The word, cystoscopy comes from two Greek roots — Kustis and skopein. The original Greek kustis meaning “bladder” was transformed through cystis in Latin to cysto in English while the Greek skopein meaning “to look at” became scope in English. The resulting combination cystoscopy means “to look at the bladder.” The mere mention of the word “cystoscopy” is often enough to trigger an immediate negative reaction, followed by a series of questions usually including, “Where do you have to go with that thing?” The “thing” of course is the cystoscope, invented in 1877 by Dr. Max Nitze.
The original cystoscope was simply a rigid hollow metal tube. The doctor wore a parabolic head mirror with a small hole in the middle through which he could see, while squinting through one eye. The light of a candle was reflected and focused by the mirror through the cystoscope into the bladder and for the first time, portions of the bladder interior could be examined directly revealing things such as inflammation, stones, foreign bodies, and tumors.
Advances followed swiftly and still continue to this day, 133 years later. In place of air, originally used to fill the bladder, sterile water was substituted. Lens systems were incorporated so the entire interior of the bladder could be inspected. A tiny light bulb, small as a grain of wheat was placed at the tip end of the cystoscope to replace the dim reflected candle light. This vastly improved light source was in turn replaced by the development of the fiber optic light source, eventually using xenon bulbs to generate light sufficient to permit photography and finally video of the bladder interior.
Accessories were developed to permit all kinds of surgical procedures to be done through the cystoscope including removal of urinary bladder stones, biopsy and removal of bladder tumors, cauterization to stop bleeding and the passage of tiny catheters up the ureters to permit dye to be injected directly into the kidneys and get x-ray pictures of the interior of the kidneys.
The next major advance in the development of the cystoscope was the invention of the flexible instrument, which could be directed to go around corners using simple hand controls. The immediate advantage was that discomfort caused by the insertion of a rigid instrument was avoided. Women with a much shorter and straighter urethra generally have no problem with cystoscopic examinations.
All these advances have made cystoscopy a comfortable and easily tolerated procedure especially when performed using lidocaine lubricating jelly, which anesthetizes the interior of the urethra upon contact. If a more extensive cystoscopic procedure is contemplated, a mild oral or intravenous sedation can additionally be given so the procedure can be done in total comfort. These days, there is no longer any reason to fear even the mention of the word, “cystoscopy”.
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