Cystoscopy and retrograde studies

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 urologist or nurse specialist as well as the surgical team at Addenbrooke’s. 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 the taking of x-rays of the kidney and/or ureter (the tube that takes urine from the kidney to the bladder) by injection of dye through a telescope placed into bladder.

What are the alternatives to this procedure?

Other forms of x-ray, magnetic resonance imaging (MRI) scan, computed tomography (CT) scan or ultrasound.

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, 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, junior urology 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.

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 short period after operation.
• Temporary insertion of a catheter.

Occasional (between one in 10 and one in 50)

• Infection of the bladder requiring antibiotics.
• Occasionally we cannot pass the tube into the ureter requiring alternative treatment.
• Temporary insertion of a soft plastic tube (ureteric stent) placed between the kidney and the bladder if thought necessary with the need for subsequent local anaesthetic removal.
• 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.

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.

What else should I look out for?

If you develop a fever, pain in the area of the affected kidney, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately.

Are there any other important points?

A follow-up appointment will be arranged following discharge from hospital and may involve an outpatient clinic appointment or further treatment, depending on the findings of the x-ray studies. If you have any concerns about the timing of further treatment, please discuss this with your named nurse or consultant.

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.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high tech equipment and/or specialist one-to-one care is required.

Hair removal before an operation

For most operations, you do not need to have the hair around the site of the operation removed. However, sometimes the healthcare team need to see or reach your skin and if this is necessary they will use an electric hair clipper with a single-use disposable head on the day of the surgery. Please do not shave the hair yourself or use a razor to remove hair as this can increase the risk of infection. Your healthcare team will be happy to discuss this with you.

References

NICE clinical guideline No 74: Surgical site infection (October 2008); Department of Health: High Impact Intervention No 4: Care bundle to preventing surgical site infection (August 2007)

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)

Box No 53, Cambridge University Hospitals NHS Foundation Trust
Hills Road, Cambridge, CB2 2QQ
+44 (0)1223 216756, cuh.pals@nhs.net
PatientLine: *801 (from patient bedside telephones only)

Chaplaincy and multi faith community
+44 (0)1223 217769, cuh.chaplaincy@nhs.net

MINICOM System (‘type’ system for the hard of hearing): +44 (0)1223 217589
Access office (travel, parking and security information): +44 (0)1223 596060

What should I do with this leaflet?

Thank you for taking the trouble to read this patient information leaflet. If you wish to sign it and retain a copy for your own records, please do so below.

If you would like a copy of this leaflet to be filed in your hospital records for future reference, please let your urologist or specialist nurse know. If you do, however, decide to proceed with the scheduled procedure, you will be asked to sign a separate consent form which will be filed in your hospital notes and you will, in addition, be provided with a copy of the form if you wish.

I have read this patient information leaflet and I accept the information it provides.

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