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Is cystoscopy a standard procedure prior to TURP?
I was scheduled to have a cystoscopy but I showed the Dr a kidney stone I passed the day before and the Dr said I didn’t need cystoscopy because the stone was causing the flow restriction, and he scheduled TURP coming up in April. And based on my CTUrology imaging studies my prostate is not enlarged, so I am wondering if it’s really my prostate or is it scar tissue in my urethra from giving birth to a kidney stone 20 years ago, which is when my flow issues became obvious and more recently over the last 5 years I have dealt with prostititis which was finally resolved by taking a 20 day course of nitrofurinol.(sp) My question is:
Should the Dr have performed the cystoscopy before scheduling TURP? Is that standard operating procedure? Should I ask him to perform a cystoscopy to make sure it’s actually my prostate and how would I word it seeing as I’m not a medical professional and I don’t want to offend my Dr.
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Cystoscopy means look (scopy) into the bladder (cyst = bladder/pouch). This is done while awake with some numbing gel into the urethra and takes 3-5 minutes. We haven't had to soundproof the walls in the clinic yet; it is very tolerable with > 99% patients not demanding the next cysto (commonly abbreviated like this) is done in the operating room. The main reason it is done is for men with blood in the urine of unknown cause (hematuria) to rule out bladder cancer, the 4th most common cancer in men.
Our urology guidelines tell us some type of characterization of the prostate should be done prior to TURP. This can include a CT, MRI or other imaging - so not everyone needs a cysto prior to TURP. If the urologist is worried about something else in the list of things that could be causing urinary symptoms like urethral narrowing or stricture or bladder stone a cysto in clinic is helpful. Some Urologists will want to do a cysto prior to help determine the best treatment approach trying to answer the ? Is there a prominent median lobe of the prostate etc.
All the best,
Dr Kohler
Professor of Urology
Head of Mayo Men's Health