source: Oxford | Concise Colour Medical Dictionary
Author: Jonathan Law, Elizabeth Martin

Ureterolithotomy

The surgical removal of a stone (see calculus, urinary tract) stuck in a ureter.

It is not commonly needed because lithotripsy and cystoscopy can be used to deal with stones.... ureterolithotomy

Amethocaine

An e?ective local anaesthetic for topical application. Rapidly absorbed from mucous membranes, it should never be applied to in?amed, traumatised or highly vascular surfaces – nor used when providing anaesthesia for bronchoscopy or cystoscopy. Amethocaine is used in ophthalmology and in skin preparations. It may sensitise the skin. (See ANAESTHESIA.)... amethocaine

Urethra, Diseases Of And Injury To

Trauma Injury to the urethra is often the result of severe trauma to the pelvis – for example, in a car accident or as the result of a fall. Trauma can also result from catheter insertion (see CATHETERS) or the insertion of foreign bodies into the urethra. The signs are the inability to pass urine, and blood at the exit of the urethra. The major complication of trauma is the development of a urethral stricture (see below).

Urethritis is in?ammation of the urethra from infection.

Causes The sexually transmitted disease GONORRHOEA affects the urethra, mainly in men, and causes severe in?ammation and urethritis. Non-speci?c urethritis (NSU) is an in?ammation of the urethra caused by one of many di?erent micro-organisms including BACTERIA, YEAST and CHLAMYDIA.

Symptoms The classic signs and symptoms are a urethral discharge associated with urethral pain, particularly on micturition (passing urine), and DYSURIA.

Treatment This involves taking urethral swabs, culturing the causative organism and treating it with the appropriate antibiotic. The complications of urethritis include stricture formation.

Stricture This is an abrupt narrowing of the urethra at one or more places. Strictures can be a result of trauma or infection or a congenital abnormality from birth. Rarely, tumours can cause strictures.

Symptoms The usual presenting complaint is one of a slow urinary stream. Other symptoms include hesitancy of micturition, variable stream and terminal dribbling. Measurement of the urine ?ow rate may help in the diagnosis, but often strictures are detected during cystoscopy (see CYSTOSCOPE).

Treatment The traditional treatment was the periodic dilation of the strictures with ‘sounds’

– solid metal rods passed into the urethra. However, a more permanent solution is achieved by cutting the stricture with an endoscopic knife (optical urethrotomy). For more complicated long or multiple strictures, an open operation (urethroplasty) is required.... urethra, diseases of and injury to

Cancer – Bladder

Neoplasm of bladder. One third of patients are over 70 years. Most cases today arise from exposure to injurious chemicals only partly eliminated from the body, as from food additives, analine dyes, etc. Evidence also links the disease to excessive coffee-drinking, the general consensus being that caffeine blocks the action of a compound named adenosine – one of the building blocks of DNA – involved in cellular energy. In this way it interferes with natural metabolic processes.

Symptoms: Blood in the urine with absence of pain on passing water in early stages. Then, burning frequency, especially at night. Kidneys become involved. Growths range from papilloma to tumour which may ulcerate in later stages.

The lesion is confirmed by cystoscopy (examination of the bladder by insertion of an instrument to illuminate inner surfaces and makes possible a direct view of the affected tissues). Even when the condition is healed this examination is repeatedly necessary to detect recurrence.

Two kinds: (1) papillary epithelioma (2) squamous cell epithelioma.

Tea. Formula. Equal parts: Marshmallow root, Clivers, Horsetail, Shepherd’s purse. 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes. 2 cups or more daily.

Decoction. Barberry bark cold infusion. 1 teaspoon to each cup cold water. Steep over night. 2 cups or more daily.

Tinctures. Formula. Horsetail 1; Clivers 2; Barberry 1. Mix. 1-2 teaspoons (5-10ml) 2 or more times daily. If inflammation is present add Meadowsweet 1.

Dr William Boericke, physician, advised Dandelion to lessen symptoms.

Diet. See: DIET – CANCER.

Supplements. Emphasis on Vitamins A and C. (Vitamin A in epithelial tumours, ‘New Scientist’ (1975) 303)

Treatment offered as a supportive to specific modern hospital techniques. Treatment by or in liaison with a general medical practitioner. ... cancer – bladder

Cancer – Prostate Gland

Adeno-carcinoma. A hormone-related tumour in elderly men. Enlargement of the gland may be benign or carcinomatous. Fibrosis (hardening) may arise from inflammation. Obstruction of the outlet of the bladder through swelling of the gland (prostatism) may cause uraemia.

Symptoms. Bladder irritability; increased frequency during the night. Feeble forked stream of urine. Sometimes blood. Three quarters of such tumours are located in the posterior lobe of the prostate gland – readily accessible to the examining finger through the front wall of the rectum. Rectal examination reveals a hard rugged prostate. Cystoscopy confirms. Bone pains in the low back or pelvis reflect a stage where the tumour has already spread. Anaemia, weight loss, urgency.

All symptoms are worse by alcohol and spicy foods.

Harvard University scientists report: heavy consumption of animal fat, especially the fat in red meat appears to increase the chance that a man will develop advanced prostate cancer.

Of therapeutic value. Comfrey, Echinacea, Horsetail, Poke root, Thuja, Cornsilk, Goldenseal.

Tea. Combination. Comfrey leaves, Horsetail, Cornsilk. Equal parts. 2-3 teaspoons to each cup boiling water. Drink freely.

Formula No. 1. Echinacea 2; Comfrey 1; Poke root half; Thuja half. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or cup of Cornsilk tea.

Formula No. 2. (Alternative) Echinacea 2; Goldenseal 1; Gotu Kola 1; Poke root half. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons in water or cup of Cornsilk tea.

Bee pollen. Of value.

Garlic. Of value.

Diet. See: DIET – CANCER.

There is a very low incidence of prostate cancer in countries where Soya products are widely consumed – Soya contains a female hormone which is a protector factor.

Supplements. Morning and evening.

Vitamin A 7500iu or more. Large doses may be required. Vitamin C 1-2g. Vitamin E 200iu. Calcium 500mg. Selenium 100mcg. Zinc.

Study. Men with prostate cancer may not need to undergo radical prostatectomy (removal of the prostate gland). A 10-year follow-up study of men with early prostate cancer left untreated showed that 10 years later only 8.5 per cent of the 223 patients had died from prostate cancer. The survival rate of 86.8 per cent in the untreated group was nearly identical to a subgroup who met all the conditions for radical prostatectomy. (Journal of American Medical Association, 22/29 April 1992)

Commonly treated with female sex hormone or by orchidectomy.

It would appear that surgical removal of the gland offers little benefit, and possibly a disadvantage to patients wishing to leave well alone, particularly the elderly. Treatment by a general medical practitioner or oncologist. ... cancer – prostate gland

Urinary Bladder, Diseases Of

Diseases of the URINARY BLADDER are diagnosed by the patient’s symptoms and signs, examination of the URINE, and using investigations such as X-RAYS and ULTRASOUND scans. The interior of the bladder can be examined using a cystoscope, which is a ?breoptic endoscope (see FIBREOPTIC ENDOSCOPY) that is passed into the bladder via the URETHRA.

Cystitis Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, and entered the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEY, DISEASES OF).

Symptoms Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identi?cation of the invading bacteria.

Treatment This includes an increased ?uid intake, ANALGESICS, doses of potassium citrate to make the urine alkaline to discourage bacterial growth, and an appropriate course of ANTIBIOTICS once a urine sample has been ana-lysed in the laboratory to con?rm the diagnosis and determine what antibiotics the causative organism is likely to respond to.

Stone or calculus The usual reason for the formation of a bladder stone is an obstruction to the bladder out?ow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.

Symptoms The classic symptom is a stoppage in the ?ow of urine during urination, associated with severe pain and the passage of blood.

Treatment This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).

Cancer Cancer of the bladder accounts for 7 per cent of all cancers in men and 2·5 per cent in women. The incidence increases with age, with smoking and with exposure to the industrial chemicals, beta-napththylamine and benzidine. In 2003, 2,884 men and 1,507 women died of bladder cancer in England and Wales.

Symptoms The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All patients with haematuria must be investigated with an X-ray of their kidneys, an INTRAVENOUS PYELOGRAM (UROGRAM) and a cystoscopy.

Treatment Super?cial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope using DIATHERMY (cystodiathermy). Invasive cancers into the bladder muscle are usually treated with RADIOTHERAPY, systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy). Local chemotherapy may be useful in some patients with multiple small tumours.... urinary bladder, diseases of

Bladder Tumours

Growths originating in the inner lining of the bladder. Many are papillomas (small wart-like growths), which tend to recur and will eventually become cancerous. Other, more malignant, growths may extend not only into the bladder cavity but may also spread through the bladder wall to involve nearby organs such as the colon, rectum, prostate gland, or uterus.

Bladder cancer is more common in smokers and workers in the dye and rubber industries. Haematuria (blood in the urine) is the main symptom of bladder cancer. A tumour may obstruct the entry of a ureter into the bladder, causing back pressure and pain in the kidney region, or may obstruct the urethral exit, causing difficulty in passing, or retention of, urine.

Bladder tumours are diagnosed using cystoscopy and biopsy of the abnormal area. If small, they can be treated by heat or surgically during cystoscopy. They tend to recur at the same or other sites within the bladder, so that regular follow-up cystoscopy is needed. Bladder tumours that have spread through the bladder wall may be treated by radiotherapy or by surgical removal of part or all of the bladder.... bladder tumours

Haematuria

Blood in the urine, which may or may not be visible to the naked eye. In small amounts, it may give the urine a smoky appearance.

Almost any urinary tract disorder can cause haematuria. Urinary tract infection is a common cause; prostatitis may be a cause in men. Cysts, kidney tumours, bladder tumours, stones (see calculus, urinary tract), and glomerulonephritis may cause haematuria. Bleeding disorders may also cause the condition.

Blood that is not visible to the naked eye may be detected by a dipstick urine test or microscopic examination. CT scanning, ultrasound scanning, or intravenous urography can help determine the cause. If bladder disease is suspected, cystoscopy is performed.... haematuria

Lithotomy

Surgical removal of a calculus (stone) from part of the urinary tract.

The procedure is only performed for large stones; smaller stones are usually crushed and removed using cystoscopy, or pulverized ultrasonically by lithotripsy.... lithotomy

Prostatectomy

An operation to remove part or all of the prostate gland.

It is performed to treat enlargement of the gland (see prostate, enlarged), cancer of the prostate (see prostate, cancer of), or prostatitis.

The most common method is trans-urethral prostatectomy, performed during cystoscopy.

If the prostate gland is very enlarged, retropubic prostatectomy may be performed.

An incision exposes the prostate and the tissue is removed.

Prostatectomy may affect potency or sexual sensation, though this is not common.

The operation usually causes sterility.... prostatectomy

Urology

A branch of medicine concerned with the structure, functioning, and disorders of the urinary tract in males and females, and of the reproductive system in males. Investigative techniques that are used in urology include urography, cystoscopy, ultrasound scanning, cystometry, and urinalysis.... urology

Urination, Painful

Pain or discomfort that occurs when urine is being passed. Painful urination is known medically as dysuria. The pain is often described as burning; sometimes it is preceded by difficulty in starting urine flow. Pain after the flow has ceased, with a strong desire to continue, is called strangury.

The most common cause, especially in women, is cystitis. Other causes include a bladder tumour, bladder stone (see calculus, urinary tract), urethritis, balanitis, prostatitis, vaginal candidiasis (thrush), or allergy to vaginal deodorants. Strangury is usually caused by spasm of an inflamed bladder wall, but it may be due to bladder stones. Mild discomfort when passing urine may be caused by highly concentrated urine.

Dysuria may be investigated by physical examination, urinalysis, urography, or cystoscopy. (See also urethral syndrome, acute.)... urination, painful

Photodynamic Diagnosis

a technique for improving the sensitivity and specificity of bladder cancer diagnosis at cystoscopy using a light-sensitive agent. This agent is instilled into the bladder, taken up by the epithelial cells, and converted into a porphyrin that accumulates only in malignant and premalignant cells. It fluoresces under light of a specific wavelength and is thus highlighted against normal bladder mucosa.... photodynamic diagnosis

Pyelography

n. X-ray examination of the renal pelvis using *radiopaque contrast material. Anterograde pyelography is performed by puncturing the renal pelvis directly with a needle through the skin and injecting contrast material. Intravenous pyelography is usually part of an examination of the whole urinary tract (see intravenous urography). Retrograde pyelography is performed after a tube has been inserted through the bladder and up the ureter at cystoscopy. Contrast material is injected up this tube as it is withdrawn and X-ray images taken. All techniques are used to show the anatomy of the renal pelvis and its drainage, as well as to demonstrate the presence of tumours and stones.... pyelography

Vesicoureteric Reflux

the backflow of urine from the bladder into the ureters. It is classified into primary or congenital vesicoureteric reflux, which is due to defective valves (which normally prevent reflux), or secondary, which is due to another condition (e.g. *neuropathic bladder). Infection may be conveyed to the kidneys, causing recurrent attacks of acute *pyelonephritis and scarring of the kidneys in childhood. Children with urinary infection must be investigated for reflux by *cystoscopy; if the condition does not settle with antibiotic therapy corrective surgery must be performed.... vesicoureteric reflux



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