What it is.

Urology is a specialist medical and surgical branch that deals with conditions affecting the male and female urinary system and external male genitalia. Principal urological conditions include cancers of the male urinary and reproductive system including prostate cancer, which is the most common cancer in men, urination disorders and urinary calculosis, which is one of the leading causes of admission to emergency rooms. The history of urology began in ancient times in Southern Italy and Magna Graecia. It appears that the first urologist documented in medical books performed the first operation in Sicily.

For males, a number of periodic checks should be performed in accordance with the age of the patient:

  • At birth, the neonatologist and paediatrician should ascertain that the testicles are located correctly and that the outlet of the urethral meatus is in a normal position at the top of the glans and not in an abnormal position.
  • At two years of age, an examination of the region between the groin and the scrotum is necessary to detect hydrocele, hernia or undescended testicles.
  • In paediatric age, for urinary disorders typical of this age range.
  • Between the ages of 8 and 10, in particular for varicocele, more frequent in the left testicle, which could lead to infertility problems.
  • Between the ages of 16-20 years, for short frenulum, the bowing of the penis along its main axis (griposis) and abnormalities of male genitalia.
  • Between 20 and 30, to assess andrological disorders, such as premature ejaculation.
  • Between 40 and 50, check of total and free prostate specific antigen (PSA) levels in the blood, urological control of the prostate, particularly if one has relatives with prostate cancer, a sign of a possible genetic predisposition.


For females of any age for the assessment of suspected urinary infections (cystitis); in case of symptoms such as renal colic or the presence of blood in the urine (haematuria).


Urethrocystoscopy is a valuable diagnostic tool, which is used to:

  • Investigate indications and symptoms: typically a cystoscopy is recommended for patients presenting macrohaematuria (‘blood in the urine’) or urinary incontinence.
  • Bladder conditions: cystoscopy can diagnose bladder tumours (“polyps”), bladder stones and cystitis.
  • Reduced urinary flow: cystoscopy allows for the detection of any narrowing (or “stenosis”) of the urethra, including narrowing at the level of the prostate due to prostatic hypertrophy.


In some cases, cystoscopy allows:

  • for the collection of urine or suspected tissue samples (bladder biopsy).
  • for the removal of small neoformations (“polyps”) in the bladder.
  • for the extraction of foreign bodies (e.g. urethral stents or millimetric stones).

Description of the procedure

A urethrocystoscopy is performed with a cystoscope, a small instrument consisting of a flexible tube connected to a camera that allows the bladder, the urethra (the duct that carries urine from the bladder to the outside) and – in men – part of the prostate, to be viewed on a monitor.


The procedure takes about 15 minutes.


The patient generally remains awake during the procedure. Before cystoscopy, the patient is asked to urinate. A local anaesthetic, usually in gel or spray form, is then applied to the urethra to render the procedure tolerable. Once the urethra has been anaesthetised, the cystoscope is inserted as far as the bladder. It is normal at this stage for the person under examination to feel a strong urge to urinate, particularly in men.


Once in the bladder, the latter is filled with sterile saline to allow each wall to be properly analysed. In certain cases, instruments can be introduced into the bladder through the cystoscope for diagnostic (e.g. biopsy) or operative (e.g. forceps for urethral stent removal) manoeuvres.


At the end of the cystoscopy, the patient is asked to urinate in the bathroom, after which they are allowed to go home.

If a urine or tissue sample (biopsy) is taken, it will be sent for histological examination (or given to the patient for the same purpose). Once the results are obtained, the outcomes of the histological examination are discussed with the patient together with the consequent indications.


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