Recent cystoscopy showed some polyps, my new urologist wants to do surgery(biopsy)

[wheelman21]

I've had a suprapubic for about 18 years. I recently had a cystoscopy with my new urologist and it showed some polyps, and he wants to do surgery for a biopsy.
Questions

1. Is normal/necessary to get a biopsy when polyps are discovered?
2. Is surgery absolutely necessary for a biopsy? The scheduler just called and said the surgery will take about an hour, and will have to stay another few hours after. It's been a while but I swear once with my very first urologist, when he noticed a polyp during a cystoscopy, he just used something to grab a biopsy right then and there. No surgery, anesthesia, or 5 hour stay at a hospital.
3. I've been getting a cystoscopy every year for the past 14 years. Is it normal to get one every year? My new urologist seamed reluctant to do one. Said he only does them when symptoms appear.

Thank you

[SCI-Nurse]

Cystoscopy is considered a surgical procedure. Normally bladder biopsies are done during a cystoscopy, whether of polyps or other tissue. I think you need to get a better explanation of what is planned from your urologist.

We used to do cystoscopies and biopsies annually for those who had used an indwelling catheter for 10 years or more, but found that if we did 3 urine cytology studies (each 24 hours apart) properly that we were able to detect any bladder cancer or pre-cancerous lesions just as well without having to do a cystoscopy (unless the urine cytologies were abnormal). Talk to your urologist about this.

(KLD)

[wheelman21]

Cystoscopy is considered a surgical procedure. Normally bladder biopsies are done during a cystoscopy, whether of polyps or other tissue. I think you need to get a better explanation of what is planned from your urologist.

We used to do cystoscopies and biopsies annually for those who had used an indwelling catheter for 10 years or more, but found that if we did 3 urine cytology studies (each 24 hours apart) properly that we were able to detect any bladder cancer or pre-cancerous lesions just as well without having to do a cystoscopy (unless the urine cytologies were abnormal). Talk to your urologist about this.

(KLD)

So a bladder biopsy doesn't typically involve anesthesia and a 4-5 hour hospital stay?

I can check with my doctor but it was my understanding from my cysto appointment that a biopsy of the polyps was all he was going to be doing.

How are urine cytology studies done?

Thank you

[SCI-Nurse]

Cystoscopy may be done with conscious sedation if you have sensation or spinal anesthesia if you are at risk for AD, whether or not a biopsy is being done.

Urine cytology involves collecting a mid-day urine (well hydrated), mixing it immediately with cytology preservative, and submitting it to the lab within one hour. It is then "spun down" and microscopically examined for abnormal bladder wall cells. (KLD)

[wheelman21]

I've never had sedation when doing a cystoscopy through the suprapubic stoma. I get some AD while it's done but nothing terrible.

The urine that gets collected, that's directly from the catheter, correct? How much urine is typically needed.

Something that also seemed odd was that the doctor said they're be going through the urethra for the procedure. Is that normal even with a suprapubic?

I think I'm going to find a different urologist and get another opinion. Are there any good ways to search for doctors with SCI experience or do I just have to call around?

[SCI-Nurse]

Pretty much you have to call and ask urologist if they have expertise/experience with SCI and/or neurourology. Many have trained (during their residency or a fellowship) or worked at a VA SCI Center, so that is a good indication.
Urine cytology usually requires 30 cc. of urine.
Going through the urethra for a cystoscopy is not usual, especially if there is a suspicious of or to screen for cancer, as it is possible to have polyps and/or cancerous tissue inside the urethra. (KLD)

[pfcs49]

Just went to Kessler this morning to get a cysto. I've had a suprapubic catheter for about 20 years. Dr (Todd) Linsenmeyer does a urodynamics and sometimes a cysto annually on me. It is customary for him to take a sample from the bladder for analysis whenever he has his camera in. When I had my annual urodynamics and cysto 3 months ago, there was a bunch of stuff in the bladder, small accretions that he removed, and he wanted to see if it stayed debris free. Apparently, these kinds of things are great environments for bladder bacteria to colonize (bladder infection). It was blessed clean, nevertheless, he took two specimens. The whole procedure in and out took just over an hour. Aside from the usual week of prophylactic antibiotic (Levaquin) as determined from a urinalysis prior to the procedure, there were no drugs or pain killer involved. If I didn't get to view it on TV, I wouldn't know he got inside me! If you get one, insist on viewing it, it's quite interesting!

Given your report, it may be that your urologist isn't familiar with neurogenic bladders. If so, I would seek out one who is!

I'm T12 complete, 27 years post injury.
In simple parlance, I could do a cysto standing on my head! Not close to a big deal.

[wheelman21]

How did you find your doctor? I think I'm going look around for a different urologist and get another opinion. What you had to do sounds so much simpler.

[SCI-Nurse]

Todd Linsenmeyer, MD is one of the best know experts in SCI bladder management in the country. He generally limits his practice to non-surgical care, but I guess he still is doing cystoscopies. He is affiliated with Kessler Rehab Institute. (KLD)