A cystoscopy is a medical procedure used to examine the lining of the bladder and the urethra, which is the tube that carries urine out of the body. During this examination, a thin, flexible tube with a light and camera, called a cystoscope, is inserted into the urethra and advanced into the bladder. An “abnormal” result indicates that something unusual or unexpected was observed within these structures. This finding does not provide a definitive diagnosis on its own but rather signals the need for further investigation to understand the underlying cause of the observation.
What an Abnormal Cystoscopy Indicates
Observations during a cystoscopy can point to various conditions affecting the bladder and urethra. One common finding is inflammation or infection, which may manifest as redness, swelling, or irritation of the bladder lining, often indicative of cystitis. The inner surface of the bladder might appear hyperemic, showing increased blood flow, or edematous, appearing swollen due to fluid accumulation.
Bladder stones, hard masses of minerals, can also be observed. These vary in size and number, appearing as distinct objects within the bladder, and can cause irritation or obstruction.
The cystoscope might also reveal growths or suspicious lesions, ranging from benign polyps to potentially cancerous tumors. Polyps typically appear as small, stalked growths, while more concerning lesions might present as irregular, sessile (flat), or papillary (finger-like) masses on the bladder wall.
Narrowing or strictures within the urethra or at the bladder neck can also be identified during the procedure. These constrictions can impede urine flow and are often visible as a reduced lumen or an area of scarring. Additionally, structural abnormalities such as diverticula, which are small pouches or out-pouchings in the bladder wall, might be observed. These pouches can trap urine, potentially leading to infections or stone formation.
Next Steps After an Abnormal Result
Following an abnormal cystoscopy, further diagnostic steps are typically recommended to precisely identify the condition. A biopsy is a common next step, where small tissue samples are collected from any suspicious areas using instruments passed through the cystoscope. These samples are then sent to a pathology laboratory for microscopic examination to determine if abnormal cells are present, which helps in diagnosing conditions like cancer or specific types of inflammation.
Imaging studies are often used to gain a more comprehensive view of the urinary tract and surrounding structures. Computerized tomography (CT) scans, magnetic resonance imaging (MRI), or ultrasound can provide detailed images of the kidneys, ureters, and bladder, helping to identify stones, tumors, or anatomical variations that might not be fully visible during the cystoscopy.
Additional urine tests may also be performed to gather more information. Urine cytology involves examining urine samples under a microscope to detect abnormal or cancerous cells that might have shed from the urinary tract lining. A urine culture, on the other hand, is conducted to identify the presence of bacteria and determine the specific type of infection, guiding appropriate antibiotic treatment.
Treatment Approaches for Abnormal Findings
Treatment approaches for abnormal cystoscopy findings are tailored to the specific diagnosis confirmed through subsequent tests. For conditions like urinary tract infections or bladder inflammation, medical management often involves antibiotics to eliminate bacterial infections or anti-inflammatory drugs to reduce swelling and discomfort.
Surgical interventions are frequently employed for conditions such as bladder stones, tumors, or strictures. Bladder stones can be removed or fragmented using specialized instruments passed through the urethra, a procedure often performed endoscopically. Tumors, depending on their size and nature, might require transurethral resection, where the growth is removed using a cystoscope-guided instrument. Urethral strictures can be treated through dilation, which involves stretching the narrowed area, or through surgical reconstruction.
In some instances, lifestyle modifications can support recovery or prevent recurrence. For example, dietary changes, such as increased fluid intake or specific food restrictions, might be recommended for individuals prone to bladder stones.
Monitoring and surveillance are also important components of managing certain conditions, particularly after treatment or for benign findings. This may involve regular follow-up cystoscopies to check for recurrence of tumors or to monitor the stability of benign lesions. Periodic urine tests or imaging studies can also be part of a surveillance plan, ensuring any changes are detected and addressed promptly.