Cystoscopy

Cystoscopy is a procedure used to see inside your bladder and urethra — the tube that carries urine from your bladder to the outside of your body. During a cystoscopy (sis-TOS-ko-pe) procedure, your doctor uses a hollow scope (cystoscope) equipped with a lens to carefully examine the lining of your bladder and your urethra. The cystoscope is inserted into your urethra and slowly advanced into your bladder.

Cystoscopy, also called cystourethroscopy, may be performed as an outpatient procedure using a local anesthetic to numb your urethra. Or cystoscopy can be performed in the hospital using regional or general anesthesia. The type of cystoscopy you undergo depends on the reason for your procedure.

Common reasons your doctor may recommend a cystoscopy include:

  • Investigating causes of bladder signs and symptoms. Cystoscopy may help your doctor learn the causes of signs and symptoms such as blood in the urine, frequent urinary tract infections, incontinence, overactive bladder and painful urination.
  • Diagnosing bladder and urinary tract diseases and conditions. A cystoscopy may be used in diagnosing bladder cancer, bladder stones and bladder inflammation (cystitis).
  • Treating bladder diseases and conditions. Special tools can be passed through the cystoscope to treat a bladder disease or condition. For instance, very small bladder tumors may be removed during cystoscopy.
  • Diagnosing an enlarged prostate. A cystoscopy may reveal a narrowing of the urethra where it passes through the prostate gland, indicating an enlarged prostate (benign prostatic hyperplasia).

In certain cases, your doctor may conduct a procedure called ureteroscopy to examine your urinary tract beyond your bladder at the same time as your cystoscopy. Ureteroscopy uses a smaller scope to examine your ureters — the tubes that carry urine from your kidneys to your bladder.

Cystoscopy carries a risk of complications, including:

  • Infection. Cystoscopy can introduce germs into your urinary tract, which can cause infection. Cystoscopy may also irritate an existing urinary tract infection, worsening it. In some cases, your doctor may prescribe antibiotics to take before and after your cystoscopy to prevent infection.
  • Bleeding. Cystoscopy usually causes some blood in your urine, but in rare cases, bleeding may be more serious.
  • Pain. Cystoscopy may cause abdominal pain and a burning sensation when urinating. In most cases, these symptoms are mild and gradually decrease after the procedure.

Signs and symptoms of a complication
Call your doctor or go to the nearest emergency room if you experience:

  • Inability to urinate more than eight hours after cystoscopy
  • Blood clots or bright red blood in your urine more than five hours after cystoscopy
  • Fever higher than 100 F (38 C)
  • Pain or burning during urination that lasts more than two days
    female urinary system

    female cystoscopy

To prepare for your cystoscopy exam, your health care team may ask that you:

  • Take antibiotics if prescribed by your doctor. In some cases, your doctor may prescribe antibiotics before and after your cystoscopy. Examples of people who may need to take antibiotics include those with artificial joints and those with heart conditions who routinely take antibiotics before a dental cleaning.
  • Wait to empty your bladder. In certain situations, your doctor may order a urine test before your cystoscopy. Wait to empty your bladder until you get to your appointment in case you need to give a urine sample.

Prepare for sedation or anesthesia
If you’ll receive intravenous (IV) sedation or general anesthesia during your cystoscopy, plan ahead for your recovery. To prepare, you can:

  • Find a ride home. You’ll be asked not to drive yourself home, so arrange a ride.
  • Clear your schedule for the day. Plan to take it easy after your procedure. Avoid being active for the rest of the day. You may need to take the day off work. Though you may feel fine, your judgment and reflexes may be slowed.
  • Ask someone to stay nearby. Have a friend or relative stay with you or check on you throughout the day.
    male urinary system

    male cystoscopy

To prepare for your cystoscopy procedure, you’ll be asked to empty your bladder. Then you’ll undress from the waist down and a drape or gown will be placed around your waist.

You’ll lie down on a table on your back. In some cases, you may positioned with your feet in stirrups so that your knees are bent and elevated.

In certain cases, you may receive a sedative or an anesthetic medication through a vein in your arm before the cystoscopy procedure. If you receive a sedative, you’ll feel sleepy and relaxed during the cystoscopy, but you’ll still be aware. If you receive general anesthesia during the cystoscopy, you won’t be aware during the procedure.

A numbing jelly will be applied to your urethra so that you feel less pain when the cystoscope is inserted. After waiting a few minutes for the numbing to occur, your doctor feeds the cystoscope, which is about the width of a pencil, into your urethra.

Several sizes of cystoscopes are available, and your doctor will choose the smallest scope possible for your procedure. Smaller scopes are often used for investigating causes of signs and symptoms. Larger scopes may be necessary to take tissue samples or pass surgical tools into the bladder.

As the cystoscope passes through your urethra and toward your bladder, your doctor will look through a lens on the end of the cystoscope. The lens works like a telescope to magnify the inner surfaces of your urethra and your bladder. In some cases, your doctor may place a special video camera over the lens that projects the images onto a video screen.

Once the cystoscope reaches your bladder, your doctor will flood the bladder with a sterile solution. The solution inflates the bladder and allows your doctor to get a better look at the entire organ. As your bladder fills, you may feel the need to urinate. This can be an uncomfortable feeling, but fight your instinct to tense your pelvic muscles, as this may increase the discomfort. Instead, try to relax and take deep breaths. As soon as your cystoscopy is complete, you’ll be allowed to empty your bladder.

Depending on your situation, your doctor may take tissue samples or perform various procedures during the cystoscopy. Once these are complete, the cystoscope is retracted through your urethra. A simple outpatient cystoscopy may take less than five minutes. When done in a hospital setting with sedation or general anesthesia, cystoscopy can take 10 to 30 minutes.

After the cystoscopy
After your cystoscopy, you may be allowed to go about your day. If you’ve received sedation or general anesthesia, you may be asked to remain in a recovery area to let the effects of the medications wear off before you leave.

In general, take it easy for the rest of the day. If your cystoscopy didn’t require anesthesia, you may be able to go back to work if you have a job that doesn’t require much physical activity. Ask your doctor about your particular situation.

You’ll likely experience some side effects after cystoscopy, such as:

  • Bleeding from your urethra, which may appear bright pink in your urine or on toilet tissue
  • Burning sensation during urination
  • Mild abdominal pain
  • More frequent urination for the next day or two

You can relieve some of the discomfort if you:

  • Hold a warm, moist washcloth over the opening to your urethra for 20 minutes to help relieve pain. Repeat this as needed.
  • Take a warm bath. Though, in some cases, your doctor may ask you to avoid baths. If you have concerns, call your doctor.
  • Drink water to flush out your bladder. This may reduce irritation. Try to drink 16 ounces (473 milliliters) of water each hour for the first two hours after your cystoscopy. Then drink 8 ounces (237 milliliters) of water every one or two hours over the next few days.

Call your doctor if you have concerns after your cystoscopy.

In some cases, your doctor may be able to discuss the results of your cystoscopy immediately after your procedure.

In other cases, your doctor may discuss your results at a follow-up appointment. For instance, if your cystoscopy involved collecting a tissue sample (biopsy) to test for bladder cancer, your doctor will send that sample to a laboratory. When the tests are completed, your doctor will let you know the results.

Ask your doctor when you can expect the results of your cystoscopy.