Cystoscopy

This card describes what cystoscopy is, why it is generally done, how it is carried out in outline, and what recovery and risks health bodies describe. It is written for patients, families and students. Individual circumstances differ, and the treating clinician decides what is right in each case.

What it is

Cystoscopy is a way of looking directly inside the urethra (the tube that carries urine out of the body) and the bladder. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes the cystoscope as a long, thin optical instrument with a rigid or flexible tube in the middle and a tiny lens and light at the tip. The urologist, a doctor who specializes in the urinary tract, watches detailed images of the bladder lining on a monitor.

The NHS describes two main versions. A flexible cystoscopy uses a thin, bendable tube with a camera inside, while a rigid cystoscopy uses a tube with a camera inside and is done under stronger anesthesia. The card on ureteroscopy covers the related, longer and thinner scope used higher up the urinary tract.

Why it is done

The NHS says a cystoscopy can be used to check what is causing bladder symptoms, to treat some bladder conditions, and to help diagnose and treat bladder cancer. Symptoms it lists include blood in the urine, repeated urinary tract infections, urinary incontinence, pelvic pain that does not go away, and changes in how urination feels.

NIDDK adds that the scope can show stones, abnormal tissue or tumors, a narrowing of the urethra called a stricture, and signs of a blockage such as an enlarged prostate. Treatment is sometimes possible through the same scope. The NHS lists removing bladder stones, repairing bladder damage and taking a small tissue sample (a biopsy), and NIDDK includes injecting medicine into the bladder. Tumor removal is covered on the TURBT card. The glossary explains terms such as biopsy and stricture.

How it is done, in outline

NIDDK says cystoscopy can take place in an office, an outpatient center or a hospital. Beforehand, a urine sample may be tested for infection, and medicines and anesthesia are discussed. The NHS adds that if an infection is found, the procedure may need to be rescheduled.

In a flexible cystoscopy, the NHS describes a numbing gel applied around the urethral opening, after which the scope is gently passed into the bladder. Sterile saline fills the bladder so the lining can be seen, and the images appear on a screen the patient can watch if they wish. The NHS says this usually takes around 10 to 15 minutes.

A rigid cystoscopy is generally done under general anesthesia or spinal anesthesia, according to the NHS, and usually takes around 30 minutes. NIDDK notes that sedatives or general anesthesia are often used when a biopsy is taken or material is injected.

Recovery

After a flexible cystoscopy, the NHS says people can go home as soon as it is finished and can return to normal activities when they feel able. After a rigid cystoscopy, people usually go home once the anesthetic has worn off and they can pass urine, which the NHS says takes a few hours for most. After a spinal or general anesthetic, the NHS advises that someone take the person home and stay with them for 24 hours, with no alcohol, driving or heavy machinery in that time.

Mild burning on urination, small amounts of blood in the urine and mild discomfort are expected. NIDDK says these should not last more than 24 hours, while the NHS says a little blood and some pain can last a few days, so timelines differ. The NHS says paracetamol or ibuprofen can help with pain. Later recovery topics, including catheters, are covered in recovery and rehabilitation and urinary catheters after surgery.

Risks

The NHS calls cystoscopy a common procedure in which serious complications are rare. NIDDK lists urinary tract infection, abnormal bleeding, pain or burning on urination, being unable to urinate, injury to the urethra, bladder or ureters, narrowing of the urethra from scar tissue, and anesthesia complications. The NHS adds that swelling can occasionally prevent urination at home, and that very rarely the bladder is damaged.

NIDDK says to seek care right away after a cystoscopy if you cannot urinate and feel that your bladder is full, have burning or painful urination lasting more than 2 days, see bright red urine or blood clots, have a fever with or without chills, or feel severe discomfort. The NHS adds that being unable to urinate with a swollen, painful abdomen needs emergency care. See also the bladder and prostate procedures overview.

Questions to ask your clinician

• Will I have a flexible or a rigid cystoscopy, and why is that the right choice for me?
• What type of anesthesia will be used, and do I need someone to take me home?
• Are you looking for a particular problem, or will a sample be taken during the procedure?
• Should I stop or continue any of my medicines, such as blood thinners, before the procedure?
• When will I get the results, and who will explain them to me?
• What symptoms afterward are expected, and which ones mean I should call right away?