Sarah Lewis, PharmD
What is a cystoscopy?
A cystoscopy is a procedure to examine the inside of your urinary bladder and urethra. Your urethra is the tube that carries urine from your bladder to the outside of your body. Your doctor may recommend a cystoscopy to diagnose problems with your bladder or urethra, including bladder cancer, obstructions, and infections.
A cystoscopy is only one method used to diagnose diseases and conditions of the urinary bladder and urethra. Discuss all of your diagnostic options with your doctor to understand which options are best for you.
Types of cystoscopy
A cystoscopy uses a cystoscope to see the inside of the bladder and urethra. A cystoscope is a thin, lighted tube with a tiny camera at the tip. The types of cystoscopy include:
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Flexible cystoscopy is the most common type of cystoscopy. It uses a flexible or bendable cystoscope. A flexible cystoscopy is generally more comfortable for patients, but may not be the best choice for complex procedures.
Rigid cystoscopy uses a rigid or unbendable cystoscope. A rigid cystoscopy causes more discomfort, but it allows the doctor to use a variety of instruments to instill fluids or remove tissue samples or foreign objects.
Other procedures that may be performed
Your doctor may perform diagnostic procedures in addition to a cystoscopy. These include:
Imaging exams, which include cystography (bladder X-ray using a contrast agent), X-ray of the kidney, ureters and bladder (KUB), and computed tomography (CT) scan
Tissue biopsy, which involves removing a sample of cells or tissues and testing it for cancer and other diseases
Ureteroscopy, which uses a longer and thinner tube to examine your ureters. Ureters are the tubes that carry urine from your kidneys to your urinary bladder.
Urodynamic studies, which include cystometry to evaluate the function of the bladder and urinary system
Why is a cystoscopy performed?
Your doctor may recommend a cystoscopy to diagnose diseases and conditions of the urinary tract including:
Blockages of the urinary tract including strictures (narrowing) and prostate enlargement
Congenital (present at birth) abnormalities including intersex abnormalities
Frequent urinary tract infections (UTIs) including frequent bladder infections
Injuries including traumatic injury to the urinary tract
Tumors including benign growths or polyps and cancer of the bladder or prostate gland
Urinalysis abnormalities including blood or abnormal cells in the urine
Urinary incontinence including overactive bladder
Urinary symptoms including painful urination, painful bladder, or frequent or urgent urination
Urinary tract stones including bladder stones
Who performs a cystoscopy?
A urologist or sometimes an obstetrician-gynecologist (for women) performs a cystoscopy. Urologists are internists or pediatricians who specialize in diseases and conditions of the genitourinary tract. Obstetrician-gynecologists specialize in the medical and surgical care of the female reproductive system.
How is a cystoscopy performed?
Your cystoscopy will be performed in a doctor's office, hospital or outpatient setting. The procedure takes about 30 minutes and generally includes these steps:
You will dress in a patient gown. You will lie on your back on a procedure table with your knees raised and apart.
You may have a medication (a light sedative) to make you drowsy and relaxed, and possibly a pain medication. You may also have deeper sedation or anesthesia, in which you are more relaxed and unaware of the procedure and may not remember it.
Your team will apply a local anesthetic to your urethra to numb it.
Your doctor will gently slide the cystoscope into your urethra and advance it into your bladder.
Your doctor may instill fluid through the cystoscope into your bladder in order to better view the lining of your bladder and urethra.
Your doctor will examine the urethra and bladder and possibly perform treatments or take a biopsy.
Your doctor will gently remove the cystoscope.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. You may feel some discomfort or pressure when your doctor inserts the cystoscope. You may also feel the urge to urinate or some discomfort when your doctor instills fluid through the cystoscope into your bladder. You may feel a pinch when your doctor removes tissue for a biopsy.
Take a few long, deep breaths to help yourself relax. Tell your doctor if any discomfort does not pass quickly.
What are the risks and potential complications of a cystoscopy?
Complications after a cystoscopy are uncommon, but any medical procedure involves risks and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery.
Complications of a cystoscopy include:
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Bladder rupture or urethral damage
Burning, discomfort and blood with urination for 24 hours following the procedure
Soreness or discomfort of the urethra
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Drinking plenty of water as directed to reduce burning and discomfort with urination after cystoscopy
Ensuring that your care team is aware of any allergies
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Notifying your doctor immediately of any concerns, such as urethral bleeding, fever, or increase in pain
Taking sitz baths as directed to relieve urethral soreness and discomfort. A sitz bath involves sitting in warm water to soothe and encourage healing of the genital area.
Taking your medications and returning for follow-up care exactly as directed
How do I prepare for my cystoscopy?
You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome.
You can prepare for a cystoscopy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Following eating and drinking instructions before your cystoscopy. You may need to drink water and not urinate for an hour before your cystoscopy in order to provide a urine sample. You may need to stop eating just before cystoscopy if you have sedation.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Telling all members of your care team if you have any allergies
Questions to ask your doctor
Having a cystoscopy can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before a cystoscopy and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a cystoscopy? Are there any other options for diagnosing my condition?
Which type of cystoscopy will I have and why?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you manage my discomfort?
When and how will I receive the results of my test?
What other tests or treatments might I need?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my cystoscopy?
Knowing what to expect after a cystoscopy can help you get back to your everyday life as soon as possible.
How will I feel after the cystoscopy?
You may have urethral soreness or discomfort after cystoscopy. To reduce discomfort, take slow deep breaths. You might feel a little drowsy from sedative and pain medications. Tell your doctor if any discomfort does not pass quickly.
Ask your doctor about medications for pain. Some pain medications can increase the risk of bleeding, so you should only take those recommended by your doctor.
When can I go home?
You will be discharged home when you are alert, breathing effectively, and your vital signs are stable. This generally takes less than an hour, depending on the type of sedation you had.
You may still be a drowsy and will need a ride home from your procedure. You cannot drive for about 24 hours. Someone should stay with you during that time.
When should I call my doctor?
It is important to keep your follow-up appointments after a cystoscopy. Contact your doctor for questions and concerns between appointments. Call your doctor right away if you have:
Bleeding from the urethra
Discomfort or blood with urination that lasts for more than 24 hours
Fever (you should not have any fever after a minor testing procedure) or chills
Inability to urinate
Lower back pain
Urinary frequency or urgency
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- Cystoscopy. American Urological Association Foundation. http://www.urologyhealth.org/urology/index.cfm?article=77.
- Cystoscopy: A Guide for Women. International Urogynecological Association. http://c.ymcdn.com/sites/www.iuga.org/resource/resmgr/brochures/eng_cystoscopy.pdf.
- Cystoscopy and Uteroscopy. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://kidney.niddk.nih.gov/kudiseases/pubs/cystoscopy/.
- Cystoscopy for Women. Johns Hopkins Medicine. http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/cystoscopy_for_women_92,P077....
- Tips from Patients, For Patients: Cystoscopy. American Bladder Cancer Network. http://www.bcan.org/wp-content/uploads/2012/02/Cystoscopy-Tips.pdf.