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Actos Lawyer: Approximately twenty percent of patients with bladder cancer will complain of irritative voiding symptoms. These symptoms include urinary urgency (a need to rush to the bathroom), burning and urinary frequency. These same symptoms are present in other urologic conditions such as infection, bladder instability and prostatic enlargement in men. These symptoms are most commonly associated with a diffuse superficial form of transitional cell cancer of the bladder called CIS (carcinoma in situ). Unfortunately for some, their diagnosis may be delayed since these symptoms are present in so many other diseases.
Cystoscopy (examination of the bladder) is usually the first step in making the diagnosis of bladder cancer. Given the signs and symptoms suggesting bladder cancer, or an X ray or ultrasound revealing a possible bladder tumor, cystoscopy is a must. Cystoscopy can be accomplished with either a flexible cystoscope or a rigid scope. The flexible cystoscope is composed of small optical fibers encased by a plastic sheath. A rigid scope has glass lenses within a metal sheath. Both cystoscopes are passed directly through the urethra into the bladder to visualize the inside surface. Cystoscopy can be accomplished in both the urologist’s office or as an outpatient at a hospital or surgicenter.
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The flexible cystoscope is easier and less painful to pass, especially for males whose urethra is longer and more tortuous than in females. Flexible cystoscopy is readily accomplished in the doctor’s office. A lubricant is applied to the scope to ease passage. Local anesthesia can be squirted into the urethra prior to passing the scope. Discomfort from the cystoscope is usually well tolerated and short in duration. The discomfort usually lasts a few seconds as the scope is passed through the prostate. At that time, you may feel a pressure sensation. In females, passage of the scope is quick and relatively painless.
During the exam, your bladder will be filled with sterile water to allow complete visualization of all the surfaces. You may feel like you have to urinate. During flexible cystoscopy, small biopsies can be obtained. Any bleeding from the biopsy site is readily controlled. The biopsy and cauterization will cause pain for a few seconds. A mild oral sedative can be taken prior to an exam, but is generally not necessary. An entire examination may take only a few minutes. If biopsies are done, the exam will be a little longer. Flexible cystoscopy is very convenient. You can drive yourself to and from the office. After the exam, you can generally go right back to work. If a tumor is found that is too large to treat with a flexible cystoscope, you will be scheduled for an additional procedure at a hospital or surgicenter.
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The rigid cystoscope, although easy to pass in a female is difficult to pass without sedation in a male. The rigid cystoscope allows for generous biopsy specimens and removal of small tumors. Cystoscopy therefore can provide for both diagnosis and treatment at the same time. If a large cancer is found, removal with a resectoscope can be used to remove it at the same time. If multiple biopsies or resection of a cancer is done, spinal or general anesthesia may be required. Since rigid cystoscopy generally causes more discomfort than flexible cystoscopy and requires more anesthetic, you can expect to be out of work at least one day. In addition, someone will need to drive you home from the surgicenter or hospital.
If you are being initially screened for asymptomatic microscopic hematuria, a urologist will often choose flexible cystoscopy as the first step. He is not certain whether or not you have a bladder cancer or other condition causing the hematuria. Flexible cystoscopy will provide that answer in a less time consuming, less painful and more cost effective way than rigid cystoscopy. On the other hand, if there is a high likelihood a tumor is present, it makes sense to do rigid cystoscopy and if required, resection all at one setting. If you are experiencing gross hematuria, flexible cystoscopy does not provide adequate visualization, and rigid cystoscopy is warranted. Many urologists use both types of cystoscopes, but some do not have the flexible cystoscope in their office.
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