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Cystoscopy

Cystoscopy is done to examine and diagnose disorders of the urinary bladder and urinary tract. In this procedure, the internal structure of the urinary bladder and the urinary tract can be examined by using the cystoscope. Cystoscopes are administered as both diagnostic and treatment tools. Cystoscopy is predominantly done for patients experiencing recurrent urinary tract or bladder infection, urinary incontinence, hematuria and pain because of obstruction in the urinary tract. The procedure is performed by a urologist by inserting a tube called cystoscope through the urethra to identify disorder.


Cystoscopy Procedure

The duration of the procedure depends upon the condition of the patient. The procedure usually lasts about 45 minutes and it is performed under local, spinal or general anesthesia. Pathological specimens of the urinary bladder can also be obtained by using cystoscopes. Patients are advised to abstain from taking food or water six hours prior to the procedure. In case of rigid cystoscopy, the inserted cystoscope is used to remove any kind of lesions present in the urinary tract or the bladder. In the flexible cystoscopy procedure, the internal lining of the urinary bladder and the urinary tract are examined for abnormalities.

With cystoscopy, small bladder stones or foreign objects can be removed; thereby eliminating surgical intervention. Cystoscopy is useful in examining enlarged prostate, kidney stones and urethral blockage. This procedure is used to place urethral catheters or stents.

Complications of Cystoscopy

The complications associated with the cystoscopy procedure are mostly due to a perforation in the urinary tract. These perforations are caused during the procedure and might lead to urinary tract infection and bleeding. In men epididymitis occurs if testicles are involved during the procedure. The other complications include difficulty in passing urine and abdominal pain. In order to avoid the onset of urinary tract infection after the procedure patients are advised to take fluids preferably water every hour.

Urinary Tract Infection

Under normal circumstances, the urinary system and its structure helps ward off infection. Immune defenses also play a part. The urinary tract is the body's filtering system for removal of liquid wastes. Women may be more susceptible to UTI because their urethral opening is near the source of bacteria. Women who are newly sexually active or have a new sexual partner may be at increased risk of contracting Urinary Tract Infection.

Causes for UTI infection in women


  • The female urethra is shorter and this makes it easier for bacteria to travel
  • If the bladder is not completely emptied, it may lead to infection.
  • Pregnant women and diabetic women are more likely to develop UTI
  • Stones or tumor in the urinary tract can cause urinary tract
  • Urinary catheters and nephrostomy tubes are also likely causes of UTI in women

UTI treatment

UTI treatment involves a course of antibiotics. Treatment of UTI is done with amoxicillin, trimethoprim-sulfamethoxazole or fluoroquinolones. Treating UTI caused by bladder outlet obstructions may necessitate surgery and hospitalization. Drinking plenty of water and fluids will aid in flushing away the bacteria from the urinary system. Some doctors recommend Vitamin C as it will make the urine acidic and thereby hostile to bacteria. The most important tip to prevent urinary tract infections, bladder infections, and kidney infections is to practice good personal hygiene.

Cause of Urinary Tract Infection

E. coli is the most common cause of UTI. When the infection is limited to the urethra, it is called urethritis. A bladder infection is called cystitis. If the UTI is not treated in time, the infection will travel up and infect the kidneys. Other microorganisms called Chlamydia and Mycoplasma are also known to cause UTI infection. Other causes of UTI are bladder outlet obstructions or suppressed immune system. Certain blood types enable bacteria to attach more easily to cells that line the urinary tract, causing recurrent infections.


Nocturia

When deep slumber at night is regularly disrupted by an urgent feeling of urination, it is a condition called nocturia. It is common in older adults, both men and women, usually in the age group of 55 and 84 years. Nocturia is different from enuresis or bed-wetting wherein the person does not wake up from sleep but involuntarily empties the bladder. Nocturia affected person experiences sleep loss due to an urgent need to urinate. Mild nocturia is characterized by a need to urinate two to three times and in severe cases it can be anywhere between five to six times on a particular night, occasionally or daily.

Nocturia types and causes

Besides the normal aging process, nocturia is also linked to other causes. In women, besides age, childbirth or pelvic organ prolapse and menopause are often contributing factors to nocturia.

Nocturnal Polyuria

There is an overproduction of urine at night. In a 24-hour cycle the urine volume may be greater than 40 ml/kg or if the volume of urine passed at night exceeds one-third of the total daily urine output. The main feature of nocturnal polyuria is that more urine is produced during sleep which in turn induces more nighttime urination.

All fluids or even certain foods like salads, vegetables, fruits, rice and pasta with high water content can cause nocturnal polyuria. Diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene and excessive Vitamin D medication can lead to frequent urination. Ankle swelling is another common cause of nocturnal polyuria. Congestive heart failure, venous stasis, hypoalbuminemia or excessive salt intake are other causes for fluid retention.


Polyuria

In adults, the normal urine production is 1 to 2 liters. Polyuria is characterized by urine output that exceeds 2500 ml/24 hours during the day as well as at night. Polyuria is common in people with diabetes mellitus and diabetes insipidus. Other conditions causing polyuria are Polycystic kidney disease, Sickle cell disease, Pyelonephritis, Amyloidosis, Sjogren syndrome and Myeloma. Vascular disease, restless leg syndrome, thyroid disorder and congestive heart failure are some causes for increased urinary output at night by the kidneys. Polydispisia or excessive thirst that compels drinking lots of water can cause polyuria. The thirst center or hypothalamus is affected due to anxiety, stress or psychiatric illness and leads to excessive thirst. Intravenous saline drip excessively administered can lead to polyuria. Hypercalcemia and hypokalemia lead to abnormal levels of electrolytes that can result in excessive urination.


Inadequate bladder storage

The urinary bladder has the capacity to hold as much as 600 ml of urine. But the desire to urinate is experienced when the level reaches about 150 ml. There are various reasons and conditions that lead to inadequate bladder storage. Bladder obstruction, bladder infection or recurrent urinary tract infection, bladder inflammation, pain in the bladder, bladder cancer can reduce bladder storage capacity. Stroke and Parkinson's disease can also lead to reduction in its storage capacity thus inducing an urgent need to empty the bladder.


Mixed Nocturia

A combination of nocturnal polyuria with reduced bladder capacity is termed as mixed nocturia.

Diagnosis of Nocturia

Basic diagnostic procedure is to record the frequency, volume and timing both daytime and nighttime for a minimum of 1-3 days. Certain diagnostic tests like urine analysis, urine culture or an ultrasound are done. Accordingly, the treatment procedure is determined. Treatment options include making dietary changes, behavioral changes with a combination of medications.

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Bibliography / Reference

Collection of Pages - Last revised Date: August 25, 2019