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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.


Pyuria

The medical term for cloudy, frothy and foul smelling pus in the urine is pyuria. It means the presence of significantly elevated level of white blood cells (leukocytes) in urine. White blood cells work with the immune system to defend against infectious diseases. A small number of white blood cells are normally present in the urine. But elevated levels indicate urinary tract problems signaling possible damage to the kidneys, ureters, urethra or bladder, inflammation or a contaminant.


Pyuria symptoms

Pyuria can be symptomatic or asymptomatic. Pyuria due to bacterial infection is symptomatic unless partially treated. Pyuria is asymptomatic when related to chronic infection from tuberculosis or mycoplasma, long-time indwelling catheters, inflammatory conditions like hemorrhagic cystitis, tubulointerstital nephritis or chronic prostatitis in men, or a contaminant such as vaginal secretions, vaginitis, cystocele etc. Asymptomatic pyuria goes away on its own, even without treatment.


  • Cloudy or milky urine
  • Foul-smelling urine
  • Frequent urgent need to urinate
  • Discomfort when urinating
  • Fever

Time to test

The test is done when individuals notice symptoms and seek medical attention. A physical examination is followed by laboratory urine test for pyuria urinalysis. If the test indicates pyuria, a culture of urine is suggested to detect the strain of bacteria that causes pyuria. To detect kidney abnormalities or infection, an intravenous pyelogram or ultrasound imaging of kidney is done. The presence of more than 3-5 white blood cells per high power field in the spun urine confirms pyuria.


Pyuria Causes

Urinary tract infection: The chance of urinary tract infection is high in men and women who are diabetic. As the urethra in women is comparatively shorter than men, it is easier for microorganisms to enter the female urinary tract and cause infection which increases the chance of women contracting urinary tract infection.

Sexually transmitted diseases: Men and women with sexually transmitted diseases are prone to pyuria.

Other causes: Other causes can be infectious or non-infectious.


  • Viral infection
  • Fungal infection
  • Anaerobic infection
  • Fastidious bacteria
  • Infection in prostate glands in men
  • Chemical poisoning
  • Kidney Stones
  • Tuberculosis of the urinary tract
  • Cancer of the urinary organs or genital organs

Non infectious: Medications, advanced age, pregnancy, tumors either benign or malignant can cause pus in the urine. Any other underlying problem in the kidney can also result in excessive levels of white cells in the urine.


Pyuria Treatment

The cause for pyuria determines treatment. For urinary tract infections, doctors prescribe antibiotic medicines. If the cause is due to sexually transmitted diseases, hygiene and other precautionary measures is recommended. Drinking plenty of water, juices sans sugar, avoiding fried foods, practicing good hygiene, not delaying for too long the urgency to urinate are proven precautionary measures of pyuria.


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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019