What is cystoscopy? What are the reasons for needing one? What are the risks and how do you prepare for the procedure? Find the answers to these questions and more in this comprehensive guide.

Understanding Cystoscopy: The Basics

Cystoscopy is a medical procedure that allows healthcare providers to visually examine the urinary tract, particularly the bladder, urethra, and the openings to the ureters. This diagnostic tool is used to identify various problems, including early signs of cancer, infections, narrowing, blockages, or bleeding within the urinary tract.

During the procedure, a long, flexible, and lighted tube called a cystoscope is inserted into the urethra and guided up into the bladder. This allows the healthcare provider to closely inspect the interior of the urethra and bladder, as well as perform additional procedures, such as taking a tissue sample (biopsy) or treating certain issues.

Reasons for Undergoing Cystoscopy

There are several reasons why a healthcare provider may recommend a cystoscopy for a patient. Some of the most common include:

• Investigating the cause of urinary problems, such as frequent urination, pain or burning during urination, or blood in the urine
• Checking for structural issues in the urinary tract that may be causing blockages or a backflow of urine
• Monitoring or treating conditions like bladder cancer, polyps, or bladder stones
• Evaluating the placement of sutures or support devices after gynecological surgery near the bladder
• Examining abnormalities in the urinary tract that may have been present since birth
• Assessing damage or injuries to the urinary tract

In some cases, the healthcare provider may also use the cystoscope to perform additional procedures, such as removing tissue samples for further examination or even treating certain issues during the same appointment.

Potential Risks and Complications

While cystoscopy is generally considered a safe procedure, there are some potential risks and complications that patients should be aware of, including:

• Infection: The introduction of the cystoscope can potentially introduce bacteria into the urinary tract, leading to a urinary tract infection (UTI).
• Bleeding: Some bleeding may occur, particularly if a biopsy or other procedure is performed during the cystoscopy.
• Urinary retention: The irritation and swelling caused by the cystoscope can sometimes lead to temporary difficulty urinating.
• Bladder perforation: In rare cases, the cystoscope can accidentally poke a hole in the bladder.

Patients with certain medical conditions, such as a history of bleeding disorders or those taking blood-thinning medications, may be at an increased risk of complications. It is important for patients to discuss any concerns or pre-existing conditions with their healthcare provider before the procedure.

Preparing for a Cystoscopy

To prepare for a cystoscopy, patients will typically need to:

• Sign a consent form that outlines the procedure and its potential risks.
• Provide a list of all medications, including over-the-counter drugs, herbs, vitamins, and supplements, that they are currently taking.
• Inform the healthcare provider if they have any allergies or sensitivities, especially to latex, iodine, or anesthetic agents.
• Discuss any history of bleeding disorders or the use of blood-thinning medications, as these may need to be adjusted before the procedure.
• Follow any specific dietary or fasting instructions provided by the healthcare provider, which may depend on the type of anesthesia used.
• Arrange for someone to drive them home if a sedative or anesthetic is administered during the procedure.

In some cases, the healthcare provider may also request additional tests or measures to ensure the patient is prepared for the cystoscopy, such as checking for a urinary tract infection prior to the procedure.

What Happens During a Cystoscopy?

The cystoscopy procedure typically follows these general steps:

1. The patient will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
2. An intravenous (IV) line may be started in the patient’s arm or hand.
3. An antibiotic may be administered before the procedure to help prevent infection.
4. Depending on the patient’s situation and the healthcare provider’s preferences, the patient may be given a sedative or anesthetic, either through the IV or as a local anesthetic.
5. The cystoscope is then carefully inserted into the urethra and guided up into the bladder, allowing the healthcare provider to visually inspect the urinary tract.
6. If necessary, the healthcare provider may perform additional procedures, such as taking a tissue sample (biopsy) or treating certain issues, using specialized instruments through the cystoscope.

The duration of the cystoscopy can vary, but it is generally a relatively quick procedure, typically taking 15-30 minutes to complete.

Recovering from a Cystoscopy

After the cystoscopy, patients may experience some discomfort or side effects, such as:

• Mild pain or burning during urination
• Blood in the urine
• Difficulty urinating or a feeling of needing to urinate frequently

These symptoms are generally temporary and should resolve within a few days. Patients may be advised to drink plenty of fluids and take over-the-counter pain medication if needed. In some cases, the healthcare provider may also prescribe an antibiotic to help prevent a urinary tract infection.

It is important for patients to follow any specific instructions provided by their healthcare provider regarding activity, diet, and medication during the recovery period. They should also contact their healthcare provider if they experience any severe or persistent symptoms, such as significant bleeding, fever, or inability to urinate.

Conclusion

Cystoscopy is a valuable diagnostic and treatment tool used by healthcare providers to assess and address a variety of issues related to the urinary tract. While the procedure may seem daunting, understanding the reasons for the procedure, the potential risks and complications, and the steps involved in preparation and recovery can help patients feel more informed and at ease throughout the process.

Cystoscopy for Women | Johns Hopkins Medicine

What is cystoscopy?

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.

Why might I need a cystoscopy?

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.

What are the risks of cystoscopy?

Complications of cystoscopy may include:

• Infection
• Bleeding
• 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.

How do I get ready for 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.

What happens during cystoscopy?

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:

1. You will need to remove any clothing, jewelry, or other objects that may interfere with the procedure.
2. If you are asked to remove your clothing, you will be given a gown to wear.
3. An intravenous (IV) line may be started in your arm or hand.
4. Often an antibiotic is given before the procedure.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. The cystoscope will be carefully removed after the procedure has been completed.

What happens after a cystoscopy?

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.

Next steps

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

Cystoscopy – Recovery – NHS

You should be able to get back to normal quite quickly after a cystoscopy.

How long it takes to recover depends if you had a flexible cystoscopy (using local anaesthetic gel) or a rigid cystoscopy (under general anaesthetic or spinal anaesthetic).

Going home

After a flexible cystoscopy

You’ll be able to go home shortly after a flexible cystoscopy, once you’ve emptied your bladder.

There’s usually no need to wait in the hospital until the anaesthetic has completely worn off.

After a rigid cystoscopy

If you have a rigid cystoscopy, you’ll probably need to stay in hospital for a few hours until the anaesthetic starts to wear off.

You can go home once you’re feeling better and you’ve emptied your bladder. Most people leave hospital the same day, but sometimes an overnight stay might be needed.

You’ll need to arrange for someone to take you home as you will not be able to drive for at least 24 hours.

Getting back to normal

After a flexible cystoscopy

You can return to your normal activities – including work, exercise and having sex – as soon as you feel able to after a flexible cystoscopy.

This will often be later the same day or possibly the day after.

After a rigid cystoscopy

After a rigid cystoscopy:

• rest at home for a day or two – you may need to take a couple of days off work
• make sure someone stays with you for the first 24 hours
• do not drive or drink alcohol for at least 24 hours

You can usually return to your normal activities – including work, exercise and having sex – when you feel able to.

After effects of a cystoscopy

After a cystoscopy, it’s normal to have:

• a burning or stinging sensation when peeing
• some blood in your pee, which may turn it slightly pink
• a need to pee more often than usual

These side effects should pass after a day or two.

Drinking plenty of water during the first few days can help. You can also take painkillers such as paracetamol to reduce any discomfort.

When to get medical advice

Contact a GP for advice if:

• the pain or bleeding lasts more than a few days
• peeing is very painful
• your pee becomes so bloody that you cannot see through it
• you see red lumps (blood clots) in your pee
• you cannot empty your bladder
• your pee smells bad
• you get a high temperature
• you feel sick or vomit
• you have pain in your lower back or side

Go to your nearest accident and emergency (A&E) department if you feel really unwell.

These problems could be caused by complications of a cystoscopy, such as an infection.

Page last reviewed: 20 April 2020
Next review due: 20 April 2023

what it is, preparation, how it is done, contraindications – health articles

Urethrocystoscopy, or cystourethroscopy, is an endoscopic examination, that is, a visual examination of the walls of the urethra, bladder and ureter outlets using optics in order to detect pathology. It is a diagnostic procedure, however, it makes it possible for targeted sampling of biomaterial (simultaneous biopsy) when pathological foci are detected and drugs are administered.

The study allows not only to examine the bladder cavity, but also to evaluate the functions of each kidney separately by the nature of the ureter discharged from the right and left mouths, since they open into the bladder and are well visualized during the procedure. It can be used as an auxiliary method for diagnosing prostate adenoma – medical indications for cystoscopy are quite wide.

When is it held?

The procedure can be prescribed at any age and is the main diagnostic method for many diseases of the genitourinary system, when safer research methods (ultrasound, radiation, magnetic resonance) do not provide the necessary information. If stones are found, they can be removed using special forceps or electroresection, and the neoplasms are sent for histological examination.

In the presence of ulcerative lesions of the mucosa, electrocoagulation (cauterization) of the damaged areas can be done.

In case of tumors and inflammatory diseases of the prostate, cystoscopy in men will help determine the degree and nature of the involvement of the bladder and urethra in the pathological process.

Indications:

• Cystitis and urethritis: pain, burning and cutting when urinating, pain in the lumbosacral spine, frequent urination with small portions of urine
• Tumors of the bladder: symptoms similar to cystitis, but atypical cells were found on a swab from the urethra or urine
• Prostatitis, prostate adenoma: frequent urge to urinate, sensation of incomplete emptying of the bladder, incontinence/urinary retention, nocturia (frequent nighttime urge to go to the toilet)
• Sexual disorders in men (male infertility): to assess the condition of the seminal tubercle
• Suspicion of urolithiasis with localization of stones in the bladder: pain and cramps in the lower abdomen, difficult painful urination in small portions, a feeling of insufficient emptying of the bladder, turbidity of the urine to a whitish hue, the appearance of salt crystals in the urine (crystalluria)
• Enuresis – bedwetting (urination occurs during sleep) in the absence of mental and neurological pathologies
• Pyuria – excretion of pus with urine (appearance of foreign light clots in the liquid, turbidity)
• Hematuria – blood impurities in the urine (discoloration and transparency of the liquid, the appearance of blood clots) in the absence of injuries
• Anomalies of the genitourinary system or suspicion of them – to assess the volume and shape of the reservoir and urinary tract
• Evaluation of the effectiveness of treatment

Contraindications

Contraindications mean that cystoscopy in these cases is indicated only when other methods are not informative.

• Acute inflammatory processes in the bladder (acute cystitis), urethra (acute urethritis), prostate (acute prostatitis), testicles (acute orchitis) – in men, in the uterus and appendages – in women, during fever
• Bleeding from the urethra of unknown etiology
• Injuries of the urethra and bladder
• Disorders in the hemostasis system (hemophilia)

Cystoscopy

Despite the fact that cystoscopy is a diagnostic procedure, with its help, as with the help of almost all endoscopic examinations, some therapeutic manipulations can be performed:

• Crushing and removal of small stones
• Removal of polyps, small tumors with their further examination with simultaneous coagulation of wound surfaces
• Coagulation of erosions and ulcers of the urethra, bladder
• Removal of clots or foreign bodies and restoration of the patency of the urinary tract when obstructed by blood, pus or small stones
• Injection of medicinal solutions, bladder and urethral lavage (lavage water is also collected for examination)

How to prepare?

Cystoscopy under anesthesia requires early (10-12 hours) refusal of food and fluids (3-4 hours), after the procedure it will take time to recover, therefore it is not recommended to use personal transport and engage in potentially dangerous activities that require concentration attention.

Cystoscopy without anesthesia does not require any special preparation: it is enough to arrive on an empty stomach, having performed the toilet of the genitals before leaving the house. Before the procedure, you should empty your bladder.

The choice of the type of anesthesia will depend on the indications: cystoscopy under anesthesia or “in a dream” is indicated for excitable or mentally unbalanced patients. Anesthesia can be both general and spinal (only the lower half of the body loses sensitivity, from the lower back, consciousness is preserved).

Since the structure of the male urethra is somewhat more complex (it can be 6 times longer than the female), spinal or general anesthesia is more often recommended for cystoscopy in men to eliminate pain. Also, anesthesia can be recommended if a long examination is expected, removal of multiple neoplasms, if the bladder of the subject has a small (150 ml or less) capacity.

How is the procedure?

• Before the start of the diagnosis, the subject is given a sterile gown, he is asked to undress and lie on the couch on his back, bending his knees, they explain how the examination will take place and what sensations will arise during this
• The external genitalia are treated with antiseptic solutions, the endoscope is lubricated with glycerin to improve glide. For men, an anesthetic is injected into the urethra using a syringe with a rubber tube and a clamp, held until the analgesic effect begins (about 10 minutes)

The technique of the procedure will vary depending on the type of instrument. There are rigid and flexible endoscopy.

• Rigid bladder endoscopy is performed using a rigid endoscope on a long (30 cm) metal tube. Such an endoscope spreads tissues well, simplifying examination, however, it is more traumatic and causes more discomfort to the examinee, especially men. A rigid endoscope is not used in the presence of large tumors of the pelvic organs, pregnancy. During hard cystoscopy, an endoscope tube is inserted into the urethra and fluid is supplied to the bladder, which simultaneously flushes it and straightens the mucosal folds, improving visualization. To supply and drain liquid, a two-way valve is connected to the endoscope tube, since if there is pus or blood in the cavity that cloud the environment, the organ must be cleaned before examination. Wash water is collected for analysis
• Flexible endoscopy uses a flexible endoscope, a movable thin tube made of polymer material with an optic and a lamp at the end. The device repeats the curves of the body and therefore can easily penetrate into hard-to-reach places, which makes the examination quite informative. This method allows minimizing injuries and nullifying pain during the procedure. In modern diagnostics, flexible cystoscopy is gradually replacing rigid

Cystoscopy for different patients

Cystoscopy of the bladder in women. As a rule, cystoscopy in women does not cause difficulties and does not require general anesthesia, since the female urethra is straight and short (up to 5 cm). For anesthesia, a local anesthetic is applied to the endoscope tube. Difficulties arise in the presence of large uterine tumors or in late pregnancy, when the uterus compresses the bladder and changes its configuration. In this case, the use of flexible endoscopy is indicated. Examination during pregnancy is performed only for health reasons, since any intervention on the pelvic organs can provoke a spontaneous abortion.

Bladder cystoscopy in men. The male urethra is 17 to 22 cm long, so the examination requires special care and experience from the endoscopist, especially at the stage of inserting the instrument. During the procedure, an anesthesiologist must be constantly in the operating room, who can anesthetize the patient if he experiences severe pain during the study.

For children, bladder cystoscopy is performed only with a flexible pediatric endoscope, which is much thinner than an adult, and only by an experienced pediatric diagnostician.

Consequences of the procedure

After the cessation of the anesthetic effect, patients, as a rule, experience slight discomfort and burning in the urinary tract, aggravated by urination (especially after cystoscopy in men), frequent urination. After using a rigid endoscope, light pink mucus may be discharged. To reduce pain, it is recommended to increase the amount of fluid consumed (which, in turn, will reduce the concentration of urine), apply an anesthetic once.

If the symptoms do not go away within three days or they are accompanied by fresh blood discharge, chills, fever, you must immediately return to the clinic or call a doctor.

Advantages of the procedure in MEDSI:

• With a high reputation of the doctors of the clinic, the price of cystoscopy is at the level of the average cost of a service in private clinics in Moscow
• Territorial accessibility
• Opportunity to conduct an examination and get expert advice before and after the procedure in the same branch
• Prevention and control of complications, hospitalization in the clinic at will or according to indications
• Experienced diagnosticians with extensive experience, availability of pediatric specialists
• Discreet staff, technical and courteous service

To make an appointment, call the round-the-clock phone number +7 (495) 7-800-500.

Do not delay treatment, see a doctor now:

• Cystoscopy
• Urologist appointment
• Laser removal of bladder masses

Endoscopic method of bladder diagnostics in Nearmedic Obninsk

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• Endoscopy of the bladder

Flexible Cystoscopy is a procedure performed using a special optical instrument called a cystoscope. A cystoscope is a long tube that is equipped with a light source and a video camera. The cystoscope allows you to see the internal structure of the urethra and bladder. With the help of cystoscopy, you can get a large amount of information that is not available with X-ray and ultrasound. For whom is cystoscopy performed with a flexible cystoscope?

Due to the anatomical structure of the male urethra, cystoscopy in men is a much more technically complex and painful procedure. The use of a flexible cystoscope can significantly reduce the pain and discomfort that occurs during the procedure and reduce the incidence of cystoscopy complications by several times.
What is the advantage of the method?

Flexible cystoscopy allows you to view the cavity of the urethra and bladder. In the diagnosis of diseases of the mucous membrane of the urethra and bladder, the method is much more sensitive and specific.

Under what conditions is urethrocystoscopy indicated?

• interstitial cystitis
• bladder stones
• urinary incontinence / overactive bladder
• Bladder tumor
• blood in the urine (hematuria)
• for ureteral catheterization
• urethral stricture
• chronic cystitis

What are the contraindications for cystoscopy?

• fresh urinary tract infection
• fresh trauma of the urethra
• urethral obstruction

How is a cystoscopy performed?

Cystoscopy can be performed on an inpatient or outpatient basis.