Flexible cystoscopy (male) - able to view the prostate?

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When a urologist does an examination using a Flexible cystoscopy can he view the prostate? Since the Flexible cystoscopy goes down the urethra and then into the bladder, how can the urologist view the actual prostate?

Since it is a closed system from the urethra to the bladder one would i imagine the urologist would only be able to view the prostate lobes against the bladder neck.

Urologist would not be able to go outside the system and actually look at prostate. Am I correct?

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  • Posted

    John  They can see how the prostate is doing.  I have them done all the time. That is the way they can tell if there is a blockage.  The only way you can look inside a prostate is to cut it open.  John by the way what did you decide ???  Ken
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  • Posted

    Thats a good question; I know because I've been wondering the same thing myself.  Seems to me that they wouldn't even be able to view ANY of the lobes from inside the urethra.  Perhaps they estimate the size from the pressure on the urethra or something.  An MRI makes more sense but would be a much more expensive procedure I would think. 

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    • Posted

      Keith.   What they can tell when they use a scope is the urethra, sphincter, the prostate ( outside ) and the bladder.  What they look for on with the prostate is if it is enlarged if it is blocking the bladder and if there is any odd shapes.  I have it done every 3 or 4 months to have my stricture checked it is right before the prostate.  That is how he found my prostate was closed.  To look inside you need a MRI  Take care  Ken  
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  • Posted

    One suggestion - use your smartphone to record the session for comparison later. I've had a cysto done twice by two different uros. While they can take still images, they did not share them with me, so having the video for later use with other doctors may be helpful.

    As others have said, you will be able to see your entire urethra and into the bladder, plus the external and internal sphincters. If there is narrowing of the prostatic urethra, this procedure would show that, though the amount of the narrowing is subjective as they have no method to measure it, that I'm aware of. Uros use either air and/or saline to flush out and open the urethra during the procedure but other than a slight amount of pressure when going through the external sphincter, it was painless.

     

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    • Posted

      You will be able to see everything if the screen is positioned to allow you.  My first urologist positioned the screen on a cart at the  table level, and past my head.  I turned my head as much as I could, but couldn't get a good view.  The screen was a 12 inch raster display, so the image quality was poor too.

      My new urologist has a pair of large overhead screens with one facing the patient who is lying down, so the patient can easily see every detail.

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    • Posted

      My first and only cystoscope the tiny monitor was over my left should making it very difficult to see what he was seeing. To top that off, the monitor didn't work rolleyes and according to nurse it hadn't worked in weeks eek

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  • Posted

    He or she will only be able to view the inside of the urethra, and any "landmarks" along the way, such as the external sphincter, any abnormalities such as strictures or lesions, and the ejaculatory duct, and the bladder mouth.  

    When TURP is being performed, there's a landmark call the verumontanum that is crucial, as it's just beyond the external sphincter.  Some doctors call this the "no touch zone" as damage to the external sphincter can cause serious incontinence.  That happened to me during a Greenlaser procedure for BPH.

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  • Posted

    You can watch it on the screen and see what he sees on the outside of the prostate and in the bladder. Speak to him and he can explain what he is seeing. Last time he pointed out a nodule on my median lobe. I've been fortunate that all three that I've had have been with the same person and we struck up a relationship. Show interest and they are happy to explain. 

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    • Posted

      So like said before earlier in this discussion, the only way to actually access the actual prostate itself is to cut through the urethra which obviously is what they do when they do a TURP.

      For myself the urologist Will be performing bladder lesion extraction during a TUR B procedure. I was concerned if an over zealous surgeon wanted to modify one's prostate in any way during a T URB bladder surgery it would be impossible for him to access the prostate in less he actually cuts through the urethra. Which would make a bladder operation into a completely different operation. I imagined that couldn't happen when one is performing a single procedure like TU RB. I imagine some surgeons are very confident and even Cavalier that's why I ask something out there question.

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    • Posted

      I'm sorry to belabor this point.  Evidently it isn't that important as there are few men on this forum that seem to think it is an issue.  But....  if there is a place where the instruments "go through it" (and also where the medium lobe of the prostate can protrude through into the urethra or bladder neck) then there must be a "region" where the urethra ends before it gets to the bladder.  I expect if one was to dissect the body parts the urethra wouldn't actually be a tube or have "urethra walls" as would a hose or tube... but rather its basicly just a space between other structures.  I don't see how a blade, laser, etc, could access the prostate without doing damage to this delicate area in order to get there.  

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    • Posted

      The prostate is made of of lobes.  My doctor said it is like a orange.   You go through the prostate to the bladder.  When the prostate get BPH the prostate swells that is why the urethra get smaller because it pushes it together because the urethra goes through the prostate.When they cut it out they make a tunnel.  They take some much from each side  Ken
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    • Posted

      Thanks for the explanation, Excellent. I guess pertaining to my situation now, was that the doctor suggested doing at TRU P a and a TURB during the same operation. I consented to both unknowingly. Then promptly canceled the TUR P. It was confirmed by the doctors administrative office that I was now only getting one procedure the TURB.

      However because of the overconfidence and "wanting to help" mentality that I am reading from the surgeon, I am worried that he may do "a little extra" during the now agreed TURB procedure. So I wanted to know if you can get to the prostate and do a little work during the TURB, where he would be removing to tiny noninvasive small papillary lesions from my bladder.

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    • Posted

      Keith,

      I've cut and pasted this description of the regions of the male urethra for you:

      Pre-prostatic (intramural): Begins at the internal urethral orifice, located at the neck of the bladder. It passes through the wall of the bladder, and ends at the prostate.

      Prostatic: Passes through the prostate gland. The ejaculatory ducts (containing spermatozoa from the testes, and seminal fluid from the seminal vesicle glands) and the prostatic ducts drain into the urethra here.

      Membranous: Passes through the pelvic floor, and the deep perineal pouch. It is surrounded by the external urethral sphincter, which provides voluntary control of micturition.

      Spongy: Passes through the bulb and corpus spongiosum of the penis, ending at the external urethral orifice. In the glans penis, the urethra dilates, forming the navicular fossa. The bulbourethral glands empty into the proximal urethra.

      I took those descriptions from an excellent site called teachmeanatomy.  If you enter that, you should be able to find it.

      NOW, to answer your question.  Yes, TURP or a transurethral laser procedure will obliterate that part of the urethra as it passes through the prostate.  This exposes small blood vessels, and there's bleeding and then clotting.  After the procedure, that part of the urethra starts to grow back.  One doctor said this usually take a week or two;  I suspect it can be longer for some men.  The procedure, either cutting or laser obliteration, causes swelling and soreness for some time.  Additionally, the water used during the procedure can push blood clots into the bladder, and they can come out for a good number of weeks.

      When I had the GreenLaser, the doctor apparently messed up and strayed outside of the prostate and damaged the membranous urethrea and the external sphincter leaving me incontinent.

      From what I've read, the different zones of urethra are not homogeneous.  For that reason, they are able to use a cancer drug, mitomycin C to inhibit stricture growth at the bladder mouth, but not in posterior areas of the urethra.

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    • Posted

      He should not be touching the prostate.  He will be going through the prostate to the bladder so he can remove the lesion.  Do not let him do anything else.  You said that you will be a wake when he does it I would make sure he is tell you everything that he is doing  I still think you should have canceled the other to  I still don't trust him. Once your on that table he can tell you anything and do what he want.  He can tell you he is having a problem getting into the bladder and then to the turp anyway.  You will not be able to stop him because he will have the instruments in you. I hope it does not happen but time will tell.  But if he do it your done for  Ken 

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    • Posted

      Thank you very much again for your advice and opinion Kenneth. It takes so long to get appointments for surgery here after three months. The consent that I sign before Will be canceled and they will as I was told by the hospital of ministration have me sign brand-new consent for only the bladder surgery. I think forgot surgery they want you to be giving in anesthesia to put you out. However if make sure that consent is in order, send the surgeon and email right before the surgery stressing that I only want the TURB done and nothing more, Plus just before the surgery is performed I can verbally consent two only the bladder surgery and nothing more to be done. I think that would ensure after surgeon would have a hard time doing anything else legally. Plus there will be others in the room to witness that final request before surgery.
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    • Posted

      Yes you can  Before you sign that paper read it and make sure it only tell you about the one surgery that you are giving consent for TURB.  Also you should state that that is the only surgery you sign for and nothing extra.  You just want the lesion removed .  No extra procedures nothing done with the bladder neck and the prostate.  And stay alert  Also if he tell you he wants to do something you say no to that .  Being on the table that is not the place to make a decision.  I hope all goes well  Ken    
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    • Posted

      You are right to make the point. You can google for images of the urethra, prostate and bladder.

      They actually show the urethra as being the spongy penis urethra, the external sphincter ;the bladder, the internal urethral sphincter just before the bladder neck. It does not leave much room for error during a TURP.

      The very precise laser will not be fired until it is the exact area to be zapped.

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    • Posted

      I sent you that out come of the Urolift  Because I did it at night and I know there is a 5 hour difference  Yes been there a few times Also would hang out in Windsor a lot when I was younger.  Was only 20 minute's thru the tunnel when I lived in Detroit.  Have a brother-in-law from Ontario     Ken  

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    • Posted

      Thanks Derek, yeah i see that now.

      Though theoretically if a surgeon was performing a bladder lesion removal would he be able to alter modify or do any thing whatsoever on the prostate or bladder neck if he thought it wouldn't impprove urinary retention symptoms. From what I understand a TURB is a fairly minor surgery, where the surgeon gently scrapes the lesion off removes it for biopsy then cauterizes the area where the lesion was removed. In order to do extra surgery on the bladder neck or prostate would not that involve a different procedure. And it is that even rational possibility? I'm asking this kind of question because the surgeon seems to have an overconfident Cavalier and almost over helpful attitude.

      However I will be rigorously making a point that I want nothing else done whatsoever other than the TURB.

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    • Posted

      Okay thanks Kenneth, again that makes a lot of sense. I think if this is stressed rigorously from the consent. To my own statement on paper. As well as vocal as I can be in stressing the point that I only  am equivocally  consenting to TU RB procedure and I don't want anything modified touched on my prostate or bladder neck. Do you think that Wood bullet proof the procedure? When one is not in control I guess the mind shifts to devious thoughts by the surgeon can do things when you are not in control.

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    • Posted

      It looks like the same tool and sounds as scary as a TURP.

      Transurethral resection of bladder tumor (TURBT) is a medical procedure that is used to remove tumors from the surface of the bladder wall. The bladder is accessed through the urethra, the tube that carries urine out of the body from the bladder. TURBT is an alternative to open surgery, during which a large incision is made in the belly in order to reach the bladder. 

      The TURBT Procedure 

      After anesthesia is given, a resectoscope (an instrument with a telescope and small, electrified wire loop) is inserted into the urethra until it reaches the bladder. The telescope allows the doctor to examine the inside of the bladder for signs of tumors or lesions. If present, the metal loop can be used to cut and remove them. 

      The resectoscope may also be used to take samples (biopsy) of the tumor, as well as a portion of the healthy-looking tissue inside the bladder. These samples will be examined under a microscope to look for bladder cancer cells, and to determine how advanced or aggressive the cancer is. 

      TURBT, which is done using either regional or general anesthesia, takes about an hour. It is usually performed as an outpatient procedure in a hospital. An overnight stay of 1 to 3 days, however, may be required for some.

      This procedure is not ideal for those with large and aggressive bladder tumors, or for those who have had recurring tumors. Instead, other cancer treatments like chemotherapy will likely be recommended.

      TURBT Recovery & Complications

      After the procedure, a flexible tube (catheter) may be inserted into the bladder through the urethra to assist with draining urine from the bladder. The catheter will usually stay in place for 1 to 3 days. For a few days after the catheter is removed, the patient may have difficulty controlling their urine. This should improve on its own. 

      Although no incision is made in the belly, TURBT is still considered a major surgery. To speed up recovery, the patient should plan on resting for a few days after the procedure. This includes avoiding stressful physical activities.

      Overexertion can cause bleeding inside the bladder. Some blood in the urine, however, is normal. If this does not clear up after several days, or if urination continues to be difficult or blood clots are present in the urine, a physician should be contacted immediately. It is also normal to notice a couple of days of bloody urine again 10 to 14 days after surgery. 

      Antibiotics may be prescribed to prevent infections, including those of the urinary tract. If so, it is important to take them as directed in order to prevent a recurrent infection. 

      Other complications of TURBT are: 

      Perforation of the bladder wall

      Pain and stinging in the lower urinary tract

      Burning while urinating 

      Outcome and Prognosis 

      It is not always possible to remove the entire bladder tumor. In addition, if the tumor has spread into the muscle of the bladder, or nearby lymph nodes and tissues, more intensive surgery or other treatments—such as chemotherapy or radiation therapy—may be required.

      In some cases, a second TURBT may be done 2 to 6 weeks later, such as when the bladder tumor was not completely removed the first time, or for more advanced tumors. 

      TURBT is most successful for patients with small, single tumors that have not spread to other tissues. Success rates in these cases is around 60 to 70 percent.

       

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    • Posted

      John you are going to be in control you will be awake..  When you sign for the new surgery read it and make sure that they are doing only the TURB surgery.  Tell them you are not giving permission for anything else. Just that surgery.  I still would feel better if you were not having it done by him.  But you just have to take control and pay attention to what there doing  Ken   
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