1. Preparation
WHAT IS A CYSTOSCOPY?
A Cystoscopy is a procedure that is carried out using a specialised endoscopic instrument called a cystoscope. The cystoscope is a long lighted tube that has a small camera at the end, allowing a view of the inside of your bladder and urethra. A Cystoscopy may reveal information that is not obvious on an x-ray.
WHY IS IT DONE?
A Cystoscopy is carried out so that a diagnosis can be made for patients who experience symptoms such as:
As well as diagnosis, a Cystoscopy may also include treatment for the following:
-
Removal of bladder tumours
-
Crushing and removing stones found in the bladder
-
Removal of obstruction in the bladder
-
Bleeding in the bladder
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer you to a Urologist who can perform the procedure.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Urological Society of Australia via their website at www.urosoc.org.au.
The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Urologists who participate in HCF’s Medicover no gap arrangement:
-
Call HCF Member Services on 13 13 34
-
Visit one of HCF’s customer service branches
-
Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.
WHAT SHOULD I ASK MY SPECIALIST?
-
Make sure you fully understand the procedure that is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
-
Apart from what the procedure is about you should also ask about:
-
Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products),
-
Blood thinners (Warfarin, heparin.),
-
Arthritis medication,
-
Pain medication,
-
Insulin.
WHERE IS IT DONE?
A Cystoscopy can be done in either a day surgery or hospital.
HOW LONG IS THE PROCEDURE?
A Cystoscopy usually takes between 5 to 45 minutes.
WHO IS INVOLVED?
The procedure is usually carried out as a day patient in a day surgery or hospital. The people involved in the procedure are:
-
The Urologist, your Specialist doctor
-
Anaesthetist: they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
-
Nurses for the procedure and recovery
-
Pathologist if any blood tests and/or specimen samples are necessary
HOW DO I PREPARE FOR A CYSTOSCOPY?
You will normally be required to fast prior to the procedure if you are having sedation or anaesthetic. The type of fasting required will depend on the type of anaesthetic to be used. Please note that if your procedure requires that you have an anaesthetic then you will need someone to escort you home. You will not be allowed to drive. Please follow any instructions given to you by the day surgery or hospital.
Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?
-
Do not bring any valuables with you
-
Leave all jewellery at home (a plain band is acceptable)
-
Wear warm comfortable clothing
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
Bring any relevant x-rays or scans.
-
You may also wish to bring something to read whilst you wait
-
Remove all nail polish and do not wear any make-up
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
For your information, the average charges for claims paid for Cystoscopic Procedure admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$620
|
|
$619
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$299
|
$116
|
$39
|
$202
|
38.0%
|
$0
|
62.0%
|
|
Pathology Services
|
$128
|
$82
|
$27
|
$42
|
0.8%
|
$0
|
99.2%
|
|
Specialist Consultation
|
$62
|
$31
|
$10
|
$44
|
28.7%
|
$0
|
71.3%
|
|
Urological Surgical Services
|
$286
|
$118
|
$39
|
$189
|
44.7%
|
$0
|
55.3%
|
|
2
Total Average Medical Services
|
$491
|
$203
|
$68
|
$265
|
50.6%
|
$0
|
49.4%
|
|
Hospital and Medical Services Average for Cystoscopic Procedure Admissions
|
$1,111
|
$203
|
$687
|
$265
|
50.6%
|
$0
|
5
49.4%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 1,728 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 36812.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
-
There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e.
you may not have all of these medical services, and/or you may also have other medical
services not indicated here e.g. radiology services. Therefore, the total average medical
service charge ($491) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of
pocket charge, as their charges are higher than those doctors who use the no-gap
arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the
average benefits plus the average out of pocket charge you pay will not equate to the
charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in
HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the
Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered
under the HCF Medicover No Gap arrangement will receive as full payment for
services provided. This also applies to unregistered providers should they charge within
the schedule of benefit listed. This arrangement ensures that our members incur no out of
pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all
cystoscopic procedure admissions. The percentages shown for each type of medical
service are much higher as they are calculated for those services only and not the entire
admission, which includes all medical services and the hospital services. In an admission
you may have one medical service with an out of pocket expense, which then excludes
the whole admission from being fully covered. Hence the significant difference in
percentage for individual types of medical services as compared to the total admission
fully covered.
2. Day of procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?
When you arrive at the hospital or day surgery, the admissions clerk will attend to the paperwork associated with your stay.
On admission to the hospital/day surgery a nurse will orientate you to your surroundings, ask your medical history, confirm your medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation.
-
Rigid Cystoscopy – This procedure is carried out either under general anaesthetic which means you will be asleep throughout or regional anaesthetic where you are given an injection into a vein to make you drowsy and another injection in your back so that you have no feeling from the waist down. Dependent on the condition, this method allows for biopsy or removal of lesion at the time of the procedure.
-
Flexible Cystoscopy – A local anaesthetic is injected down the urethra to reduce sensation but you are fully awake for the procedure as no sedation is required.
The advantage of the flexible Cystoscopy is that you do not need to be anaesthetised and no fasting is required. The disadvantage is that if a lesion is found and removal or biopsy is needed, it may not be possible using a Flexible Cystoscopy, so you will have to come back and have it done at a later date.
An intravenous drip may also be started prior to you being taken to theatre.
WHAT CAN I EXPECT DURING A CYSTOSCOPY?
If you are having a Flexible Cystoscopy, local anaesthetic will be applied to the area. Once it has taken effect, the surgeon will gently pass the cystoscope into your urethra.
If you are having a Rigid Cystoscopy, the cystoscope will be inserted into the urethra once you are asleep following the administration of the general anaesthesia.
As the cystoscope is passed through the urethra your Urologist will inspect the mucosal layer for any abnormalities or obstructions.
Once the cystoscope is in the bladder, your Urologist will slowly inject sterile water or saline to help expand the bladder for better visualisation. The entire bladder, including the lining, will be inspected for any abnormalities.
If required, a small device will be passed through the cystoscope to collect tissue samples for a biopsy or possibly treat any problems that may be detected. A urine sample may also be obtained at this time.
3. Aftercare
WHAT HAPPENS AFTER A CYSTOSCOPY?
After the Cystoscopy, you will be taken to the recovery room. If sedation or anaesthetic was used, nursing staff will monitor your vital signs until your blood pressure, pulse and breathing are stable and you are alert. The recovery process varies depending on the type of sedation given. Many Urologists require that you urinate at least once prior to being discharged. Before you go home, your doctor will discuss the results, any management plan or follow up appointments that may be required. You will also be given a set of discharge instructions relevant to your procedure by the Recovery staff.
In most cases you will be able to resume your usual diet and activities unless your doctor advises differently. Your doctor will encourage you to drink extra fluids because it dilutes the urine and reduces urinary discomfort, such as burning. Some burning with urination is normal after the procedure but will lesson over time. A warm bath may be recommended to help alleviate any urinary discomfort.
You may notice blood in your urine for a short period of time after the Cystoscopy but the amount of blood reduces over one or two days. Consult your doctor regarding pain relief once you are home as aspirin or other pain medication may thin the blood and increase the chance of bleeding. You may be given a prescription for antibiotics after the procedure to decrease the chance of infection. Some doctors may also suggest a drink that will reduce the amount of acid in your urine.
Notify your doctor if you have any of the following symptoms:
1. Preparation
WHAT IS A CYSTOSCOPY?
A Cystoscopy is a procedure that is carried out using a specialised endoscopic instrument called a cystoscope. The cystoscope is a long lighted tube that has a small camera at the end, allowing a view of the inside of your bladder and urethra. A Cystoscopy may reveal information that is not obvious on an x-ray.
WHY IS IT DONE?
A Cystoscopy is carried out so that a diagnosis can be made for patients who experience symptoms such as:
As well as diagnosis, a Cystoscopy may also include treatment for the following:
-
Removal of bladder tumours
-
Crushing and removing stones found in the bladder
-
Removal of obstruction in the bladder
-
Bleeding in the bladder
HOW DO I CHOOSE A SPECIALIST?
Your GP, or the doctor you first consult, will be able to recommend and refer your to a Urologist who can perform the procedure.
You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Urological Society of Australia via their website at www.urosoc.org.au.
The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).
To access a list of Gastroenterologists who participate in HCF’s Medicover no gap arrangement:
-
Call HCF Member Services on 13 13 34
-
Visit one of HCF’s customer service branches
-
Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor
Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment. Some doctors who participate in the HCF medicover no gap arrangement have chosen not to be listed on the HCF website. Therefore you will need to check with your doctor.
WHAT SHOULD I ASK MY SPECIALIST?
-
Make sure you fully understand the procedure that is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
-
Apart from what the procedure is about you should also ask about:
-
Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
-
Aspirin (or any related products),
-
Blood thinners (Warfarin, heparin.),
-
Arthritis medication,
-
Pain medication,
-
Insulin.
WHERE IS IT DONE?
A Cystoscopy can be done in either a day surgery or hospital.
HOW LONG IS THE PROCEDURE?
A Cystoscopy usually takes between 5 to 45 minutes.
WHO IS INVOLVED?
The procedure is usually carried out as a day patient in a day surgery or hospital. The people involved in the procedure are:
-
The Urologist, your Specialist doctor
-
Anaesthetist: they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
-
Nurses for the procedure and recovery
-
Pathologist if any blood tests and/or specimen samples are necessary
2. Costs and Charges
WHAT IS IT GOING TO COST?
Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.
For your information, the average charges for claims paid for Cystoscopic Procedure admissions for the financial year 06/07 are provided below:
|
|
On Average
|
|
|
Charge
|
Medicare Pays
|
HCF Pays
|
3
If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement
|
4
If your doctor USES HCF’s No Gap Arrangement YOU PAY
|
% of all admissions where your doctor USES HCF’s No Gap Arrangement
|
|
Total Average Hospital Component (accommodation, theatre and hospital related services)
|
$620
|
|
$619
|
|
|
|
|
|
1
Medical Services Component
|
|
|
|
|
|
|
|
|
Anaesthetic Services
|
$299
|
$116
|
$39
|
$202
|
38.0%
|
$0
|
62.0%
|
|
Pathology Services
|
$128
|
$82
|
$27
|
$42
|
0.8%
|
$0
|
99.2%
|
|
Specialist Consultation
|
$62
|
$31
|
$10
|
$44
|
28.7%
|
$0
|
71.3%
|
|
Urological Surgical Services
|
$286
|
$118
|
$39
|
$189
|
44.7%
|
$0
|
55.3%
|
|
2
Total Average Medical Services
|
$491
|
$203
|
$68
|
$265
|
50.6%
|
$0
|
49.4%
|
|
Hospital and Medical Services Average for Cystoscopic Procedure Admissions
|
$1,111
|
$203
|
$687
|
$265
|
50.6%
|
$0
|
5
49.4%
|
Points to Note:
-
Charges are based on HCF claims for a sample size of 1,728 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 36812.
-
As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
-
There is no excess payable for same day admissions.
1 These medical services are in-patient services only.
2 The medical charges are based on averages and each episode of care is different, i.e.
you may not have all of these medical services, and/or you may also have other medical
services not indicated here e.g. radiology services. Therefore, the total average medical
service charge ($491) differs from the sum of the individual average charges as shown.
3 Doctors who do not use the HCF no-gap arrangement have a higher average out of
pocket charge, as their charges are higher than those doctors who use the no-gap
arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the
average benefits plus the average out of pocket charge you pay will not equate to the
charge as shown in the table.
4 Doctors’ charges vary so always ask your doctor whether he/she will participate in
HCF’s No Gap Arrangements.
HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the
Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered
under the HCF Medicover No Gap arrangement will receive as full payment for
services provided. This also applies to unregistered providers should they charge within
the schedule of benefit listed. This arrangement ensures that our members incur no out of
pocket expense.
5 This percentage indicates the total coverage of hospital and medical services for all
cystoscopic procedure admissions. The percentages shown for each type of medical
service are much higher as they are calculated for those services only and not the entire
admission, which includes all medical services and the hospital services. In an admission
you may have one medical service with an out of pocket expense, which then excludes
the whole admission from being fully covered. Hence the significant difference in
percentage for individual types of medical services as compared to the total admission
fully covered.
HOW DO I PREPARE FOR A CYSTOSCOPY?
You will normally be required to fast prior to the procedure if you are having sedation or anaesthetic. The type of fasting required will depend on the type of anaesthetic to be used. Please note that if your procedure requires that you have an anaesthetic then you will need someone to escort you home. You will not be allowed to drive. Please follow any instructions given to you by the day surgery or hospital.
Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed.
WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?
-
Do not bring any valuables with you
-
Leave all jewellery at home (a plain band is acceptable)
-
Wear warm comfortable clothing
-
Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
-
Bring any relevant x-rays or scans.
-
You may also wish to bring something to read whilst you wait
-
Remove all nail polish and do not wear any make-up
2. Day of procedure
WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?
When you arrive at the hospital or day surgery, the admissions clerk will attend to the paperwork associated with your stay.
On admission to the hospital/day surgery a nurse will orientate you to your surroundings, ask your medical history, confirm your medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation.
-
Rigid Cystoscopy – This procedure is carried out either under general anaesthetic which means you will be asleep throughout or regional anaesthetic where you are given an injection into a vein to make you drowsy and another injection in your back so that you have no feeling from the waist down. Dependent on the condition, this method allows for biopsy or removal of lesion at the time of the procedure.
-
Flexible Cystoscopy – A local anaesthetic is injected down the urethra to reduce sensation but you are fully awake for the procedure as no sedation is required.
The advantage of the flexible Cystoscopy is that you do not need to be anaesthetised and no fasting is required. The disadvantage is that if a lesion is found and removal or biopsy is needed, it may not be possible using a Flexible Cystoscopy, so you will have to come back and have it done at a later date.
An intravenous drip may also be started prior to you being taken to theatre.
WHAT CAN I EXPECT DURING A CYSTOSCOPY?
If you are having a Flexible Cystoscopy, local anaesthetic will be applied to the area. Once it has taken effect, the surgeon will gently pass the cystoscope into your urethra.
If you are having a Rigid Cystoscopy, the cystoscope will be inserted into the urethra once you are asleep following the administration of the general anaesthesia.
As the cystoscope is passed through the urethra your Urologist will inspect the mucosal layer for any abnormalities or obstructions.
Once the cystoscope is in the bladder, your Urologist will slowly inject sterile water or saline to help expand the bladder for better visualisation. The entire bladder, including the lining, will be inspected for any abnormalities.
If required, a small device will be passed through the cystoscope to collect tissue samples for a biopsy or possibly treat any problems that may be detected. A urine sample may also be obtained at this time.
3. Aftercare
WHAT HAPPENS AFTER A CYSTOSCOPY?
After the Cystoscopy, you will be taken to the recovery room. If sedation or anaesthetic was used, nursing staff will monitor your vital signs until your blood pressure, pulse and breathing are stable and you are alert. The recovery process varies depending on the type of sedation given. Many Urologists require that you urinate at least once prior to being discharged. Before you go home, your doctor will discuss the results, any management plan or follow up appointments that may be required. You will also be given a set of discharge instructions relevant to your procedure by the Recovery staff.
In most cases you will be able to resume your usual diet and activities unless your doctor advises differently. Your doctor will encourage you to drink extra fluids because it dilutes the urine and reduces urinary discomfort, such as burning. Some burning with urination is normal after the procedure but will lesson over time. A warm bath may be recommended to help alleviate any urinary discomfort.
You may notice blood in your urine for a short period of time after the Cystoscopy but the amount of blood reduces over one or two days. Consult your doctor regarding pain relief once you are home as aspirin or other pain medication may thin the blood and increase the chance of bleeding. You may be given a prescription for antibiotics after the procedure to decrease the chance of infection. Some doctors may also suggest a drink that will reduce the amount of acid in your urine.
Notify your doctor if you have any of the following symptoms: