Well, this will be a long one...
Last week I had some mild abdominal pain and some discoloration in my urine, so I went to my general practitioner where I was seen by my usual physician assistant (PA). After checking my vitals, she had me provide a urine sample and wrote me a referral to a urologist. As I’ve mentioned previously, I recently moved to the area so I didn’t have my usual specialists.
Urine tests came back designating hematuria – blood in the urine, and kidney stones were suspected. So I called the urologists’ office and took the first appointment available the next day where I met with a female LPN. She was middle aged (50ish) and dressed professionally wearing a white lab coat. She took my vitals, asked lots of questions about diet, medical history, etc. She wrote me a referral for an abdominal CT scan at the nearby hospital so they could get imaging to confirm the presence and location of any kidney stones. She said that she wanted to consult with “Dr. K” and left me sitting in the exam room for about 15-20 minutes.
When she came back, she said that “Dr. K” would like to do a cystoscopy and could fit me in later that afternoon if I could come back. Admittedly, I had no idea what a cystoscopy was or what it would entail. I asked the LPN if I needed to do anything special prior to the procedure – was it okay to eat lunch, etc. She said that I could eat a normal lunch and that they’d just ask me to empty my bladder prior to the procedure.
Okay, I thought, no big deal... and I went in to the office and went to work. I guess I should have looked up cystoscopy on the Internet, but figured that if I could eat a normal lunch and come back that afternoon, that it was probably a non-invasive procedure.
I showed up at their office about 15 minutes prior to my appointment time and almost immediately upon checking in a nurse took me back (different nurse). She introduced herself as “N” - she was a woman in her early-to-mid thirties with short dark hair – almost shaved on the sides and long on top, wearing purple scrubs (which matched a streak of purple in her hair) with a black long-sleeved top underneath, and running shoes. The first thing she did was direct me to the restroom and stated “Even if you just went, we need to make sure that your bladder is empty as possible.” When I came out of the restroom she took me down the hall to the exam room. This was a different room than the one I was in that morning. At this point, I realized that I had greatly underestimated what a cystoscopy entailed. Upon entering the exam room, there was a curtain hanging just beyond the arc of the door, blocking the view into the room. The main feature in the room was the exam chair. It had a cushioned back that was reclined to about a 60 degree angle and a seat that was short, with leg pads coming off at
about a 45 degree angle, stirrups, and in the center/front, a funnel leading down to a collection jar. There was a covered tray beside the exam table/chair and a large screen monitor.
I guess the nurse saw that I hesitated slightly and said “Are you familiar with this procedure?” I said “No” and she went on to explain: “I’m going to ask you to get undressed from the waist down - pants and underwear. It’s so cold in here, so you can leave your socks on. Once I get you prepped, Dr. K will come in and perform the procedure where he’ll use a flexible scope to examine your urethra and your bladder so that we can see what’s going on and make sure that there is nothing that needs to be dealt with immediately. The scope uses a saline solution to inflate your bladder, so you may feel like you need to urinate during and after the procedure. You’ll be able to watch on the screen if you’d like. Okay?”
I said “Okay” and I guess she could see the shock on my face because she said “It’s a very simple procedure and shouldn’t take more than 5 or 10 minutes. I’ll use a numbing agent, so you shouldn’t feel any discomfort other than perhaps pressure on your bladder like you need to urinate.”
She showed me where I could hang my coat and hat and handed me a small, folded paper drape. She said “Okay, go ahead and remove your pants and underwear and have a seat on the exam chair. Here is a drape to put in your lap. I’ll be back in a few minutes to get you prepped.”
I did as instructed and unfolded the drape until it was about the size of a placemat that you’d use on the dinner table, placed it over my crotch, and folded my hands over it to wait. I did not spread my legs and put them on the supports, instead I sat (kind of awkwardly) with an approximation of normalcy. About 5 minutes later the nurse came back in and went to the counter to my right. She started washing her hands and said “I’m going to apply some sterile drapes and then wash your penis with some iodine (she might have said betadine, I really don’t remember). If at any time you have any questions, please let me know.”
She came over and stood in front of me and told me that I needed to spread my legs out and rest them on the supports. She offered assistance, but it was unnecessary. She then told me to move my hands up to my belly, and when I did so, she quickly folded the paper drape up over my hands, leaving me feeling very completely exposed. She said “I need you to keep your hands there and not touch anything once I get everything sterile.” She then applied blue paper/cloth drapes over each thigh and across my stomach, covering my hands with another layer. She then said, “Now I’m going to wash your penis and the surrounding area. I’m sorry, this might be a little cold.” I should mention that it was probably in the 20s outside and the room was decidedly on the chilly side.
Sitting the way that I was, reclined with my legs spread and drapes over my stomach, I could not see what was going on. I felt her pick up the tip of my penis with her the thumb and forefinger of her right hand and stretch it out – not hard, but about as far is it could be stretched without being painful. I then felt what was probably a gauze pad drenched in betadine/iodine – make that a cold gauze pad – circle the top of my penis two or three times, and then methodically scrub up and down the length of the shaft, around the full circumference. She let go of my penis, and after adding more betadine/iodine she lifted my penis back up out of the way and methodically washed my scrotum. At this point, I remember a cold drop of betadine/iodine running down my left thigh to the edge of my anus – I could flex, but couldn’t move to wipe it away – I knew that it would bug me. She then said, “I’m going to apply a numbing agent, so you might feel a little sting.”
I figured that she was coming in with a Q-tip and was going to pinch open my urethra to apply a topical. Remember, I couldn’t see what she was doing. She picked up my penis again with one hand, pinching the tip. Then I felt a needle go in what felt like the underside of the very tip, NOT what I was expecting, and not a very pleasant experience – but it was over quickly. When she was done she laid my penis back into its normal position, threw the gauze sponges into a waste container and the syringe into a sharps container, and went back over to the counter to wash her hands. She said “I’m going to go get Dr. K and will be
back shortly. Remember to not move or touch any of the sterile areas.” After washing her hands she came back over to stand in front of me and said “This is really a simple procedure and should be over before you know it. Do you have any questions?” I assured her that I did not, and she left the room, making sure that the curtain was closed behind her.
She was gone much longer than I expected, and I just sat there with my butt on the edge of that exam chair and my legs spread out at a 45 degree angle and completely exposed, while the betadine/iodine dried (and cooled even more), feeling extremely vulnerable and, I’ll admit it, a bit scared.
After what seemed like 15 or 20 minutes (but was probably less than 5), the nurse came back in followed by a man in his late twenties / early thirties wearing light green scrubs with a thermal top on under the scrubs. He was fit/athletic with dark brown/black hair cropped close and coffee brown eyes. He introduced himself and briefly explained the procedure. He then told me that I could watch on the monitor, and I said, “Uh, I’m not really sure that’s something I want to see.” He expressed his surprise and then both he and the nurse went over to the counter to my right to wash hands and glove up. At this point I remember thinking ‘did the nurse glove up before she did all of the prep?’ I’m sure that she did, but I had no recollection of her gloving up or removing her gloves when she was done. I cannot imagine that she didn’t/wouldn’t – but it’s something that I
haven’t been able to reconcile in my memory.
After gloving up, Dr. K took a seat on a stool between my legs while the nurse uncovered the tray of instruments to my left and stood behind the doctor. I felt Dr. K pick up my penis and squeeze the tip, and within seconds felt pressure and some discomfort in the area where my penis meets my abdomen. I guess I shifted or grunted or something, because Dr K said, “Okay, we’re in, so that should be the worst of it.” He commented that I had done a good job of emptying my bladder (Gee, thanks Doc! Something to be proud of!) and that he was going to be pumping some saline into my bladder to inflate it. At this point I did look at the monitor. He noticed and started describing what he was seeing. He pointed out where the ureters entered my bladder from my kidneys and gave me a tour of the inside of my bladder. I did feel pressure in my bladder like I needed to urinate really bad, but I also heard fluid starting to dribble into the collection jar under the end of the exam chair.
After three or four minutes, he withdrew the scope (rather quickly, it felt), stood up and said “After Nurse ‘N’ gets you cleaned up and you’re dressed, I’ll meet you in one of the other exam rooms” and he left. All told, I’d guess that he was in the exam room less than 10 minutes. As he left, I noticed that he did not close the curtain behind him, so anyone in the hallway who was at the right angle could have seen me there in the exam chair. To the best of my knowledge, although I saw some staff out there with their backs to the door, there was no one positioned to see in.
The nurse came back over from the sink with a wet towel/cloth and did an initial wipe down of my pubic area, penis, scrotum, and upper thighs. I should note that she used warm water to wet the towel, and it felt great after everything else being so cold. After the initial wipe down, she said that I could use the sterile drapes to finish cleaning up/drying off and that I when I was dressed I should just step out into the hall. She then ungloved, washed her hands, and left, closing the curtain before going out the door.
When I stepped out into the hall, she led me immediately to the restroom so that I could empty my stretched-out bladder, and then to an exam room down the hall. After a few minutes Dr. K came in and said that everything looked fine. After discussing symptoms he said that the stones were probably still contained in my kidney(s), but that the CT scan would tell them more. He then explained the different therapies available. He said that we’d determine the best course of action after the CT scan, but given my symptoms and his experience, that he’d probably recommend a lithotripsy procedure (external shockwave therapy to break up the stones) but much would depend on the location and size of the stones.
He then recommended that I go by the local pharmacy to pick up a box of AZO to help with any discomfort during urination – which he said should resolve in 24 hours or less.
On a side note, AZO makes your urine the color of orange Gatorade!
CT scan is scheduled for Thursday. I’ll try to update this weekend.