tial cystitis occurs more often in women. However,
doctors do not know what causes interstitial cysti-
tis, either. Finding the cause will likely shed light
on all dimensions of this chronic and disruptive
condition.
See also BLADDER CATHETERIZATION; NEPHRITIS.
cystocele A hernialike condition in which a
woman’s BLADDERbulges into her VAGINA. Cystocele
is more common after MENOPAUSEand in women
who have given birth vaginally. It occurs as a con-
sequence of weakened vaginal and pelvic muscles
and ligaments that allow the supportive structures
for the bladder to relax and the bladder itself to
drop. Doctors believe the prime culprit is the
intense straining that occurs during vaginal birth,
which weakens muscles, coupled with changes in
the elasticity of MUSCLEtissue that take place when
levels of ESTROGENSdrop in a woman’s body with
menopause.
The symptoms of cystocele may include the
sensation of vaginal pressure, difficulty urinating,
or URINARY RETENTION. Chronic URINARY TRACT INFEC-
TION (UTI) may also occur, especially when the
extent of the cystocele is such that residual URINE
remains in the bladder after URINATION. The doctor
can usually diagnose cystocele via vaginal palpa-
tion during a PELVIC EXAMINATION, as the sagging
bladder causes the vaginal wall to bulge inward.
When the diagnosis or the extent of the cystocele
is uncertain the doctor may conduct a voiding CYS-
TOURETHROGRAMto determine whether the bladder
fully empties with urination.
Mild cystocele that causes no symptoms may
require only watchful waiting. The urologist or
gynecologist may also recommend a pessary, a
device placed within the vagina that gives added
support to the vaginal wall. Surgical repair is the
treatment of choice for cystocele that interferes
with urination, particularly when such interfer-
ence causes chronic UTI. The surgery tightens the
ligaments and muscles of the pelvic floor, restoring
support for the bladder. Open surgery requires six
to eight weeks for full recovery. Often the surgeon
can do the repair laparoscopically, reducing recov-
ery time to two to three weeks.
See also HYDROCELE; KEGEL EXERCISES; MINIMALLY
INVASIVE SURGERY; RECTOCELE; SPERMATOCELE; SURGERY
BENEFIT AND RISK ASSESSMENT; VARICOCELE.
cystoscopy An endoscopic procedure for visual-
izing the interior of the BLADDER. The cystoscope is
a narrow tube with a tiny light and camera on the
tip. Cystoscopy requires no preparation or recov-
ery time and takes place in an outpatient surgery
setting under sterile procedures. The urologist
anesthetizes the URETHRA, then inserts the cysto-
scope through the urethra and into the bladder,
visualizing the progress on a closed-circuit televi-
sion monitor. Some people find the insertion
mildly uncomfortable. The urologist then injects
saline through the cystoscope to fill the bladder,
which may create the urge to urinate. However,
the bladder must be full to distend its walls for
complete examination. Cystoscopy takes 10 to 20
minutes.
Cystoscopy allows the urologist to visualize the
interior of the bladder to examine it for signs of
INFLAMMATION or tumors (BLADDER CANCER). The
urologist can use cystoscopy to biopsy suspicious
findings, remove bladder stones, and administer
medications such as antibiotics or anti-inflamma-
tory drugs. Cystoscopy also allows the urologist to
evaluate BENIGN PROSTATIC HYPERPLASIA(BPH) in men.
Some people experience HEMATURIA(BLOODin the
urine) and discomfort or burning (DYSURIA) with
URINATIONfor a day or two after cystoscopy, a con-
sequence of the cystoscope irritating the urethral
tissues. The urologist should evaluate dysuria or
hematuria that continues beyond two days as this
may indicate a URINARY TRACT INFECTION (UTI)
requiring ANTIBIOTIC MEDICATIONS; the cystoscope
may carry BACTERIAfrom the SKIN’s surface into the
urethra and bladder.
See also ENDOSCOPY; UROLITHIASIS.cystourethrogram A diagnostic imaging proce-
dure that shows the flow of URINEfrom the BLAD-
DERthrough the URETHRA. The radiologist instills a
radio-opaque solution (contrast medium) into the
bladder through a catheter, then takes a series of
X-rays as the solution fills the bladder and ure-
thra. The radio-opaque solution makes these soft
tissue structures visible on X-RAY. In a voiding cys-
tourethrogram, the radiologist takes additional X-
rays with the person urinating, to visualize the
entire flow of urine.
Cystourethrogram shows structural abnormali-
ties, such as narrowing or stricture, of the urethracystourethrogram 185