Hydrodistention With Cystoscopy
Cystoscopy with hydrodistention allows physicians to take a much closer look at the bladder wall. It’s use, however, is controversial. The American Urological Association no longer suggests that it be used as a diagnostic method unless a diagnosis is in doubt. The Europeans, on the other hand, require a hydrodistention before they will make a diagnosis of IC/BPS. The Canadian Urology Association, on the other hand, does not recommend this procedure at all.
A traumatic procedure for the patient and the bladder, hydrodistentions may provide modest relief in IC symptoms which can last from three to six months. As a result, it requires careful consideration and discussion with your urologist.
The stretching of any hollow organ can cause severe pain thus hydrodistention of the bladder is ALWAYS performed under general or spinal anesthesia in a hospital setting. Patients are usually admitted for an outpatient procedure and most leave the hospital a few hours later. Some patients, however, may require an overnight stay if their bladder is ruptured during the procedure.
While you are asleep, the physician will first insert a cystoscope through the urethra and into the bladder to take a close look at the bladder wall. They are looking for any Hunner’s ulcers, lesions, growths or any unusual signs. They will then begin the hydrodistention portion of the procedure by filling your bladder with fluid at a very low pressure. The American Urological Association ONLY recommends low-pressure (60-80 cm H2O), short duration (less than 10 minutes) procedures. The high pressure, long duration procedures popular years ago should no longer be performed to reduce the risk of bladder rupture.
After several minutes, the fluid is released. The physician will then look at the bladder wall again, searching for the small broken blood vessels (glomerulations or petechial hemorrhages) found in IC bladders. If the doctor finds anything unusual, they may also perform a biopsy to rule out bladder cancer, eosinophilic cystitis or other bladder conditions. Your doctor may also take some pictures of your bladder for your medical records and personal use. Some may also use a video recording. Of course, if any Hunner’s lesions are found, they are usually treated at this time.
Once the hydrodistention is complete, you will be sent to the recovery room. Some patients find the post op recovery very easy while others report pain, pressure and discomfort after the procedure. Under NO circumstance should you drink soda, cranberry or orange juice if offered. Please request a lower acid drink such as water or apple juice instead.
It may take several hours for your bladder to wake up enough for you to urinate. The first few times you do urinate afterwards, your urethra may be quite painful. This is normal because your urethra was stretched by the cystoscope. It’s a classic “bite your lip” moment. You will get better. Your urine may also contain blood or clots that should also diminish over time.
Once you are able to urinate on your own, you will be sent home under the supervision of family and/or friends. Because the pain can be severe for the first 24 to 48 hours, patients are normally provided a small amount of stronger pain medication, such as short acting opiate (i.e. Vicodin). In general, patients slowly improve throughout the following week. If your symptoms or bleeding worsens, your pain levels increase and/or you experience a sudden fever, you should contact your physician immediately. Postoperative bladder infections are frequent complications of this procedure and may require additional antibiotic therapy.
The recovery period varies. Some patients can return to work after a few days while others require a week off work. If the bladder has been ruptured, recovery may take substantially longer. You should rest during this recovery period, follow the IC diet carefully to avoid irritating your already traumatized bladder wall. Some patients find using a heating pad very comforting a soothing. Moderation of activities is strongly recommended. Do not assume that you can make a long car ride or plane flight in the days after a hydrodistention. With time and gentle care, your symptoms should slowly diminish and, with luck, be reduced dramatically for up to six months afterwards. Please note, however, that some patients believe that their hydrodistentions made them worse.
Your physician will normally schedule a follow up visit a week or two after the procedure to review the results.