Rigid cystoscopy (including biopsy if required ± stent removal)

What is the evidence base for this information?

This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence-based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your GP or other healthcare professionals. Alternative treatments are outlined below and can be discussed in more detail with your urologist or specialist nurse.

What does the procedure involve?

This procedure involves inspection of the bladder and urethra with a telescope and, occasionally, bladder biopsy or removal of abnormal areas with the use of heat diathermy; we can also remove a ureteric stent during this procedure.

What are the alternatives to this procedure?

Flexible cystoscopy or observation.

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, specialist registrar, junior doctors and your named nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• an artificial heart valve
• a coronary artery stent
• a heart pacemaker or defibrillator
• an artificial joint
• an artificial blood vessel graft
• a neurosurgical shunt
• any other implanted foreign body
• a prescription for Warfarin, Aspirin, Rivaroxaban, Dabigatran, Apixaban, Edoxaban or Clopidogrel , Ticagrelor or blood thinning medication
• a previous or current MRSA infection
• high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human derived growth hormone)

What happens during the procedure?

Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.

You will usually be given injectable antibiotics before the procedure, after checking for any allergies.

A telescope is inserted through the water pipe (urethra) to inspect both the urethra itself and the whole lining of the bladder. Occasionally, it is necessary to stretch the opening of the urethra to introduce the instrument.

What happens immediately after the procedure?

You will normally be allowed home once you have passed urine satisfactorily. If a catheter is left in place, this will normally be removed within 24 hours and you will be discharged once you have passed urine satisfactorily.

The average hospital stay is one day.

Are there any side effects?

Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than one in 10)

• Mild burning or bleeding on passing urine for a short period after the operation
• Temporary insertion of a catheter

Occasional (between one in 10 and one in 50)

• Infection of the bladder requiring antibiotics
• Finding of cancer or other abnormalities may require further surgery or other therapies
• Permission for telescopic removal / biopsy of bladder abnormality / stone if found

Rare (less than one in 50)

• Delayed bleeding requiring removal of clots or further surgery
• Injury to the urethra causing delayed scar formation
• Very rarely, perforation of the bladder requiring a temporary urinary catheter or open surgical repair

What should I expect when I get home?

When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

When you get home, you should drink twice as much fluid as you would normally for the next 24 to 48 hours to flush your system through. You may find that, when you first pass urine, it stings or burns slightly and it may be lightly bloodstained. If you continue to drink plenty of fluid, this discomfort and bleeding will resolve rapidly.

What else should I look out for?

If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately.

Are there any other important points?

If a biopsy has been taken, it may take 14 to 21 days before the results are available. It is normal practice for all such biopsies to be discussed in detail at a multidisciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion.

If you have any continuing problems regarding the tests, you can telephone the specialist nurses or speak to your GP at his / her surgery.

Depending on the underlying problem, an outpatient appointment, further treatment or another admission may be arranged for you before you leave the hospital. Your consultant or named nurse will explain the details of this to you.

Driving after surgery

It is your responsibility to ensure that you are fit to drive following your surgery. You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.

Is there any research being carried out in this field at CUH?

There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly audit and clinical governance meeting.

Who can I contact for more help or information?

Oncology nurses

Uro-oncology nurse specialist: 01223 586748

Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG): 01223 274608

Prostate cancer nurse practitioner: 01223 216897 or bleep 154-620

Surgical care practitioner: 01223 348590 or 256157 or bleep 154-351

Non-oncology nurses

Urology nurse practitioner (incontinence, urodynamics, catheter patients): 01223 274608 or 586748 or bleep 157-237

Urology nurse practitioner (stoma care): 01223 349800

Urology nurse practitioner (stone disease): 01223 349800 or bleep 152-879

Patient advice and liaison service (PALS)

Telephone: 01223 216756
PatientLine: *801 (from patient bedside telephones only)
Email PALS
Mail:
PALS,
Box No 53
Cambridge University Hospitals NHS Foundation Trust
Hills Road,
Cambridge,
CB2 2QQ

Chaplaincy and multi faith community

Telephone: 01223 217769
Email CUH chaplaincy
Mail:
PALS,
Box No 53
Cambridge University Hospitals NHS Foundation Trust
Hills Road,
Cambridge,
CB2 2QQ

MINICOM System (‘type’ system for the hard of hearing)

Telephone: 01223 217589

Access office (travel, parking and security information)

Telephone: 01223 596060