Cystoscopy

What is Cystoscopy?

Cystoscopy is a commonly performed endoscopic procedure which allows direct visual inspection of the urethra and bladder. It also facilitates obtaining tissue samples (biopsy) when cancer is suspected. There are 2 types of endoscopes which can be used, depending on the specific circumstances.

Flexible Cystoscopy

In flexible cystoscopy, a flexible (‘bendy’) instrument is introduced via the urethra into the bladder, this causes only mild discomfort to the patient, and can be performed under local anaesthetic. Flexible cystoscopes typically employs the use of fibreoptics for light and image transmission. And being flexible, it can be easily deflect as much as 270 degrees, allowing it to be maneuvered easily.

No fasting is needed prior to a patient undergoing flexible cystoscopy, and patient can go home after the procedure.

No fasting is needed prior to a patient undergoing flexible cystoscopy, and patient can go home after the procedure.

What is Cystoscopy?

Cystoscopy is a commonly performed endoscopic procedure which allows direct visual inspection of the urethra and bladder. It also facilitates obtaining tissue samples (biopsy) when cancer is suspected. There are 2 types of endoscopes which can be used, depending on the specific circumstances.

Flexible Cystoscopy

In flexible cystoscopy, a flexible (‘bendy’) instrument is introduced via the urethra into the bladder, this causes only mild discomfort to the patient, and can be performed under local anaesthetic. Flexible cystoscopes typically employs the use of fibreoptics for light and image transmission. And being flexible, it can be easily deflect as much as 270 degrees, allowing it to be maneuvered easily.

Rigid Cystoscopy

Rigid cystoscopy, on the other hand, requires spinal or general anaesthesia as it uses a rigid metal instrument, and is useful in situations where deeper biopsies are required, or some form of therapeutic intervention is needed.

When is Cystoscopy necessary?

Some common situations cystoscopy is indicated include:

  • Haematuria (blood in urine) – to find out the cause, and help rule out cancer
  • Irritative symptoms (urinary frequency/urgency) which may be indicative of underlying bladder cancer/carcinoma-in-situ or cancer
  • When bladder biopsy is planned
  • Follow up and surveillance for patients with previously treated bladder cancer
  • Removal of small foreign bodies/stones

What are the after-effects and complications of Cystoscopy?

Some patients may experience mild burning discomfort and light bleeding after cystoscopy. This usually goes away after a few hours, or at most a day or two.

Though not common, infection may set in, with or without fever, and antibiotic treatment may be required.

Other complications include: urethral stricture (narrowing due to scar formation), delayed bleeding after biopsy, bladder injury (including perforation), urine retention requiring insertion of catheter

Rigid Cystoscopy

Rigid cystoscopy, on the other hand, requires spinal or general anaesthesia as it uses a rigid metal instrument, and is useful in situations where deeper biopsies are required, or some form of therapeutic intervention is needed.

When is Cystoscopy necessary?

Some common situations cystoscopy is indicated include:

  • Haematuria (blood in urine) – to find out the cause, and help rule out cancer
  • Irritative symptoms (urinary frequency/urgency) which may be indicative of underlying bladder cancer/carcinoma-in-situ or cancer
  • When bladder biopsy is planned
  • Follow up and surveillance for patients with previously treated bladder cancer
  • Removal of small foreign bodies/stones

What are the after-effects and complications of Cystoscopy?

Some patients may experience mild burning discomfort and light bleeding after cystoscopy. This usually goes away after a few hours, or at most a day or two.

Though not common, infection may set in, with or without fever, and antibiotic treatment may be required.

Other complications include: urethral stricture (narrowing due to scar formation), delayed bleeding after biopsy, bladder injury (including perforation), urine retention requiring insertion of catheter

How long are you asleep during an endoscopy?

You will be asleep until the endoscopy is completed. As the sedation medication we use are quite short-acting, you will wake up quite quickly after we complete the endoscopy.

This is typically about 10 to 15 minutes for gastroscopy, and about 30 to 45 mins for colonoscopy.

What type of cancers can endoscopy detect?

This will depend on the type of endoscopy that is performed:

What diseases can be detected by endoscopy?

Other than cancerous growths, endoscopy can also detect benign growths, such as polyps. In addition to detection of polyps, the specialist can also use the endoscope to remove such polyps and send them for tests (pathology examination).

Apart from growths, what does an endoscopy test for?

Many diseases can be diagnosed using through endoscopy. Some examples include infection and inflammation. This is usually combined with biopsies, in order to get an accurate diagnosis. Doctors can also use the endoscopy to diagnose sources of bleeding into the intestine, and even perform some procedures to stop the bleeding.

Who can perform the endoscopy?

Endoscopy can only be performed by specially trained doctors called endoscopists. These doctors have to go through a rigorous training programme before they are given the license (also called accreditation) by the hospital to perform endoscopy.

Only General Surgeons and Gastroenterologists can perform endoscopy of the digestive tract, namely gastroscopy, colonoscopy and sigmoidoscopy.

At Nexus Surgical, Dr Jane Tan, Dr Ho Choon Kiat, Dr Lim Khong Hee, Dr Lee Chee Wei and Dr Chan Chung Yip are trained and accredited endoscopists. They each have performed more than 1000 gastroscopies and 1000 colonoscopies in their career. Dr Ho Choon Kiat also served as the Director of Endoscopy Centre of Tan Tock Seng Hospital as well as Director of the Endoscopy Centre of Mount Elizabeth Novena Hospital previously.

Dr Lee Yee Mun is a Urologist who is accredited to perform cystoscopy.

All of them are also accepted into the Medisave / MediShield accreditation scheme. This is a scheme by the Ministry of Health Singapore, which allows patients treated by approved doctors to claim from their Central Provident Fund for payment of the endoscopy. The Ministry only allows trained endoscopists to join this scheme.

Do I need an anaesthetist during endoscopy?

Firstly, sedative drugs will be administered to you during the endoscopy so that you will be comfortable, relaxed and pain-free. This is not the same as General Anaesthesia.

Most of the time, the sedation is administered by the specialist who is performing the endoscopy.

However, there are some patients for whom it will be safer to engage an anaesthetist. Some of the common medical reasons for engaging an anaesthetist are:

  • Patient has underlying heart problem
  • Patient has underlying lung problem
  • Patient has underlying kidney problem
  • Patient is very old and / or frail
  • Patient is a heavy snorer (and hence may have underlying sleep apnoea)
  • Patient is very over-weight (obesity)

Which is better? CT scan or endoscopy?

Endoscopy allows the doctor to view the insides of a patient in real-time and with high-definition colour images. This allows the detection of even very small polyps <5mm. Furthermore, endoscopy allows the doctor to perform treatment like removing polyps.

CT scan produces images in different shades of grey. Very small polyps may be missed. Even if a polyp is detected, the CT scan cannot remove the polyp. Therefore from a diagnostic and therapeutic point of view, the endoscopy is better.

However, the endoscopy does carry some risks, though very small. Such risks include injury to the intestine (perforation). CT scan does not carry such risks. Therefore, for certain patients, a CT scan may be safer.

What happens if you drink water before an endoscopy?

As the patient will be sedated during the endoscopy, we usually tell our patients to fast from food for about 6 hours before their endoscopy.

However, with regards to plain water, sips of water are permissible, especially if the patient has to take his or her usual daily medications, like medication for high blood pressure, etc. However, if possible, the last drink of water should be 2 hours before the endoscopy.

They should refrain from milk feeds at least 4 hours before the endoscopy.

Consult Our Doctor

Dr. Lee Yee Mun
Senior Consultant Urologist

MBBS (Singapore), FRCSEd, M.Med (Surg), MPH
Urologist Singapore

Dr Lee Yee Mun

Senior Consultant Urologist

Endoscopy FAQs

First and foremost, be relaxed. Endoscopy is a very safe procedure and you will be sedated during the procedure, and therefore you will be comfortable.

As for the specific preparations, it all depends on what type of endoscopy you are going for and what time is the endoscopy.

If you are going for gastroscopy, which is endoscopy of the oesophagus, stomach and duodenum, you need to fast from food at least 6 hours before the procedure. However you can still drink plain water till about 2 hours before the procedure.

If you are going for colonoscopy, which is endoscopy of the colon and rectum, in addition to the fasting instructions which is similar to gastroscopy, you will have to take some bowel cleansing medications to clear your colon of faeces. This is very important. It allows the doctor to have a clear examination of your colon

The type of anaesthesia is called Moderate Sedation. Moderate sedation can effectively reduce the patient’s anxiety and discomfort, and gives the doctor an ideal environment for a detailed examination. The patient will usually sleep throughout the procedure.

Under moderate sedation, the patient still breathes on his own. The patient is also rousable, and therefore can be awakened quite quickly at the end of the procedure.

This is different from General Anaesthesia. When under general anaesthesia, the patient will need assistance to maintain his airway and support his breathing. They are also not rousable, even with painful stimuli. They will take some time to regain full consciousness following the end of the general anaesthesia.

There is almost no down time after the endoscopy.

Whether you are going for a gastroscopy or a colonoscopy, you will feel quite well when you wake up from the moderate sedation. However, because you have received sedation, you are advised against driving or operating heavy machinery for the rest of the day. You are also advised against making critical decisions or signing important documents for the rest of the day.

However you can eat as per normal.

Therefore, we usually only issue a 1-day Hospitalization Leave for the patient.

Endoscopy (whether gastroscopy or colonoscopy) is recommended whenever the patient complained of symptoms, and we need the endoscopy to look for the underlying reasons. As long as there is a medical reason, we will offer it, regardless of the patient’s age.

However, if we are talking about screening – looking for a disease in the absence of symptoms and based on the patient’s risk profile – there is some age recommendation.

Screening colonoscopy to look for colon cancer is recommended for everyone, both male and female, starting at age of 50. If there is a family history of colon cancer, then the screening colonoscopy should begin at 10 years prior to the youngest case in the family, or age 40 years, whichever earlier.

How about screening gastroscopy? As the cases of stomach cancer in Singapore is very low, the Health Promotion Board does not recommend screening gastroscopy. However, because of the high incidence of stomach cancer in Japanese and Koreans, these people are encouraged to go for gastroscopy screening every 2 to 3 years starting from age 40 years.

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