CYSTOSCOPY & HYDRODISTENSION
What is it?
A procedure performed for the assessment and treatment of patients with symptoms of a hypersensitive bladder; such as bladder pain, and a frequent and urgent desire to pass urine.
What does it involve?
Under a general anaesthetic a telescope inserted up the urethra, (the tube from the bladder), to inspect the lining inside the bladder. The bladder is then filled with sterile water to measure its capacity under anaesthesia. This filling is then repeated to stretch the bladder. Pinpoint areas of bleeding from the lining of the bladder as a result of the stretch are noted as these can sometimes be a sign of a condition called Interstitial Cystitis (I.C.), although they are also found in other conditions and even some normal bladders. Biopsies of the bladder lining can be taken to be sent for analysis. The whole procedure takes about 20 minutes.
Why is it done?
Examination of the bladder and biopsies can exclude other more serious causes of your bladder symptoms such as bladder cancer. If small growths are found they can often be removed at the time (and then the bladder stretch is not performed). The bladder stretch can help diagnose Interstitial Cystitis. Normal bladder capacity under an anaesthetic is about a litre. This may be reduced in Interstitial Cystitis (although not always) and a low bladder capacity can be an indication of how severe the condition is. Some patients with I.C. (5-10%) have 'ulcers' in their bladder. If these are found they are resected or diathermied as this usually gives good relief of bladder pain. If any growth or ulcers are resected causing bleeding, patients may need to stay in hospital, as a catheter is usually left in the bladder for until the urine clears of blood, usually 1-2 days.
How does the bladder stretch help relieve symptoms?
We don’t really know. The stretch may damage the nerve endings in the bladder lining which are oversensitive. Stretching the bladder does not seem to result in any long term bladder dysfunction.
What is the usual post-operative course?
This is usually performed as a day procedure. Following the procedure, once you have passed urine adequately you can go home. The first time you pass urine it may burn and you may see some blood. These symptoms continue to improve and resolve over the next 24 hours. Most patients (80%) with Interstitial Cystitis experience a flare of their symptoms afterwards. This means when they wake up their pain is worse. Analgesia is provided postoperatively and to continue with after discharge as needed. The pain then slowly improves over 2-3 weeks. About 60% will then notice an improvement in their symptoms lasting for an average of 6-9months.
Can the procedure be repeated?
Yes, if symptoms return, or other treatments can be considered. Also if a patient does not have any improvement in their symptoms after the initial hydrodistension it can be repeated as some patients show improvement only after the 2nd or 3rd treatment.
What are the potential risks and complications?
There is a small, <5%, risk of developing a urine infection in the few days following the procedure. If you become unwell, or develop a fever, urgency or pain urinating you will need a urine test for infection and possibly a course of antibiotics. If you experience heavy bleeding or the bleeding is not resolving in 24-48 hours, contact your surgeon at the rooms, or through Calvary Hospital.
There is a very small risk of perforating the bladder, especially if the bladder is severely diseased and thin. This will usually heal by leaving a catheter draining the bladder for 5-7days but can sometimes require open surgery to repair the bladder. Damage to the blood supply of the bladder from stretching is very rare.
It is often not possible to warn patients of every possible risk or potential complication with surgery especially if very rare. Yet it is important that you are aware of what risks are involved, especially the more common ones. This information is not meant to alarm you but allow you to make an informed consent to have surgery. It is very rare but unfortunately some patients can suffer complications and end up worse off as a result of their surgery.
What are the alternatives?
A cystoscopy is usually required to examine the bladder and exclude other causes of your symptoms. This alone can be performed under local anaesthesia but is may be uncomfortable for patients with a painful bladder. The bladder distension requires a general anaesthetic (or regional anaesthetic in some cases). The bladder distension is useful for the diagnosis and treatment of interstitial cystitis but other treatments are available, including oral medication and treatments that are put directly into the bladder via a catheter.
What preparation is required?
You will need to fast beforehand. Please read the information sheet for a Day Stay procedure with general anaesthesia.
You will be given analgesia to take home and an appointment to see your surgeon in the rooms in a few weeks to assess your response. Earlier review is available if needed for any reason. The results from any bladder biopsies taken are usually available within a week by phoning the rooms.
Version: V3, July 2017