A cystoscopy is a medical procedure used to examine the inside lining of the bladder and urethra. For individuals treated for non-muscle invasive bladder cancer (NMIBC), especially after Bacillus Calmette-Guérin (BCG) therapy, this procedure is an important surveillance tool. It allows healthcare providers to directly visualize the bladder for signs of cancer recurrence or changes, helping to monitor treatment effectiveness and detect issues early.
Understanding BCG Treatment and Surveillance
Bacillus Calmette-Guérin (BCG) is a form of immunotherapy used in the management of non-muscle invasive bladder cancer. This treatment involves instilling a weakened strain of Mycobacterium bovis directly into the bladder, prompting an immune response within the bladder lining. The goal of BCG therapy is to activate the body’s immune system to target and eliminate residual cancer cells, reducing the likelihood of cancer recurrence or progression. BCG stimulates immune cells like T-cells, natural killer cells, and macrophages to attack malignant cells and establish an immune memory against future tumor growth.
Despite BCG’s effectiveness in preventing recurrence, bladder cancer can still return, making regular surveillance necessary. Approximately one-third of NMIBC patients may not respond to BCG, and about 50% of those who initially respond might experience a recurrence or progression. This highlights the importance of ongoing monitoring to identify any changes promptly.
Cystoscopy is the primary method for this surveillance, enabling direct visualization of the bladder lining to detect suspicious areas or recurrent tumors. This allows for early intervention, which is associated with more successful disease management. The procedure provides a direct view that other imaging methods might not offer, making it a key part of post-BCG follow-up.
The Cystoscopy Procedure
Before a cystoscopy, patients are typically asked to empty their bladder, and sometimes a urine sample is collected to check for infection. If an infection is present, the procedure might be rescheduled to prevent complications. There are generally no restrictions on eating or drinking before the procedure, though specific instructions may vary if sedation or general anesthesia is planned.
During the procedure, the patient lies on their back, often with feet in stirrups and knees bent. A local anesthetic gel is applied to the urethra to minimize discomfort during the insertion of the cystoscope, a thin, flexible tube with a camera at its end. The cystoscope is gently advanced through the urethra into the bladder, and sterile saline solution is then pumped into the bladder to inflate it, providing a clearer view of the lining.
Patients may experience sensations such as pressure, an urge to urinate, or mild discomfort during the procedure. The images from the cystoscope are often displayed on a screen, which the patient may be able to view. The procedure typically takes between 5 to 15 minutes, though it may take longer if sedation or general anesthesia is used.
Immediately after the cystoscopy, it is common to experience mild burning during urination, increased urinary frequency, or pink-tinged urine for 24 to 48 hours. These symptoms usually resolve on their own. Increasing fluid intake can help alleviate them by flushing the bladder.
Interpreting Findings and Follow-Up
During a cystoscopy, the healthcare provider examines the bladder lining for abnormal areas, growths, or suspicious lesions. The appearance of the bladder wall can vary; a healthy bladder wall typically looks pink and clear.
Findings may include a “normal” or “clear” result, indicating no visible signs of recurrence. Sometimes, the bladder lining may appear inflamed or irritated, a common side effect of BCG treatment that does not always mean cancer has returned. However, any suspicious areas, such as new growths or lesions, may indicate a recurrence. In such cases, a biopsy is often performed to obtain tissue samples for laboratory testing, providing a definitive diagnosis.
The follow-up schedule after BCG treatment varies based on the individual patient’s risk of recurrence and progression, but general guidelines exist. For high-risk non-muscle invasive bladder cancer, cystoscopies are typically recommended every three to four months for the first two years. If the bladder remains clear, the frequency may decrease to every six months for the next two years, and then annually thereafter. For intermediate-risk patients, the schedule might involve cystoscopy and cytology every three to six months for two years, then every six to twelve months for the next two years, followed by annual checks. Adhering to this prescribed surveillance schedule is important for long-term monitoring and for detecting any potential recurrence at an early, more manageable stage.