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Methods of treating prostatitis
Doctor's comments on cystoscopy

Cystoscopy

The cystoscopy is a very frightening prospect -- having an instrument pushed up your penis is no man's idea of a good time. But experiences vary widely. Below is a range of newsgroup postings on cystoscopy to help you get oriented:

A cystoscopy uses a device which is inserted into the urethra via the opening at the end of the penis. It allows the doctor to visually examine the complete length of the urethra plus the bladder for polyps, strictures, abnormal growths and other problems.  Prostatitis patients should insist on the use of a flexible fiber optic scope rather than the traditional rigid cystoscope (see illustrations.)
(Illustrations not to scale)
Rigid Cystoscope
Flexible fiber optic cystoscope
For a male this is probably the scariest test there is. The thought of having something pushed down that little hole in the penis makes the skin crawl but as the following posters agree it is not that bad in practice. However, do insist on the most sterile settings and procedures. It is possible to introduce bacteria into your bladder and prostate this way. Patients are usually given a 3 day course of a powerful antibiotic to prevent an infection. This is important so insist on it.
John:
I've had this numerous times. The first two were under anesthesia. The last few have been office procedures with local deadening. My experience has not been as bad as it may sound. It's not that there is *no* pain or discomfort. There is, but it isn't anywhere near extreme. My office procedures have gone as follows. (1) A nurse gives a betadine wash, then inserts some deadener into the urethra, puts a clamp in place, and leaves for 15 minutes or so. The insertion of the deadener may be the most uncomfortable part of the whole procedure, but it doesn't take very long and it isn't all that bad. (2) During the cysto itself, I have been uncomfortable but not in much pain. Again, this doesn't take very long - a few minutes - perhaps less than 5. (3) You may have a little blood on urinating, and possibly a little pain, for a few days.
Roger:
I have had two cystos. Since I have other kidney problems in addition to my prostatitis, then for me they are merited. If you have a problem, even if it turns out to be only prostatitis, then you need to have the proper check-up. You need to know what is going on in there. The cysto will check for physical problems, obstructions, stones, etc. Is it painful? No, only for the ego. I found it deeply embarrassing and for my second trip, I elected to be put under. After the drugs wear off, your first few urinations will be A LOT OF FUN! The cysto did nothing for me related to prostatitis, but just eliminated cancer and Urethral obstructions.
Ed:
in my case, cystoscopy turned out to be of the utmost importance and benefit as it disclosed a malignant polyp in my bladder which had simulated very well the symptoms of BPH and/or prostatitis. There was no blood in my urine which is a classic indicator of bladder cancer. According to my urologist, the urine test for cancer was negative prior to the cystoscopy. So, I cast a definite vote for having it done. It is not comfortable but not as bad as you think it will be. Good luck!
Don:
I've had cystoscopic exams every three months for the past four years because of a recurring bladder cancer. IT IS VITAL THAT YOU DETERMINE IN ADVANCE WHAT KIND OF EQUIPMENT YOUR UROLOGIST WILL USE.
If he uses a flexible telescoping cystoscope, the process is psychologically demeaning, but painless. (Stretching a stricture is not painless, but I know it can often be done quickly in a doctor's office and kept open by occasional restretching.)
If he has a rigid cystoscope RUN, do not walk, to another urologist; I found those agony. In either case, I found it is important to drink a lot and keep the urine dilute to avoid discomfort on urination. When I tried not to drink, so I didn't have to urinate, it really hurt when I did for the first day. Now I drink a lot of iced tea and pee away without discomfort.
Be sure to get a good antibiotic for a 2-3 days following a cystoscopic exam. Avoids infection from the process. Really, with a flexible telescoping cystoscope it is no big deal.
WV:
An attempted cystoscopy was unsuccessful because of a narrowing or stricture at the bladder neck which prevented entry into the bladder and revealed that the stricture was indeed the cause of my symptoms. Once the stricture was relieved via mechanical dilation the prostatitis symptoms were gone and a normal cystoscopy was possible without undue discomfort.
It's my (largely uninformed) opinion that many prostate symptoms are caused by strictures, especially at the bladder neck, and can be easily eased with dilation or a quick transUrethral "snip" by a good urodoc. Mine has suggested such a procedure but so far I have opted for periodic "stretches" and not the knife. Quite satisfactory.
The "flex" scopes which are now used are virtually painless ...unlike the old "iron bar" of a few years ago. I think it should be used early on to look for scarring, strictures and other problems in the urethra that could be causing the symptoms. I believe these are quite common and largely overlooked until late in the diagnosis process. In my case it was after 8 months of Bactrim and floxin that they decided to scope it. All those months of discomfort and worry when it was something simple all along.
Anonymous:
Whatever you do don't ever have a rigid scope in a doctors office (worst pain I have ever had, and I used to crawl on my hands and legs with back pain before my disc operation). The old fart uros still have their rigid scopes because they don't want to get rid of them. What a bunch of crap. These doctors should retire.
I would vote for the second option (which will be my next one), ie the flex scope in an outpatient environment with the "bug juice" to relax you. General anesthesia is overkill, especially since you are going to have to undergo the post procedure pain when urinating for a couple days or so anyway
Anonymous:
I definitely will vote for option one. I have had two cystoscopies. The first one was about nine years ago with a rigid scope and under general anesthesia. The second one, about 3 years ago, was in the office with a flexible scope. Believe me, the flexible scope procedure is no big deal. It is a bit uncomfortable when the doctor is viewing the prostate and the bladder, but it doesn't take more than a few minutes. And unless the doctor has a video camera and monitor setup, you don't see a thing. I didn't.
There was some discomfort for the first two days when I urinated. Just be sure to get something for the pain from the doctor before you leave the office.
Anonymous:
I also had a cystoscopy in a doctors office about 2 years ago. I got a local deadening and then a flexible tube inserted. It was very painful and I was told to expect air passing when I urinated. What I wasn't told about was the possibility of an infection. In three days I was running a temp. of 102 and in the hospital for 3 days. Be sure to ask your doctor for Cipro or other protection from infection after the test.
Anonymous:
My cysto was one of the biggest mistakes I ever made. If I had had any idea of how bad the pain would be (and of what little value would be gained from it) I never would have done it.
I went to the uro complaining of "cramping" pain in my groin, and bleeding after urinating. I still don't think anyone ever listened to me when I said AFTER urinating, as they kept saying to me things such as, "Well blood IN the urine can mean...". I was only bleeding after I finished urinating. Then I could bleed for up to five minutes. This was happening about every six weeks. I did not have blood in my urine. The cramping was happening mostly at night, mostly after orgasm, and about every four to five weeks. There was no discomfort at all in between times when I had the cramps.
I was placed on Septra for one week, and an IVP was ordered. The IVP came back normal, and the Septra made no difference. Thinking back on it I have no idea why an IVP was ordered. An IVP focuses on the Kidneys. The idea (as I understand it) is to make sure the blood is not coming from a source inside the bladder or kidneys. How on earth I could be blood could flow bright red from my penis after I've stopped urinating and be coming from my kidneys is beyond me! But, I didn't know then what I know now.
So, I showed up at the Uro for the Cysto. The cysto was done with a flexiscope and no sedation. During the procedure I was in moderate discomfort, but not too bad. The uro said the bladder was normal, and that the prostate was bleeding when the scope touched it. I think he spent most of his time at the prostate. He put me on four weeks of floxin and said this ought to cure it, that I most likely wouldn't need to come back.
I had to urinate after the procedure so I stopped in the men's room, and ouch! I felt a burning sensation that has not gone away for the 8 months since the procedure. That night I had a cramp that had me on the floor in a cold sweat. I was so sick I thought I was going to die.
Ever since I have been in constant pain. The pain is low level to high level mostly centered in my groin and radiates into my thighs, back and abdomen.
Do I think the cysto caused the pain? YES! If not it is the biggest coincidence ever. Would I ever have another Cysto. NO!
Needless to say, the Floxin didn't work. I went back to the Uro and he told me, "there are some things I can't cure." So, I got a new Uro. The story continues to this day.
Anonymous:
I am 42 years old and had my first symptoms over a year ago, after a cystoscopy (performed to look for a bladder tumor, when in fact I had bleeding caused by kidney stones; The first of many misdiagnoses). I handled the procedure fairly well, but had extreme pain on urinating for 2-3 weeks afterwards. Now my symptoms (pain in the sphincter and bladder, occasional urge to urinate) are somewhat mild, but frustrating because they never completely go away. I have had some temporary success with floxin. Saw palmetto works well too, and after reading some of the postings here, I've added garlic and zinc to my pill popping regimen. Acupuncture and Chinese herbs seemed to work only a few days. I might try them again though.
My question is, did the cystoscopy cause my prostatis? Or perhaps aggravate a preexisting condition? X-rays before the cystoscopy did show a slightly enlarged prostate, but I was symptom free at the time. My urologist is no help and looks at me like it's all in my head. An internist I see thinks my wife and I may be re-infecting each other with whatever virus or bacteria is causing the prostatis.
Anonymous:
For the past 6 months I have been suffering from an inflamed prostate. My first visit to my uro was about 3 weeks after I start getting the symptoms. After doing a DRE and PSA test he believed that I had a stricture which was causing all the problems. He advised me that I should have a scope done. Being the chicken I was I told him I would think about it but in the mean time could we not try something else.
So he put me on floxin (3 weeks) and saw palmetto. The floxin didn't help so he switched me to amoxicillin for 4 weeks which did for the most part cleared it up accept for the heaviness I still had in my rectum, which meant the prostate was still swollen. I have been and avid reader of this newsgroup and have done postings in the past to get some ideas and alternatives. I tried all the sitz baths I could, 4 bottles of saw palmetto, zinc, garlic, muscle relaxers, hytrin, you name it I have tried everything. However not a massage because my uro did not think it would help and my urine and blood did not show any bacteria or infection, which by the way according to my uro a blood and urine test and prostate fluid test would show any of these. So what I had was a nonbacterial prostatitis.
A month after taking the amoxicillan all my symptoms returned so I called my doctor and asked if he could change the script and he said no because anything he gives me will only temporary help and all symptoms would return. He said "Bill you need the scope because I think you have strictures". Finally I agreed and this past Thursday I had the outpatient surgery. My doctor found two stricture which were causing the urine to backflow and inflaming my prostate. It is now Saturday and I would like to tell you that all my symptoms are going away and I am starting to feel better. The cystoscopy was a pain free experience.
Now I am a firm believer that if anyone acquires prostatitis and you have at least tried two medications and they didn't help then you need to get this procedure done because the strictures are the problem. Just think all 6 months living with this condition, trying all these non medical remedies, when all it was was a simple procedure and finally a cure. And besides feeling better, now I know I do not have anything "up there" wrong with me.
What a relief and I am so grateful to my uro. I just feel now I should have listen to him in the first place. They are the experts. I am a firm believer now if you get prostatitis, no medicines, vitamins or massages as such is going to cure you. It may find a temporary cure but it will be back. Don't put off what really you need.
This has only been my experience and also don't get me wrong because I support the newsgroup 100%. Its great to talk to people who exchange ideas and compare experiences.
Anonymous:
If this involves a catherization and you can be out for it or at least numbed down below go for it. Had a cystogram yesterday and it was very uncomfortable...I will admit it only hurt going in and then when it was taken out.. However I have had a heck of a time urinating the past two days because it really burns and hurts to do so. No ejaculation for fear of the pain. Tonight it is subsiding thank God..But as I told the nurse yesterday this is a small price to pay to be rid of this problem.
Anonymous:
I have had recurring bacterial prostatitis for 19 years for which American uros have performed three IV pylegrams, two cystoscopies and one TURP and more one-time-only finger waves than I can remember. The prostate infection is still with me. The infection readily spreads to my bladder, and sometimes to my ureters and kidneys. To have a cystoscopy performed in order to rule out cancer, ulcers etc. is a darn good idea. Peace of mind is valuable and vital. We all agree on that.
But I want to share with you an experience I had 19 years ago which might help someone sometime. The uro who did my first cysto 19 years ago told me he wanted to do the cysto with a general anesthesia. When I questioned the need and wisdom of the general anesthesia he offered to have the anesthesiologist speak to me. I accepted the offer. I was in the hospital at the time. The cystoscope to be used was rigid, not flexible.
In answer to my specific questions I learned from the anesthesiologist that a spinal block would be much safer than a general anesthesia and less discomfort afterward. So I told the anesthesiologist to give me a spinal block only and "absolutely nothing else."
The next day I was wheeled down the hall on a gurney to the door to the procedure room. There I was confronted with a nurse reaching for my arm to prepare to give me an injection in my arm. I pulled my arm away and asked her what she was up to.
She said that the anesthesiologist had ordered a shot. The shot was valium. Can you believe it! The anesthesiologist was trying to give me this stupefying agent contrary to my explicit instructions!! I twice refused the nurse and twice she went away to talk in whispered tones to a male voice behind a screen in the procedure room. When she came back the third time with the needle I started to get off the gurney and announced in a loud voice I was going to walk back to my hospital room and check out of the hospital. Instead, they decided to give up on the shot in the arm. Notice that I had to shout loud enough for that cowardly-hide-behind-a-skirt male anesthesiologist hiding behind the screen inside the procedure room to hear me loud and embarrassingly clear and I had to threaten "mayhem" to him to avoid his giving me that stupefying agent. Valium is not for pain. It is more properly classified as a harmful stupefying agent. It is for the convenience and best interests of the doctor, not the patient --- and it is administered at the patient's risk. Researchers have warned us that valium caused permanent brain damage even in minute quantities when tested on animals.
The uro had ordered the valium. Against my orders the anesthesiologist was going to do the uros bidding, Perhaps this was because the uro was Chief of Staff of the hospital. The excuse they give patients is that valium "is for pain", "it will make everything more comfortable for you", "to ease your anxiety" "put you into a twilight zone." My anxiety is the damage being done to me, not knowing what the hell the physician is up to and just WHAT is really going down!
A cystoscopy done with a flexible scope does not require a general anesthesia or a spinal block. Just some lanacaine up the urethra for a few minutes before the procedure. One reason my uro wanted the general anesthesia, it turned out, was because he planned to insert a metal rod up the urethra (the bent metal rod is called a male sound) and then squeeze the bejeebers out of the prostate by rectal digital massage against the metal rod. The spinal block was all I needed to endure that. I saw it all and felt nothing. But when the spinal wore off hours later I started getting restless and eventually needed a shot of Demoral to get through the night. The uro forgot to put that on my chart so we woke him up at midnight to get the order for Demoral. Served the bum right. I guess I would label that pain as "restless legs" or "climbing the walls." I probably wouldn't have been able to understand what was going on inside of me or understand the source of the "pain" if I hadn't watched the cysto procedure, known what went down, and discussed the potential consequences of the metal rod massage with the uro at the time of the cysto procedure. Fortunately for me, one shot of demoral eliminated the pain permanently.
Before my second cysto I had read some good advice in a health newsletter. It advised that if you do decide to permit a cystoscopy to be performed you should insist that it be done with a flexible scope. And ask the uro to agree in advance to let you look through the scope and see for yourself anything and everything significant. I did this on the second cysto. Very good advice. But as it turned out, the female uro who talked me into my second cysto had a scheme up her sleeve to try to sell me my second TURP even with me looking into the scope. I am going to post that story separately to the newsgroup under the title "Cystoscopy - Example of dishonest use of."
Anonymous:
I think everyone should get at least one of these tests done when they first start having prostatitis symptoms. I have read about so many cases of prostatitis that were caused by something else like a stricture, obstruction, etc. In my case, my doctor found a very bad stricture with a test called a Retrograde Urethragram (RUG). The test consists of shooting some contrast stuff into the urethra through the penis and then x-raying it. It is not a very pleasant test, but the results were amazing. You could see the stricture as clear as day. Now I am going to have a small surgery this week to get rid of the stricture and hopefully after that, my prostate problems will be over. I have had prostate trouble because of this stupid stricture for over a year and it took that long to finally to anything other than give me way too much Cipro. I could have had this taken care of a long time ago if I had just had one of these tests in the first place. So, my advice to all you prostatitis sufferers who haven't had any kind of test like this is, GET ONE DONE!
Anonymous:
Having had four cystos over eight years, my results were pretty good. A minority of patients with prostatitis will have a complication condition called Urethral stricture disease. This can cause reflux of urine into the proximal portions of the small prostate ductules...resulting in irritation and inflammation. If you also happen to have in infected, swollen prostate, then the symptoms can be worse. The only way to check for strictures is a cysto. l have had multiple strictures every time, which has resulted in a dilatation.
Unfortunately, this is often done in the setting of an inflamed urethra, and the little devils have a tendency to recur. Believe me, if you need a dilatation, you want to be under anesthesia. (These are pretty quick procedures). My last dilatation was a little different.
The urologist (my friend) put a numbing jelly down the urethra, then inserted a long wire with a balloon around in as far as the bladder...while we chatted about hospital politics. Then he blew up the balloon, much like an angioplasty for heart patients, and stretched the urethra. It hurt a good bit, but not for long. It was not as much dilatation as you get in the operating room, but has seemed to work better over time. My flow is good, and symptoms much, much better.
Anonymous:
During the late morning of January 10, in preparation for the TUMT I plan to have at the Prostate Treatment Center in Toronto, here in Western Washington State, I placed the heels of each foot in ice-cold stirrups and submitted to a cystoscopy.
Having successfully located my diminutive organ in the frigid room, the good Doctor squeezed a topical anesthetic into my urethra by way of the penile aperture and pinched the tip to discourage egress of same. Within three minutes or so she was preparing to insert he cystoscope, warning me that as it passed my enlarged prostate I might feel some discomfort.
As the chromium instrument entered the penile or penumbrous urethra I felt nothing. Nor did I experience sensation as it passed the prostatic urethra. She was explicit in preparing me for and describing each phase of the protocol. Once in the bladder I felt nothing more than a vague sense of foreboding--due most probably to the exotic strangeness of the situation--and a slight pressure from time to time as my Urologist moved the rigid instrument up and down and from side to side so as to inspect the condition of my bladder and attendant systems. At no time did I have pain or physical unease.
She did find trabeculations in the bladder wall but this was expected. The ureter openings were looked at, one being a bit more difficult to see because of the intruding middle lobe of the prostatic tumor that had, quite normally and expectedly, invaded the area proper to the bladder. All was well, no stones or diverticula were found. It would appear that I have an enlarged prostate, normal to and representative of someone my age which is 61. So within three or four minutes total and without sensing the withdrawal, my Physician had quitted the urinary tract leaving me intact and completely comfortable. As I cleaned up I noticed the absence of blood and this is as it should be. In the six (6) hours that followed I experienced urinary urgency and frequency and I had to force myself to drink copious quantities of water and cranberry juice as I dreaded the intense burning felt in the Urethral passage when I voided.
But this decreased incrementally and by that night I was back to normal and have been ever since. My next test in preparation for the TUMT is an ultrasound on Monday which will serve as a diagnostic tool for irregularities and/or illness and also permit measurement of the present size of my burgeoning organ while ascertaining the quantity of urine being retained by the bladder because of this growth. Both measurements are useful in determining which surgical procedure is indicated and proper.
Several aspects of this experience are worth delineating: Knowledge is power and inspires confidence and tranquility — I am not an expert but I knew what to expect, what to ask Inquiry on the part of a knowledgeable patient is paramount--know what to ask and how to interpret the responses I live in a small town and normally eschew medical assistance here for serious problems--but my Urologist is professional, attentive, patient, and humane--she listens to my questions, answers them to my satisfaction, and focuses on me as her patient vice treating me as a numbered client--in effect she shares her expertise and learning with me and makes me feel that together we are working toward a resolution--anything less than this and I suggest that one look elsewhere for medical aid and counsel And always remember that "medicine is an art that utilizes science." This is not physics or mathematics. We are involved with sliding scales, bell curves, and the seemingly treacherous bogs and fens of statistics and averages. Do the best we can, deal with the results and if something should go awry double our efforts the next time. I shall try to deal with any inquiries or comments in a timely manner; don't hesitate to so advise.
Anonymous:
I've had cystoscopic exams every three months for the past four years because of a recurring bladder cancer. IT IS VITAL THAT YOU DETERMINE IN ADVANCE WHAT KIND OF EQUIPMENT YOUR UROLOGIST WILL USE.
If he uses flexible telescoping cystoscope, the process is psychologically demeaning, but painless. (Stretching a stricture is not painless, but I know it can often be done quickly in a doctor's office and kept open by occasional restretching.)
If he has a rigid cystoscope RUN, do not walk, to another urologist; I found those agony. In either case, I found it is important to drink a lot and keep the urine dilute to avoid discomfort on urination. When I tried not to drink, so I didn't have to urinate, it really hurt when I did for the first day. Now I drink a lot of iced tea and pee away without discomfort.
Be sure to get a good antibiotic for a 2-3 days following a cystoscopic exam. Avoids infection from the process. Really, with a flexible telescoping cystoscope it is no big deal.
Anonymous:
I think everyone should get at least one of these tests done when they first start having prostatitis symptoms. I have read about so many cases of prostatitis that were caused by something else like a stricture, obstruction, etc. In my case, my doctor found a very bad stricture with a test called a Retrograde Urethragram (RUG). The test consists of shooting some contrast stuff into the urethra through the penis and then x-raying it. It is not a very pleasant test, but the results were amazing. You could see the stricture as clear as day. Now I am going to have a small surgery this week to get rid of the stricture and hopefully after that, my prostate problems will be over. I have had prostate trouble because of this stupid stricture for over a year and it took that long to finally to anything other than give me way too much Cipro. I could have had this taken care of a long time ago if I had just had one of these tests in the first place. So, my advice to all you prostatitis sufferers who haven't had any kind of test like this is, GET ONE DONE!
Anonymous:
Hi. I recently had a cystoscopy and like you I worried for some 4 weeks before the appointment. Believe me, the worry is far worse than the actual inspection which took all of 4 minutes. Do not be upset that the procedure is performed in an operating theater and that antibiotics are given via a drip immediately before the inspection. The antibiotics are given to anyone who has recently suffered an infection. (mine was two UTI's some weeks previous).
The cystoscope is like a small telescope with about 20 inches of thin flexible tube attached to it. A clear gel is squeezed into the orifice of the penis then the thin tube is slowly and gently inserted. When the tube reaches a sphincter (valve) near the prostate there is a sharp but quick pain just like a dentist touching a sensitive tooth. Try to relax as this does make the pain less. A second similar pain occurs when the tube passes through another valve and enters the bladder. That is it, no more pain just slight discomfort as the tube is removed.
My uro also performed a urine flow test which involved inserting a thin wire through the cystoscope tube while the cysto was still in the bladder. I forgot to mention that warm water is flowing through the cysto all the time it is being used - you can feel your bladder slowly filling. The cysto is then removed leaving the thin wire in place. A small balloon is pushed into your anus and inflated and then you are invited to stand up and pee into a container. A transducer in the fine wire measures the flow rate a produces a graph. The flow rate test takes about 3 minutes and is totally painless even when the fine wire is removed. Hope this helps.

From: jdimitrakov@my-deja.com
Concerning the answer to you question regarding Urethral stricture following cystoscopy or other Urethral procedure I am reposting an earlier explanation of the unique structure of the urethra. But first, here are the results from a review by Lentz HC, Mebust WK, Foret JD, and Melchior J entitled "Urethral strictures following transUrethral prostatectomy: review of 2223 resections" published in the Journal of Urology 1977; 117: 194-196. The authors concluded from their analysis, that the important factors foe a Urethral stricture were
  1. initial calibration of the urethra to determine the anatomical adequacy prior to instrumentation,
  2. gentle dilatation of the urethra,
  3. the use of perineal urethrostomy in patients with a stricture noted at the time of initial endoscopy (n=142), and
  4. the size of the Urethral catheter used postoperatively (not significant).
Second, here's the opinion of the expert:
From "Standard Surgical Interventions: TUIP/TURP/OPSU" by C.G. Roehrborn ( www.urohealth.com )
"In nine TUIP (transUrethral incision of the prostate) studies, 21 of 1218 patients developed a Urethral stricture with a mean probability of 1.7 (1.2-2.5)%. Seventeen studies reported the incidence of Urethral stricture disease following TURP (transUrethral resection of the prostate). These studies total 12 003 patients with an average age of 67.6 years. A total of 269 patients developed Urethral stricture disease with a mean probability of 3.1 (0.5-9.7)%. Three studies reported relatively high incidences of 16%, (Nielsen HO. TransUrethral prostatotomy versus transUrethral prostatectomy in benign prostatic hypertrophy.
A prospective randomised study. Br J Urol 1988; 61: 435-438) 16.3% (Meyhoff HH, Nordling J, Hald T. Urodynamic evaluation of transUrethral versus transvesical prostatectomy. A randomized study. Scand J Urol Nephrol 1984; 18: 27-35) and 13%;(Meyhoff H H, Nordling J. Long term results of transUrethral and transvesical prostatectomy. A randomized study. Scand J Urol Nephrol 1986; 20: 27-33) however, they are carefully documented and contemporary."
Here is an interesting link to an excellent urology book "Surgical Management of Urologic Disease. An Anatomic Approach" Edited by Michael J. Droller (Mosby Year Book 1992, p757-758):
"The unique structure of the anterior urethra is primarily responsible for its predisposition to stricture formation. The wall of the bulbo-penile urethra [the part of the urethra located between the anus and base of penis and along the penis] is formed by a layer of uroepithelim applied almost DIRECTLY to the vascular spaces of the surrounding erectile spongy-tissue. It is this spongio-thrombotic healing response of this delicate vascular tissue - and the consequent spongio-fibrosis - that primarily determines the nature of the stricture of the bulbo-penile urethra and also its predisposition to restenosis after definitive surgical procedures.
Spongio-thrombosis is thus the natural consequence of damage to the spongy tissue. Its extent varies according to whether it results from simple exposure to urine after superficial uroepithelial denudation, from INFECTION, or from localised trauma. Its inevitable progression to spongio-fibrosis is the fundamental factor that predisposes the bulbo-penile urethra to stricture formation and to a tendency to postoperative restenosis."
So, it turns out that the bulbo-penile urethra is unique since it especially vulnerable and prone to fibrosis (which manifests itself as stricture at that level) because of the direct contact of the epithelial lining with the vascular spaces of the erectile spongy tissue. The wall of the urethra is simply formed by erectile tissue lined by a thin layer of uroepithelium and any infection (asymptomatic or overtly symptomatic) results in denudation of this lining. So, what normally forms the conduit for urine and sperm is lost and urine comes in direct contact with the exposed vascular spaces which thrombose (so that they can close) and this naturally leads to spongio-fibrosis. The extent of the spongio-fibrosis depends upon the extent of the associated damage to the spongy tissue itself. After a simple denudation, the natural closing pressure that evacuates the bulbo-penile urethra approximates the margins of the residual uroepithelim: the intervening clefts are intermittently opened by the voiding stream but the spongio-thrombotic/spongio-fibrotic process gradually contracts to stricture the lumen.
So, in conclusion, bleeding is rare (occurring in about 1 % of patients following cystoscopy) and depends on whether it is performed using a flexible cystoscope and the "gentleness" of the urologist. Bladder neck contracture can predispose to a subsequent stricture following cystoscopy.
Best regards,
Jordan Dimitrakov, MD

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