A cystoscopy is a medical procedure that allows a specialist to look directly inside the bladder and the urethra. This examination uses a cystoscope, a thin, flexible or rigid tube equipped with a light and a camera lens. The procedure is often recommended when a patient experiences symptoms such as blood in the urine, recurrent urinary tract infections (UTIs), or ongoing pain during urination.
The cystoscopy investigates the cause of these symptoms by visually inspecting the lining of the lower urinary tract. A healthy bladder lining should appear smooth, pale, and uniformly pink. An abnormal finding signifies a physical deviation from this normal appearance, indicating an underlying health issue within the urinary system.
Visual Indicators of Abnormality
The urologist systematically examines the bladder wall for visual evidence deviating from the expected smooth, uniform surface. A common sign of abnormality is a change in color, often presenting as intense redness (erythema), which suggests localized or widespread inflammation (cystitis). This redness indicates that blood vessels in the tissue are dilated, signaling irritation or infection.
Abnormal texture is also a significant indicator. This might manifest as trabeculation, a thickening and ridging of the bladder muscle caused by the bladder working harder against an obstruction. More concerning are visible masses, which may be papillary (finger-like projections) or sessile (flat and broad-based) growths protruding from the lining.
Other irregularities include foreign bodies, such as bladder stones (calcifications or hard, crystalline structures). The urologist may also observe ulcerations (open sores) or diverticula (small pouches) forming in the bladder wall. Scarring of the urethra, called a stricture, appears as a noticeable narrowing of the tube, hindering the passage of the scope and requiring further investigation.
Common Diagnoses Following Abnormal Findings
Specific visual indicators observed during the cystoscopy are associated with a range of medical conditions. When a urologist identifies a papillary or sessile mass, the most serious concern is a bladder neoplasm, or cancer. The majority of these are urothelial carcinomas, which arise from the cells lining the bladder. These tumors are classified by their growth pattern and how deeply they invade the bladder wall.
A frequent finding is the presence of hard, mobile objects diagnosed as bladder stones or calculi. These stones often form due to chronic obstruction or prolonged infection, where mineral salts crystallize in the stored urine. They can cause irritation, leading to bleeding and recurrent infections.
If the cystoscopy reveals diffuse inflammation, pin-point hemorrhages, and potentially a distinct ulcerated patch known as a Hunner’s lesion, the diagnosis may point toward Interstitial Cystitis (IC), also called Bladder Pain Syndrome. This chronic condition is characterized by pain and pressure in the bladder area.
Inflammation not readily explained by a current bacterial infection may suggest a chronic inflammatory condition. This might include chronic cystitis, urethritis, or radiation cystitis in patients who have received pelvic radiation therapy. Distinguishing between these diagnoses relies on correlating the visual findings with the patient’s medical history.
Confirmatory Procedures and Treatment Planning
Once an abnormality is visually confirmed, the physician often obtains a tissue sample, or biopsy, to establish the diagnosis. For suspicious growths, this is frequently done through a Transurethral Resection of Bladder Tumor (TURBT), which removes the entire visible mass for analysis. The tissue sample is then sent to a pathology lab to determine the exact cell type and confirm whether a tumor is benign or malignant.
If the growth is malignant, the pathologist analyzes the sample to determine the tumor’s grade and stage. Grading describes how aggressive the cancer cells appear under a microscope. Staging determines how deeply the tumor has penetrated the bladder wall, classifying it as non-muscle-invasive or muscle-invasive. This analysis guides the subsequent treatment plan.
Treatment planning depends entirely on the confirmed diagnosis. For bladder stones, treatment may involve surgical removal or fragmentation using specialized instruments passed through the cystoscope. Non-muscle-invasive bladder cancer is often managed with repeated surveillance cystoscopies and intravesical therapy, which places medication directly into the bladder. More advanced cancer requires extensive intervention, such as surgical removal of the entire bladder or a combination of chemotherapy and radiation.