Cystoscopy images are real-time pictures captured during a procedure called a cystoscopy, where a doctor looks inside the bladder and urethra. Using a specialized instrument with a camera, a urologist directly examines the urinary tract lining. The images provide a detailed view that helps in diagnosing a range of conditions, from minor inflammation to more serious issues.
The Cystoscopy Procedure
A urologist uses an instrument called a cystoscope, a thin tube with a light and camera, to perform the procedure. There are two main types: a flexible scope, which is bendy and used with a local anesthetic, and a rigid scope, which is straight and requires general or spinal anesthesia. The choice depends on the procedure’s purpose; diagnostic evaluations often use a flexible scope, while interventions like taking a tissue sample may use a rigid one.
The process begins with the patient lying down, and a numbing gel is applied to the urethra to minimize discomfort. The urologist then gently inserts the cystoscope into the urethra and advances it into the bladder. To get a clear view, the bladder is filled with a sterile solution, which stretches the bladder wall for inspection. The camera transmits high-definition images to a monitor, showing the internal structures in detail.
Images of a Healthy Bladder and Urethra
A healthy bladder lining, known as the urothelium, looks smooth and has a consistent pale pink color. The bladder wall itself should be free of any growths, lesions, or areas of discoloration. As the bladder fills with sterile water, its walls stretch uniformly, showing no signs of stiffness or irregularities.
During an examination, the urologist identifies anatomical landmarks. This includes locating the two ureteral orifices, the small openings where urine enters the bladder from the kidneys. These openings should be seen to gently pulse as they release urine. The trigone, a smooth, triangular region at the base of the bladder, is also inspected for a smooth appearance.
Interpreting Abnormal Cystoscopy Images
Bladder Stones
The presence of bladder stones, or calculi, is a clear abnormality. These are hard mineral deposits that can vary significantly in size, shape, and number. Some may be small and gravel-like, while others can be quite large. Their surface can be either smooth or jagged, and they are identifiable as they move freely within the bladder.
Inflammation (Cystitis)
Inflammation of the bladder, known as cystitis, presents a very different visual from a healthy bladder. Instead of a pale pink, the bladder lining appears red, irritated, and swollen. The blood vessels on the bladder wall may become more prominent and, in some cases, there can be visible patches of bleeding. The overall texture of the urothelium loses its smoothness and can look raw and agitated, which is a direct visual confirmation of an inflammatory process.
Tumors or Polyps
Growths inside the bladder, such as tumors or polyps, are another significant finding. These can appear in several forms. Low-grade tumors often have a distinctive finger-like or cauliflower-like appearance, growing out from the bladder wall on a stalk. High-grade tumors, conversely, tend to be more solid, flattened, or ulcerated, with an irregular and often nodular surface. Enhanced imaging techniques, such as using a special blue light after a drug is placed in the bladder, can make cancerous cells glow pink, helping to identify tumors that might otherwise be missed.
Urethral Strictures
A urethral stricture is a narrowing of the urethra caused by scar tissue. While technically in the urethra and not the bladder, it is often diagnosed during a cystoscopy. As the scope is passed through the urethra, the doctor will observe a section that is significantly narrower than the rest of the tube, obstructing the path. This narrowing can range from a slight constriction to a nearly complete blockage, preventing the cystoscope from passing into the bladder easily.