Cystoscopy is a procedure that lets the healthcare provider view the urinary tract, particularly the bladder, the urethra, and the openings to the ureters. Cystoscopy can help find problems with the urinary tract. This may include early signs of cancer, infection, narrowing, blockage, or bleeding.
To do this procedure, a long, flexible, lighted tube, called a cystoscope, is put into the urethra and moved up into the bladder. Here, the healthcare provider can look closely at the inside of the urethra and bladder. He or she can also wash the bladder, and access the structures with special instruments used through the scope.
During a cystoscopy, the healthcare provider may remove tissue for further exam (called a biopsy). Some problems can be treated during the procedure.
A cystoscopy may be advised if your healthcare provider thinks you have a problem of the urinary tract. For example, a structural problem may lead to a blockage of urine flow or a back flow of urine. If untreated, this may lead to complications.
Cystoscopy may also be used after gynecologic surgery near the bladder to check for proper placement of sutures and support devices.
Some medical problems of the urinary tract that may be found during cystoscopy include:
- Cancer or tumor of the bladder
- Polyps or overgrowths of normal tissue
- Bladder stones, which are calcium crystals that can lead to infection, inflammation, bleeding, and blockages in the urinary tract.
- Scarring and damage caused by frequent urinary tract infections (UTIs)
- Abnormalities of the urinary tract that may be present at birth and may lead to a backflow of urine or kidney problems
- Injury of the urinary tract
There may be other reasons for your healthcare provider to recommend a cystoscopy.
Complications of cystoscopy may include:
- Urinary retention due to irritation and swelling from the procedure
- Bladder perforation (poking a hole in the bladder with the cystoscope)
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the procedure.
Urinary tract infection may interfere with a cystoscopy.
- Your healthcare provider will tell you about the procedure and you can ask questions.
- You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if anything is not clear.
- The type of fasting (not eating or drinking anything) needed before the procedure will depend on the type of anesthesia used. Your healthcare provider will give you specific instructions regarding how long to fast. You may be given other instructions about a special diet to follow for a day or two before the procedure.
- If you are pregnant or think you might be, tell your healthcare provider.
- Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, iodine, tape, or anesthetic agents (local and general).
- Make sure your healthcare provider has a list of all medicines (prescribed and over-the-counter), herbs, vitamins, and supplements that you are taking.
- Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
- If local anesthesia is used, you will be awake during the procedure, but you may be given a sedative. You will need someone to drive you home afterwards.
- If you think you have a urinary tract infection, tell your healthcare provider, because cystoscopy should not be done. Your healthcare provider may check your urine for infection before doing the procedure. (Signs of infection include things like frequent urination, pain or burning when passing urine, fever, and urine that looks dark, cloudy, or reddish in color and smells bad.)
Based on your medical condition, your healthcare provider may request other specific preparation.
A cystoscopy may be done on an outpatient basis or during a hospital stay. Procedures may vary, depending on your condition and your healthcare provider's practices.
Generally, a cystoscopy follows this process:
- You will need to remove any clothing, jewelry, or other objects that may interfere with the procedure.
- If you are asked to remove your clothing, you will be given a gown to wear.
- An intravenous (IV) line may be started in your arm or hand.
- Often an antibiotic is given before the procedure.
- You may be given an IV sedative or anesthetic, depending on your situation and the type of scope that will be used. This will make you sleepy and not feel pain during the cystoscopy. If a sedative or anesthetic is given, your heart rate, blood pressure, breathing, and blood oxygen level will be monitored throughout the procedure.
- You will be positioned on an exam table on your back with your knees up and spread apart. Your feet will be placed in stirrups.
- A numbing medicine in the form of a gel will be put into your urethra. This may be mildly uncomfortable until the area is numb.
- Once the urethra is numb and/or the anesthesia has taken effect, the healthcare provider will put the cystoscope into the urethra. You may have some discomfort when this is done.
- As the cystoscope is passed through the urethra, the healthcare provider will check the lining. The cystoscope will be moved up until it reaches the bladder.
- Once the cystoscope is in the bladder, the healthcare provider may put sterile water or saline into the bladder to help expand it and make the lining of the bladder easier to see. While the bladder is being filled, you may have the urge to urinate or feel mild discomfort.
- The healthcare provider will check the bladder for any abnormalities. A long, thin tool may be passed through the cystoscope to take out a piece of bladder tissue for testing. A urine sample may be taken from the bladder, too.
- The cystoscope will be carefully removed after the procedure has been completed.
After the procedure, you may be taken to a recovery room for observation if sedation or anesthesia was used. Your recovery process will vary depending on the type of sedation that was given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. Cystoscopy is most often done on an outpatient basis.
You may go back to your usual diet and activities unless your healthcare provider tells you otherwise.
You will be encouraged to drink extra fluids, which dilutes the urine and reduces urinary discomfort, such as burning. Some burning with urination is normal after the procedure but should lessen over time. A warm sitz or tub bath may be urged to help ease urinary discomfort.
You may notice blood in your urine after the procedure. This is normal and should clear up over the next day or two.
Take a pain reliever for soreness or discomfort as advised by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.
You may be given an antibiotic to take after the procedure. This is to help prevent infection. Be sure to take the antibiotic exactly as instructed.
Tell your healthcare provider if you have any of the following:
- Fever and/or chills
- Urinary frequency or urgency
- Inability to urinate
- Lower back pain
- Continued burning with urination or blood in the urine
Your healthcare provider may give you other instructions after the procedure, depending on your situation.Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Greenstein, Marc, DO,Finke, Amy, RN, BSN