Cystoscopy Cystoscopy and Stent Removal Cystoscopy and Biopsy

1. CystoscopyCystoscopy and Stent RemovalCystoscopy and Biopsy PATIENT INSTRUCTIONS and CONSENT FORM

2. Appointment You Have Been Scheduled For A Cystoscopy __________________________at _________________________a.m/p.m. In our office located at [ ] Avon, 120 Simsbury Road [ ] Farmington: 399 Farmington Ave. [ ] Glastonbury: 330 Western Blvd. [ ] Meriden: 455 Lewis Ave. [ ] Hartford: 85 Seymour Street, Suite 416 [ ] Enfield: 100 Hazard Avenue

3. Let’s Get You Ready

4. First: The Terminology • Cystoscopy: A Procedure For Viewing The Urethra And Entire Interior Of The Bladder • Cystoscope: The Telescope And Tube Inserted Into The Bladder • Stent: A Small Tube Inserted Into The Ureter (Tube Connecting The Bladder With The Kidney) • Biopsy: The Term Used To Clip A Small Piece Of Tissue For Pathological Analysis

5. The Goal of A Cystoscopy • To Determine The Health Of The Urethra, And Bladder • Blood In Urine, Frequent Urinary Tract Infections • Bladder Stones • Cystitis (Bladder Inflammation) • Suspicious Tissues • Biopsy Suspicious Tissues For Pathological Analysis • To Remove A Previously Inserted Stent

6. Cystoscopy3 Different Procedures • Cystoscopy Procedure • Viewing of the Bladder Only • Cystoscopy with Biopsy • Viewing of the Bladder • Biopsy of Suspicious Tissues • Cystoscopy with Stent Removal • Viewing of the Bladder • Removal of the Stent

7. Cystoscopy: Male

8. Cystoscopy: Female

9. Purpose of a Cystoscopy • Assist In Obtaining Biopsies (“Bx”) • Targeting Of Suspicious Areas • Guidance For Systematic Biopsies • Collect A Urine Sample From The Bladder • Remove A Previously Inserted Stent • Treat Certain Bladder Conditions

10. Cystoscopy Procedure • Using A Small Flexible Cystoscope With A Light • Local Anesthetic With Lubricant Is Used For Ease Of Entry Into Urethra • Inserted Up To The Bladder • Water Or Saline Infused Into Bladder • Physician Looks Through Telescope For Abnormalities • May Biopsy Suspicious Tissues • May Remove A Previously Inserted Stent • Total Time: 10 Minutes

11. Tissue and Cell Analysis • Tissues from Biopsies and Cells in the Urine are sent for Pathological Analysis • To Determine: • Inflammation • Cancerous Tissues • Cancerous Cells • Type and Categorization

12. Preparation for Cystoscopy • Let Your Urologist Know The Medications You Take • Blood Thinner Medicines: Coumadin, Plavix, Aspirin • Over-the-counter • Vitamin E • Glucosamine • Let Your Urologist Know • If You Are Allergic To Local Anesthesia • Novocaine • Xylocaine • Let Your Urologist Know If You Are Allergic To • Latex Or Iodine Type Compounds

13. PreparationThe Day of the Cystoscopy • You May Drive Before And After The Procedure • Empty Your Bladder Just Before The Procedure • Total Time Of Procedure Is 10 Minutes • Complete Consent Form Upon Arrival

14. How is the Cystoscopy is Done • Office Procedure • You May Drive Yourself To The Appointment • Local Anesthesia (Lidocaine) Desensitizes The Urethra. Time 5 Minutes • Actual Cystoscopy: 3-4 Minutes • Removal of Stent or Biopsy. 1-2 minutes • Time From Beginning To End Is About 10 Minutes

15. What to Expect During the Cystoscopy • Mild Abdominal Discomfort • Strong Sense Of Urgency To Void • If A Biopsy Is Taken, A Momentary Twinge • Then A Slight Burn Sensation If The Site Of The Biopsy Is Cauterized • If A Stent Is Removed, • A Momentary Feeling Near The Kidney. It Normally Takes 1-2 Seconds To Remove The Stent.

16. How Painful Will The Procedure Be? • The Procedure Will Be Uncomfortable • Pain Will Be Minimal • Lubricant With Anesthetic Is Used To Desensitize The Urethra • The Vast Majority Of Patients Can Tolerate This In An Office Setting And Thereby Avoid Hospitalization • Anxiety Heightens The Pain Response

17. What To Expect After the Cystoscopy • Blood In The Urine • Typically Resolves Within 8-12 Hours • More Frequent In Men Than Women • Burning Sensation During Urination • More Frequent Urination During The Next Day Or Two

18. Blood In Urine – What to Look For • Look At Your Urine In A Clear Glass If You Are Worried About The Amount Of Blood You See. • Red, But Clear = Ok (Like Diluted Red Punch) • This Is Expected • Drink More Water • Thick And Dark Red = Too Bloody • Rest And Drink More Water

19. What to Call Us About

20. Complications • Cystoscopy Carries Rare Risk Of Complications • There Is A 1% Chance Of An Infection • Less Than 1% Chance Of More Serious Bleeding • Men With Large Prostates May Develop Urine Retention And Require Catheters To Drain The Urine • Cystoscopy May Not Be Performed On Men With Narrowing Of The Urethra (Urethral Stricture)

21. Please Call • Fever Higher Than 100 Degrees • Dark, Thick Red Urine That Does Not Clear With Increased Fluid Intake And Rest • Pain Of Burning During Urination That Last More Than Two Days

22. Bladder and Urine Tissue Pathology Results • Typically, Results Are Back Within 10 Working Days. • Special Staining And Second Reviews May Take Longer. • Your Results Will Be Given To You By Phone • If You Have Not Heard From Our Office Within 10-14 Days, Please Call

23. Consent Form • Please Thoroughly Read The Consent Form • It Explains In More Detail The Cystoscopy Procedure • Ask Yourself: • Are You Comfortable With Knowing About The Procedure? • Have All Your Questions Been Answered? • When Complete, Please Sign The Consent Form Indicating You Have Read And Understand The Procedure. Bring It With You To Your Appointment

24. Billing • Your Insurance Will Be Billed For: • The Procedure by Hartford Clinical Associates • A LaboratoryWill Bill For The Pathological Analysis. • A Reference Laboratory May Bill For The Technical Preparation Of The Slides For The Pathologist. • Number of Bills You May Receive • Hartford Clinical Associates for the Procedure • A Pathologist Group for the Pathological Analysis • Another Laboratory for the Technical Preparation of Slides