Cystoscopy #2

It’s eleven am and I’m sitting in the Urology Clinic’s waiting room. I’m here mid-day for my second Cystoscopy exam where Surgeon will view the surgery site to see how things have healed. While I wait, I read a new book on my iPhone.

“Mr. New, hello,” smiles Tech 3. “We need another urine sample. You remember the procedure?”

I nod.

“Okay. Here is the cup and the wipe. Mid-stream, please. Bring it to the last room down this hallway.” She points to make sure I see it. “The room with the door ajar.”

“Okay.

After the usual routine, I place the sample on a counter next to my paperwork. Oh, yeah, I remember this room. Some sterile pads sit folded on a sterile sheet on another counter top. Sitting next to them are some sterile glove pairs. On a blue, sterile sheet rests the cystoscope with the sixteen-or-so-inch-long black probe. Hooked up to it is the sterile water and the view screen.

“Mr. New,” says Tech 3, “please remove your shoes, pants, and underwear. You can place them on this chair by the wall. Keep your socks on as the floor can be cold sometimes.”

“Yeah, I remember.”

“Have a seat on the examination table and cover yourself with this sheet. I’ll be back in a moment.”

I do as I’m told and contemplate the coming event. I’ve been through it before. It was fairly simple and easy. I’m not too worried about it.

There’s a knock on the door.

“Come in,” I say.

Tech 3 re-enters. “All right, Mr. New. Here, let me pull out these stirrups—

“Stirrups! What?”

Tech 3 grins. “Surgeon always has his patients use these. Makes no matter if you’re male or female.” She shrugs. “It’s the way he was trained. Lift your feet, please.”

Again, I do as I’m told. I’m so pliant. I feel a U-shaped ridge under each heel. These are the raised rear supports of the stirrups, designed to cup the heel of a woman. Both of my feet are oversized for these stirrups.

“Okay, lean back onto the exam table.” She moves to my side and fluffs up the pillow as I lower my head onto it.

Tech 3 steps to the sterile counter and gingerly pulls on a pair of sterile gloves: Snap-snap! Then she moves back to the exam table’s business end. “Mr. New, please lift your buttocks. I have to slide a sterile pad in place. Thank you and you can lower yourself.”

She moves back to the sterile counter for another pad. She grabs one, moves back to the bottom end of me, and opens it up. Very carefully, Tech 3 positions the pad between and over my legs, tucking it down and around my vital structures.

“Making a sterile field, are you?”

“Yes, Mr. New,” she says with a smile. “Surgeon is a surgeon, after all. This is what he prefers.”

She finishes tucking and positioning, and then reaches for some sponge-tipped tongue depressors. “Mr. New, I’m going to sterilize you with the iodine on these sponges, okay?”

“So, there is an opening down there amid all of that padding?”

She smiles again at me. “Sure is, just big enough for business.”

“Sure thing. Go ahead.”

After three applications, she’s done.

“Now I’m going to administer the numbing jelly. There might be a bit of stinging.”

She applies the tip of the loaded syringe to my urethral opening and steadily plunges it home. The anesthetic does sting a little. “Now, I’ll place a clamp on you so nothing drips back out.”

Clamp? What’s this? I feel her do something, but I’m not sure what it is.

“Don’t go anywhere. I’ll see if Surgeon is ready.” She pulls off the no-longer-sterile-gloves and tosses them in a trashcan near the door.

She leaves. I’m flat on my back with my bottom exposed and she expects me to go somewhere? Oh, yeah, medical humor. Geez.

A few minutes pass. The air conditioning is making everything—and I do mean everything!—cool in the room. There’s another knock on the door and Surgeon enters followed by Tech 3. “Hello, Mr. New. Are you ready to see what we can see?” Both of them move over to the sterile counter and pull on additional sterile gloves. Snap-snap!

“Ready as I’ll ever be.

“Okay, then,” says Surgeon.

He picks up the Cystoscope. I decide to ignore anything I might feel from down there. I turn my head to watch the view screen.

The picture is fuzzy, out of focus. Then it clears and I watch a light pink-and-cream colored tunnel open up as the probe travels along.

“We are in your urethra. Here’s your prostate gland, Mr. New. There’ll be some pressure. Just relax.”

I make a conscious effort to do so.

“There we go. Now, through the sphincter valve and we’re in.”

The picture is of an off-white, lumpy looking wall. As Surgeon moves the camera around, the vein streaked walls curve away on both sides.

“I’ll have to let more of the water in to fill and expand out the bladder walls,” Surgeon narrates. “With the bladder empty, the tissue collapses and folds in on itself.”

He pushes the camera tip at a drooping section of bladder wall. The flowing water pushes it taut. 

“While we’re waiting, let’s find the ureters.”

He moves the camera around and finds the left one.

“Mr. New, take a deep breath and let it out.”

I do so. From the kidney, a rush of water flows out of the ureter.

“Good, nice and clean,” says Surgeon.

He moves the camera over to the other ureter and tells me to do it again. Another rush of water exits the ureter.

“Good, good. Now let’s find the surgical site.” He moves the camera some more. “Ah, there it is.”

I stare at the spot the “tufted mulberry bush” once grew from. It is clean and colored off-white. It’s also bare of the dark-red veins that track across the rest of the bladder’s interior. Oh, yes, everything was cauterized—burned clean to sterilize and close the remaining vein tips. I’d expected to see a blackened, charred landscape—the remains from the cauterizing. However, the surgery was back right before Thanksgiving. That was just over three months ago. That gave plenty of time for the cauterized and dead cells to slough off, replaced by new ones from bladder tissue underneath.

“Looking very good, Mr. New. 

I can see his smile reflected off the flat screen.

“Oh, oh,” Surgeon says.

“What is it?” He’s positioned the camera at a new entity. It’s oblong and bulging out from the bladder wall. It’s off-white with a light-brown checkered surface.

“This, Mr. New, is another tumor growth. Guess we’ll have to make another appointment to deal with this.”

“Hey, Surgeon, since you’re already in there, why not take care of it now? You can do that, right?”

“Umm, yes, we can. You want to?”

“Might as well!” I say.

“Okay! Tech 3, go get me—”

I missed what he calls for. His commands and her questions quicken into shoptalk. 

Tech 3 returns with a sterile bag. Surgeon opens it and withdraws a long, thin, twisted-wire looking apparatus. It has what looks like a pair of scissor handles on the hand end and a tiny set of alligator jaws on the business end.

“Yes, Tech 3, that will do nicely. Hold on, Mr. New, I’m going to grab that growth.”

Surgeon slips the new item into the cystoscope, threading it along into my bladder. Presently, a large, metallic item appears on camera.

“Good! This tumor is very small, Mr. New. Going by the size of the jaws, I would judge it is one millimeter wide by two millimeters long. Tiny, in fact. You might feel a slight pinch.”

On screen, Surgeon opens the alligator jaws wide, presses them above and below the small tumor, and shuts them, squishing the growth between them. He tugs backwards and the tumor disappears, replaced by leaking blood from the site. I’m not sure I feel anything at all.

“Your urine will be slightly bloody the first time you urinate, Mr. New, but it should clear up quickly. I remember from your first surgery workup that your PTI and PTT results are normal.”

Good. My coagulation system works fine. I knew that. “Not a problem, Surgeon.”

“Fine. I’ll retract this out of the cystoscope and—Tech 3, you have the formalin cup?”

“Yes, sir, right here.”

I watch as Tech 3 twists open a small plastic cup with a clear liquid inside it. Surgeon opens the alligator jaws and drops the bit of tumor and tissue into the formalin. The formalin will preserve it for the slicing-and-dicing performed in Cytology. Tech 3 twists the top back on the cup.

“And here comes the ‘scope,” Surgeon says, withdrawing the cystoscope from my urethra.

“Okay, Mr. New!” Surgeon strips off the gloves into a waste can and approaches my side, holding his hand out.

I take the offered handshake and return his wide smile.

“We had a good day, today! Found a surprise and took care of it. Good! Now Tech 3 will clean this mess up and allow you to get dressed. By the way, you may have heard this before, but because of the new tumor site, we are going to start you on what we call a maintenance schedule of three BCG treatments. We might do this for a while, depending on what we find after each cystoscopy. It’s a preventative treatment to help you fight off more tumor developments. Same as before, just not as many treatments this time. All right?”

“Okay, Surgeon, and thanks for pulling that new one.”

“You’re welcome. Have a good day.”

Surgeon leaves. Tech 3 finishes bustling about.

“Okay, Mr. New, you can get dressed now. Don’t leave the room yet.”

She takes my paperwork, urine sample, and the formalin cup, closing the door behind her. I wipe myself clean and get dressed. Then I stand in the doorway.

Tech 3 returns with paperwork. “Mr. New, here are the orders for the front desk to schedule your BCG treatments. Since you work here at the hospital, you can have them scheduled after work, like you did before. In three months, you come back for another cystoscopy.”

“Good deal! That’s it?”

She nods.

“Great! I gotta go pee. Then I’ll do lunch, and back to work I go.”

“Use the restroom you used earlier, Mr. New.”

 

Final Results: Surgery site recovered well and the plucking of a tiny, new growth ensued. Three more BCG maintenance treatments, followed by another cystoscopy. In addition, possibly a repeat of all that as well. Fun, fun, fun—but I’m healthy!

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