The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [443]
Haemorrhage
On average, haemorrhage occurs in 3 in 1000 procedures but the incidence and complication rates may be higher where a procedure involves a polypectomy. The postprocedure monitoring by the nurse again includes observing for signs and symptoms of bleeding (Smith and Watson 2005, Swan 2005). Depending on the severity of the bleed, it may be managed conservatively or in haemodynamically unstable patients angiography may be required (Farrell and Friedman 2005).
Cystoscopy
Definition
Cystoscopy examines the inside of the urethra and bladder using a cystoscope and is one of the most widely used invasive urological investigations. It gives direct visualization of the urethra and bladder for both males and females but it is especially important in males as the urethra is much more complex (Fillingham and Douglas 2004, Rodgers et al. 2006).
Anatomy and physiology
Urethra
The urethra extends from the external urethral orifice to the bladder (Waugh et al. 2006).
Male urethra
The male urethra is approximately 19–20 cm long and provides a common pathway for urine, semen and reproductive organ secretions. The three parts of the male urethra are the prostatic, membranous and spongiose or penile urethra. Originating at the urethral orifice of the bladder, the prostatic urethra passes through the prostate gland. The narrowest and shortest part of the urethra is the membranous urethra, originating from the prostate gland and extending to the bulb of the penis. The penile urethra ends at the urethral orifice (Fillingham and Douglas 2004, Waugh et al. 2006).
Female urethra
The female urethra is located behind the symphysis pubis and opens at the external urethral orifice. It is approximately 4 cm long (Waugh et al. 2006).
Evidence-based approaches
Rationale
A cystoscopy is undertaken to gain direct visualization of the urethra and the bladder to aid diagnosis of urological complications and diseases such as bladder cancer (Fillingham and Douglas 2004).
Indications
Bladder dysfunction.
Unexplained haematuria.
Diagnosis of bladder cancer.
Staging of bladder cancer.
Obstruction or strictures.
Dysuria.
Contraindications
Confirmed urinary tract infection.
Preprocedural considerations
Equipment
A cystoscope may be flexible or rigid. A rigid cystoscope is utilized in the operating theatre where the patient is anaesthetized. The flexible cystoscope can be used in the outpatient setting with local anaesthesia. The flexible cystoscope is useful for patients who require more regular examinations for follow-up after bladder cancer treatment (Fillingham and Douglas 2004).
Specific patient preparations
It is essential that the patient does not have a urinary tract infection as the organism that is responsible for the infection may be spread into the bloodstream during the procedure. If the patient is having a general anaesthetic, they will have to fast prior to the procedure, dependent on anaesthetic instruction. Patients undergoing a local anaesthetic can usually eat and drink as normal prior to the procedure. The patient should empty their bladder prior to the procedure (Fillingham and Douglas 2004). It may be necessary for some patients to be treated with antibiotics before the procedure to reduce the risk of infection (AUA 2008).
Postprocedural considerations
Immediate care
Dependent on the type of procedure, recovery will vary. After a general anaesthetic, the patient will be recovered by recovery nursing staff. In the outpatient setting, physiological observations may be required. Nursing staff should monitor for signs of haematuria, infection and excessive pain.
Ongoing care
It is common for the patient to experience some burning sensations whilst passing urine for a few days. It is advised that the patient drink plenty of water post procedure