Cystoscopy procedure, feed back

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Hi to everybody, is someone who undertook a cystoscopy exam? Is it a really accretive diagnostic tool worthing the hassle?

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  • Posted

    Don't understand the use of accretive in this way. BPH could be described as accretive but cystoscopy wouldn't be the tool for diagnosis of BPH. Something like ultrasound, or better still MRI, are the best tools for checking on the extent of accretion.

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  • Posted

    if BPH is your concern, then a cysto exam in conjunction with others can give a good doctor a full picture of whats going on. A doctor can look at the bladder lining for signs of overactivity caused by BPH, as well as obstruction. It obviously depends on your case. Im a rare case in that Im 36 and was diagnosed with BPH, and it took a whole bunch of tests (such as urodynamics) to rule out other things, such as prostatitis, etc. The test sucks, but its worth it if you havent been given concrete answers.

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  • Posted

    When I was fully in urine retention at 100%, the tool the urologist used was the cystoscopy. I've had them done to look for bleeding in the bladder, for checking why I was blocked (as I mentioned) and to go in and try to knock off some scabs/clots and scar tissue. If you're looking at an enlarged prostate, there are also MRI and ultrasound, as others suggest. I also had a procedure called a Urogram which is a CT scan from kidneys on down. DRE is a tool used in conjunction with the other tests. Finally, if your concern is prostate cancer, you would have your urologist keep track of your PSA numbers and, if necessary, a biopsy.

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  • Edited

    I have had 3 cystoscopy's, asked for them as a diagnostic troubleshooting tool.Here's my story:

    Had a slow stream and hard to get it started for many years since age 25. When I hit my mid 50's it began to get worse and I started down the urology road that would have ended up in a TURP. Wasn't going to do that. Started on Flowmax and got reasonable results for a year or so and the problem got worse again. So I decided to do some troubleshooting. Step 1: Urodynamics. Tests for flow rate, nerve function bladder pressure and the point at which the flow is held up. All indications were normal except the flow was being held up at the bladder neck which is a smooth muscle sphincter between the base of the bladder and the top of the prostate. Step two: Cystoscopy: Take an HD video camera up the urethra and look at the pathway all the way to the bladder. In my case, the path was normal until the bottom of the prostate where the tunnel narrowed to a close. We pushed past the prostate and popped up into the bladder and did a 180 and saw the bladder neck was pushed up into the bladder instead of a funnel pointing down. So I now knew why I was having issues. Enlarged prostate and inverted bladder neck. I went for a PAE procedure 3 times and each time got better flow and each time I cystoscopied to see the progress. Bottom line is if you don't know what's holding up the flow, how can you decide what to treat? Hope that helps. Bruce

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  • Edited

    You've already got some very good answers, I'll mention a couple of things. Assuming you meant effective rather than accretive, it's the only diagnostic tool that lets the uro actually visualize your prostate and bladder neck from the inside. I had my first one after meds failed to work good enough. My uro said I was obstructed and that a UroLift would help. I saw photos and it was very helpful to see what he was talking about. That was done with a rigid scope under anesthesia.

    You can also have one done with a flexible scope in his office. That doesn't require sedation but does cause some anxiety and mild discomfort. Like Bruce, I was able to see see what uros call "the volcano" during the flexible cystoscopy formed by my bladder neck pushing up into my bladder. The end of the instrument can be articulated by the uro to look 180 degrees backward once in the bladder.

    The advantages of a rigid cystoscopy over flexible are (1) you don't feel a thing being under anesthesia; (2) the uro is able to do things like cauterize any lesions he sees in your bladder by running an electric or laser cutting device through the cystoscope sheath; (3) similarly he's able to crush any calcified stones in your bladder or biopsy any suspicious growths; and (4) while you're out he can also do a procedure like dilating your urethra.

    I'd also recommend getting a urodynamics study done as it can be used to rule out your bladder as the source of the problem. Not the most enjoyable thing you'll ever do but it's over in about 45 minutes.

    I also had a transrectal ultrasound done to measure the size of my prostate. They have to do that to know the size of your prostate as it can affect the type of procedure you can have done.

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  • Posted

    I have had 7 cystoscopies in the last 30 months, most as checkups after (successful) bladder cancer surgery and immunotherapy. In my experience, it is mildly uncomfortable but generally lasts less than a minute. I have never experienced any actual pain.

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  • Edited

    Phoebush,

    .

    If you have BPH that is bad enough that surgery is a possibility, then having a cystoscopy is pretty basic 101 kind of stuff. It is minimally invasive, takes only a few minutes and does not hurt. The cystoscopy will:

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    1. show the extent/length of enlargement
    2. show the type of enlargement (lateral lobe, median lobe, or both)
    3. show if the BPH has caused bladder damage (trabeculation, other)

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      Make sure that your urologist lets you see the video output and explains what they see. If the don't do that, then find another urologist. I can't be any clearer than that.

      .

      Actually, my cystoscopy which was done 2 weeks before my very successful Rezum was by far the coolest part of my whole BPH journey. It showed moderate bladder trabeculation. I had flunked my urodynamics 4 months earlier, so we did not know if the Rezum would work but after 10 months of catheters, I decided to give it a try.

      .

      The Rezum was successful but due to bladder damage, my PVR's were still high. At 9 months, my PVR's dropped below 100 ml and now they are below 50 ml. Bladder damage takes a long time to recover. My IPSS went from 29 to 6. Now, I am curious what another cystoscopy would show about bladder recovery but I don't want to spend the money.

      .

      Good luck to you,

      .

      Steve

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    • Posted

      I think whether or not it involves any pain is dependent on the person. I've only had things shoved up my urethra twice while I was conscious -- one an instrumented catheter during urodynamics, the other a flexible cysto by a uro I hadn't seen before. Both times going in and up to the outer sphincter was not painful but was a weird feeling. I suppose I'd get used to that after a few times. But both times when the device went through my sphincter then prostate I felt a sharp pain that only lasted 1-2 seconds until it got into my bladder. I may be one of those people with a more acute angle at the sphincter. Regardless it's not something to fear.

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    • Edited

      russ_777,

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      Yup my cystoscopy did feel a bit weird but never painful. After 9 months of self-cathing, the flexible cystoscope wasn't much different. Again yup, it's not something to fear.

      .

      Steve

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  • Posted

    Good discussion. I had a cystoscopy about a year ago, and it determined I had a large median lobe

    blocking my urethra. I am on tadafil and flow is somewhat better and I like the medication, still retaining 30ml; we are on watch and wait, since otherwise I don't have any significant issues and my uro is conservative about surgery (which I appreciate) and not too worried about the retention. Last time I went he saw some white cells and evidence of possible contamination which could lead to uti so he put me on antibiotics for a week.)

    Am doing fine; will likely have some further treatment down the road, but not now.

    Back to the cystoscopy: mine was flexible and quick but my urine flow was much more obstructed for a couple of weeks afterward, possibly due to irritation of an already narrow path. But it got better.'

    This is just to say that if you have a case like mine, the cystoscopy might trigger some obstruction in flow.

    Makes me not eager to get another one, but I did get valuable information from it.

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