Reasons for a cystoscopy?

This is not unusual. Almost all men pee slower at night and on first waking in the morning, whether they've noticed it or not.

This is because the internal urinary sphincter which is the primary continence control is smooth muscle under the control of the autonomous nervous system, not under conscious control. The autonomous nervous system takes longer to wake up than your conscious nervous system, so you are basically peeing when the nervous system controlling the internal sphincter is still half asleep.

However, as you've had a prostatectomy, you no longer have an internal urinary sphincter (it's removed with the prostate) - you just have the external one, and this leads me to some conjecture. The external sphincter in men (although not women) is normally thought of as skeletal muscle under conscious control. I've asked a few urologists how this learns to become the primary continence control after prostatectomy, and none seem to know, but certainly in women it's both a skeletal muscle under conscious control and a smooth muscle under control of the autonomous nervous system (women don't have the internal urinary sphincter in the first place, so their sphincter has to do some of both roles). My guess is that gaining continence after prostatectomy is the brain transferring autonomous nervous system control from the lost internal sphincter to smooth muscle parts of the external sphincter, so the same considerations would apply of the autonomous nervous system being half asleep when you are trying to pee at night, with or without a prostatectomy.

Any urinary tract outflow obstruction will make slower peeing at night worse, particularly if the obstruction is in the sphincter itself. In minor cases (at least when prostatectomy isn't involved), Tamsulosin may be given to take with the last meal of the day (so it works overnight) to help relax the internal urinary sphincter more, but it might be that there's a stricture (scar tissue causing narrowing) at that point which needs dilating, and that can sometimes be done with the cystoscopy camera if it's minor.

Bri
The local anesthetic for cystoscopy is in the lubrication gel (Instillagel), not any sort of injection, and you would certainly have had the lubrication gel. You might also have an additional local anesthetic if they plan to do something other than just a camera observation.

Edited by member 07 Jan 2020 at 16:19  | Reason: Not specified

I've thought about this quite a bit (which is why I've asked questions of urologists, only to find they don't know).

Let me start by explaining smooth muscle and skeletal muscle a bit more. Smooth muscle is under the control of the autonomous nervous system, and without direct conscious control. Another key aspect of smooth muscle is that it can remain contracted without ever tiring, which is kind of important for the primary continence control. Also, it doesn't contract and release very quickly. Conversely, skeletal muscle is under conscious control. (It can be, and often is, taught to behave automatically without consciously considering every muscle. For example raising your arm requires synchronised actions of very many muscles - at a very early age, you learnt to raise your arm by operating those muscles subconsciously, indeed "learning" meant committing them to your subconscious, because the action is too complicated to do with manual control of all the individual muscles. However, you can still consciously control them individually if you really want to.) Skeletal muscle operates quickly, but tires, and cannot remain contracted for extended periods. That's not much use for primary continence control.

Men have two urinary sphincters, an internal one between bladder and prostate (actually part of the bladder wall), and an external one below prostate and integral with pelvic floor muscles. The conventional wisdom is that the internal one which is smooth muscle provides primary continence, relaxing when you want to start peeing, and the external one is skeletal muscle and provides secondary conscious control of continence, e.g. contracting when you want to suddenly stop peeing mid-stream when your grandmother unexpectedly walks into the bathroom. We know the external one does more than just this - you learned at a very early age to contract the external one also when you cough, or stand up, or jump and land, and other actions than might cause the internal one to leak, but these are short lived contractions which need to happen quickly, and ideally suited to skeletal muscles.

My guess is that the male external urinary sphincter is probably both smooth muscle and skeletal muscle, just as it is in women (who have only one urinary sphincter). If this wasn't the case, the external urinary sphincter could never take over primary continence control when the internal one is lost during prostatectomy. This means when a man learned continence at a very young age, he had two options to pick, using just the internal urinary sphincter, or using both urinary sphincters - both methods will work. 60 years later when he loses the internal urinary sphincter in a prostatecomy, if he had originally learned to use just that for continence, he will now be leaking. However, if he's always been using smooth muscle of both sphincters for primary continence control, he will be dry as the external one is still there and working. Interestingly, if it's this simple, it should be possible to tell men in advance if they will leak or be dry after prostatectomy.

This is just my theory, because it fits what I know of the anatomy and the results seen after prostatectomy. However, it seems we simply don't know how this really works.