Definition
A cystoscopy is a medical procedure that allows healthcare providers to examine the inside of the bladder and urethra using a specialized instrument called a cystoscope. This tool is a thin, flexible or rigid tube equipped with a light and camera, enabling detailed visualization of the urinary tract.
Purposes for Cystoscopy
- To inspect bladder wall directly for tumor, stone or ulcer.
- To inspect urethra for abnormalities.
- To allow insertion of urethral catheters for radiographic studies.
- Prior to renal/genitourinary surgery.
- To see configuration and position of ureteral orifices.
- To remove calculi from ureter and bladder.
- To diagnose and treat lesions of bladder, urethra, and prostate.
- To measure bladder capacity and look for evidence of vesicoureteral reflux.
- To take biopsy from bladder and urethra.
- To fulgurate bleeding areas in the bladder.
- To implant radium seeds.
- To dilate bladder in case of interstitial cystitis.
Articles
- Sterile fiberoptic cystoscope.
- Irrigation solution-normal saline.
- Dressing pack.
- Cleaning solution.
- Draping set (leg draping).
- Specimen container.
- Sterile gloves.
- Mask.
- Apron.
- Local anesthetic agent, such as lignocaine jelly.
- Syringes 20 ml. (2).
Preprocedural preparation
- Patient should be NPO for 6-8 hours prior to the procedure if procedure is planned under general anesthesia or spinal anesthesia.
- Encourage lot of fluids intake if procedure is planned under local anesthesia.
- Perform bowel preparation on the evening before test.
- Explain procedure and obtain informed consent.
- Ask the patient to empty bladder before sending to operation theater (OT). Initiate IV access.
- Administer prescribed premedications.
- Send patient with records to OT.
Procedure for Cystoscopy
| Nursing action | Rationale | |
| 1. | Receive patient with appropriate records. | Helps in confirming identity of the patient and in obtaining information on the test to be done. |
| 2. | Position patient in lithotomy. | Helps in visualization of urethra. |
| 3. | Clean the genitalia with an antiseptic solution before procedure. | Prevents entry of infection. |
| 4. | Local anesthetic gel is instilled into urethra before insertion of cystoscope. | Reduces pain and discomfort. |
| 5. | Instruct patient to lie still and take deep breaths and relax. | Prevents trauma. |
| 6. | Ensure that the irrigation system is ready. | Saves time, energy and efforts. |
| 7. | Ensure that IV fluids are on flow. | Ensures that a good flow of urine is present at the time of procedure. |
| 8. | Reassure and comfort patient during insertion and examination with cystoscope as it is painful. Inform patient that he may experience an urge to void during insertion. | |
| 9. | Send specimens collected to laboratory with proper labels. | |
| 10. | Wash cystoscope with antiseptic solution and replace articles. | |
| 11. | Document time, findings, specimen collected, and patient’s response. | Helps in communication between staff members. |
Postprocedural care
- Advise patient to be on bed rest for 4-6 hours.
- Instruct patient to avoid standing immediately after procedure as it may cause syncope and dizziness.
- Inform patient that pink colored urine is common, but report to the physician if bleeding and clots are present.
- Instruct patient to expect back pain, bladder spasms and burning micturition during the initial period.
- Administer or teach self-administration of antibiotics prophylactically as ordered to prevent urinary tract infection.
- Advise warm sitz bath or analgesics to relieve discomfort after cystoscopy.
- Provide routine catheter care if an indwelling catheter is present.
- Encourage fluid intake and monitor intake and output.
Complications
- Bleeding due to trauma.
- Perforation of the bladder.
- Urinary tract infection.
- Strictures (late complications).
Special Consideration
- Help the patient into the appropriate position, such as lithotomy for rigid cystoscopy or supine for flexible cystoscopy.
- Ensure proper draping to maintain the patient’s dignity.
- Observe the patient’s vital signs and comfort level throughout the procedure.
- Offer verbal reassurance and explain each step as it happens to reduce anxiety.
- Assist in maintaining a sterile field by handing instruments to the physician and ensuring proper handling of equipment.
- Observe the patient for immediate side effects, such as bleeding, discomfort, or difficulty urinating.
- Provide assistance if the patient feels lightheaded or unsteady.
- Advise the patient to drink plenty of fluids to flush the bladder.
- Inform them about mild burning or blood in the urine, which is normal for a day or two, and when to seek medical attention (e.g., signs of infection like fever or persistent pain).
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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