Urinary Issues: When to Consider Cystoscopy for Diagnosis

Q: Urinary Issues: When to Consider Cystoscopy for Diagnosis

Hello： Due to the presence of symptoms, it is possible that the stone has not been expelled, so it is essential to confirm that there is no renal hydronephrosis and that urine tests show no hematuria and no symptoms before discontinuing monitoring. <br>As for the cystoscopy, it d

Dysuria

Hello Dr.
Du,
I am 27 years old and have recently experienced difficulty urinating and hematuria over the past two months.
I previously visited a clinic where I underwent urinalysis and ultrasound examinations.
The urinalysis showed the presence of red blood cells, bacterial infection, and crystals (Amorphous urate).
The clinic prescribed a 3-day course of antibiotics, and during the medication period, my hematuria improved.
However, two days after stopping the medication, I noticed blood in my first morning urine again, and it was darker than before my visit.
Consequently, the clinic referred me to a larger hospital for further evaluation.
At the larger hospital, urinalysis still showed red blood cells, and the ultrasound revealed mild hydronephrosis in the right kidney.
I also experienced slight discomfort in the lower right abdomen during urination.
The physician suspected the possibility of urinary stones and arranged for an intravenous pyelogram (IVP).
The X-ray showed hydronephrosis in the right kidney and ureter but no obstruction or obvious stones.
Ultimately, the physician advised me to increase my fluid intake and prescribed pain medication, with a follow-up urinalysis scheduled for one week later to check for improvement.
A week later, the urinalysis results were normal with no hematuria, and the ultrasound indicated improvement in the hydronephrosis.
However, I still experienced mild discomfort in the lower right abdomen during urination.
The physician concluded that there might still be some small stones and reiterated the recommendation to drink more water.
Since no clear cause could be identified, a follow-up urinalysis was scheduled for two weeks later.
If I continue to experience other uncomfortable symptoms, a cystoscopy may be necessary.
This is a summary of my medical visits for your reference, Dr.
Du.
I have been increasing my fluid intake, and visually there is no hematuria; however, I still experience mild discomfort in the lower right abdomen during urination, and I have noticed 1-2 drops of urine leaking out about one minute after urination, which is quite bothersome.
The latest symptom is that although I feel like I have a full bladder in the morning, the force of urination seems insufficient.

Based on your assessment, do you think I need to undergo a cystoscopy?

Arbit, 20~29 year old female. Ask Date: 2017/10/14

Dr. Du Shixi reply Urology

Hello: Due to the presence of symptoms, it is possible that the stone has not been expelled, so it is essential to confirm that there is no renal hydronephrosis and that urine tests show no hematuria and no symptoms before discontinuing monitoring.
As for the cystoscopy, it depends on whether you are willing to undergo it.
Since the procedure is invasive, the physician will recommend it if they believe it is necessary based on the examination results.
Wishing you good health.

Reply Date: 2017/10/14

More Info

Based on your detailed description of your urinary issues, it seems that you have experienced a series of concerning symptoms, including hematuria (blood in urine), urinary discomfort, and the possibility of urinary stones. Given your age and the symptoms you've described, it's understandable that you are seeking clarity on whether a cystoscopy is warranted at this stage.

Cystoscopy is a procedure that allows a physician to examine the bladder and urethra using a thin, flexible tube with a camera (cystoscope). It is typically recommended in cases where there are persistent urinary symptoms that cannot be explained by non-invasive tests, such as urinalysis or ultrasound. In your case, while you have shown improvement in hematuria and kidney swelling, the ongoing discomfort and the presence of potential small stones may justify further investigation.

When to Consider Cystoscopy
1. Persistent Symptoms: If you continue to experience urinary discomfort, especially if it is localized to the right lower abdomen during urination, this could indicate an underlying issue that may not be visible through imaging studies alone. Cystoscopy can help identify any abnormalities in the bladder or urethra that might be causing these symptoms.

2. Recurrent Hematuria: Although your recent urinalysis showed no blood, the history of hematuria, especially if it recurs, is a significant reason to consider cystoscopy. Blood in urine can be caused by various conditions, including infections, stones, or even tumors. A cystoscopy can help rule out these possibilities.

3. Unexplained Findings: The ultrasound indicated mild hydronephrosis (swelling of the kidney due to urine buildup), which can sometimes be caused by stones or strictures. If the cause of hydronephrosis is unclear, cystoscopy can provide direct visualization of the urinary tract to identify any obstructions or abnormalities.

4. Assessment of Stones: If there is a suspicion of small stones that are not causing significant obstruction but are still leading to discomfort, cystoscopy can be used to visualize and potentially remove these stones if they are located in the bladder.

Additional Considerations
- Follow-Up: Since your symptoms have improved, it may be reasonable to continue with the follow-up urinalysis as suggested by your physician. If your symptoms persist or worsen, or if you experience any new symptoms (such as fever, increased pain, or changes in urination), it would be prudent to revisit the idea of cystoscopy sooner rather than later.

- Hydration and Diet: Continue to stay well-hydrated, as this can help flush out any small stones and reduce irritation in the urinary tract. Discuss with your physician if dietary changes could also help in managing your symptoms.

- Consultation with a Urologist: If you have not already, consider consulting a urologist who specializes in urinary tract issues. They can provide a more tailored approach to your symptoms and help determine the best course of action.

In conclusion, while your symptoms have shown some improvement, the ongoing discomfort and previous episodes of hematuria suggest that cystoscopy could be a valuable diagnostic tool to ensure that there are no underlying issues that need to be addressed. It is essential to have an open discussion with your healthcare provider about your symptoms and the potential benefits and risks of proceeding with cystoscopy.

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