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How Can A Cystoscope Be Done For A Small Urethral Opening?

Posted on Wed, 22 Nov 2023

Question: I'm 58 and had what could be my 1st possible UTI. Well now I'm scheduled for a cystoscopy. I've read the flexible ones are no wider than a pencil and the rigid are bigger. My urethral opening is smaller than a pencil, how are they going to get that in me without ripping me? It's going to be in the Dr's ofc which means local only. What will happen if it doesn't fit?

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
You seem to have Senile Urethral Stenosis.

Detailed Answer:
Hello
Thanks for query.

Based on the facts that you have posted it seems that you are getting repeated episodes of UTI due to Post Menopausal Urethral stenosis and scheduled for Urethral Calibration and Cystoscopic Dilatation .

Though you are apprehensive about passing Urethroscope through tight and narrowed urethra .It is a routine practice to install local anesthetic gel in urethra before the procedure making it numb for 15-20 minutes so that surgeon can do calibration and dilatation of urethra and carry out the endoscopic examination without patient getting pain .

Do not worry. It is very simple procedure .

Hope I have answered your query, please feel free to ask if you have more questions,I shall be happy to help you.

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. P. T. Patil (1 hour later)

Interesting answer. First off I don't know that I had a UTI. The culture was neg for bacteria. I witnessed hematuria which is reason for cystoscopy. Doctor doesn't know what urethra looks like, it's like an investigational cystoscopy. I'm always being sent for a CT urography with and without contrast. While I am past menopause, my urethra has always been small. I never thought about it. I'm just wondering course of action if too small and there's no way I'll put myself through dilation under local only.

Answered by Dr. Dr. P. T. Patil (8 hours later)

Brief Answer:
It is routine practice to do Cystoscopy under local anesthesia

Detailed Answer:
Hello
Thanks for follow up .

I can understand your apprehension about how Urologist would pass his endoscope through narrowed urethra .

It is a routine practice to do endoscopic examination in female under local anesthesia as female urethra is straight,short and gets dilated easily compared to males .However you can discuss your apprehension with your Urologist so that he can plan to do it under short General anesthesia.

Thanks and Regards.
Dr.Patil..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (13 hours later)

Ok I guess that's what I was looking for, whether the urethra would expand easier without tearing. I do have another question regarding this area that I just came across. The possibility that it's small because of straddle injuries. I did it twice as a child on a boy's bicycle. I don't know if I did anything bad, I never brought it up to my mother. The only thing I've never forgotten is the pain each time. I never hurt the vagina, just the front two areas.

Answered by Dr. Dr. P. T. Patil (59 minutes later)

Brief Answer:
Urethral stenosis is entirely due to hormonal changes after menopause.

Detailed Answer:
Hello again,
Thanks for following up with the details.

Riding a bicycle in childhood cannot be the cause of narrowing urethra (urethral stenosis) It is entirely an aging process resulting from hormonal changes that occur after menopause.

As regards making the urethral passage wider to accommodate large size sheaths it is done by dilating urethra with sequential dilators which are calibrated in gradual increasing diameters and not by tearing it.

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. P. T. Patil (24 minutes later)

Ok what is a sheath? It's always been this small, this isn't a new occurrence, I'm not sure how I feel about the possibility of a bigger hole. Oy.

What is a sheath, please?

Answered by Dr. Dr. P. T. Patil (2 days later)

Brief Answer:
Sheath is an instrument that holds Telescope

Detailed Answer:

Detailed Answer:
Hello,
Thanks for following up.

A sheath is an instrument that holds the telescope (Cystoscope in this case) and has a channel for water to flow continuously during the examination of the bladder and urethral passage.

I'd request you not to stretch your anxiety and apprehension too much and just get relaxed... It is a simple procedure that is carried out routinely as a primary diagnostic procedure in dealing with Urological problems.

Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (3 hours later)

Thank you, I am trying. It is not easy. I've heard it is painful especially rigid or dilation.

Answered by Dr. Dr. P. T. Patil (28 minutes later)

Brief Answer:
O.K bye

Detailed Answer:
Hello
Thanks for follow up .

Go ahead and get it done .It is not that painful as you fear it to be .

Thanks and Regards.
Dr.Patil.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar