What is a cystoscopy?
A cystoscopy is a procedure done by a urologist, a doctor specializing in the urinary system. During a cystectomy, the urologist uses a scope to look at the inside of the bladder, where urine is stored, and in the urethra, the channel that urine flows through out of the bladder.
A cystoscopy may also be used to remove something that shouldn’t be there, such as a bladder stone, or to take a biopsy (a sample of tissue) from the bladder lining to analyze it in the lab for further information.
The procedure can also help with placing a catheter, which is a thin drainage tube for urine.
When is a cystoscopy needed?
The cystoscopy procedure is ordered by the urologist when more information is needed about what is happening inside the lower urinary tract. Most often it is used to check for any problems in the bladder and its lining. The procedure is also an important tool to identify what may be causing abnormal problems, such as:
- Frequent urinary tract infections (UTIs)
- Hematuria, or blood in the urine
- Urinary frequency, or urinating more than 8 times a day
- Urinary urgency, or the sudden, strong urge to urinate
- Urinary retention, or when the bladder does not empty completely
- Urinary incontinence, or urine leakage
- Pain or burning before, during, or after urination
- Trouble starting the flow of urine, completing urination, or both
- Abnormal cells found in a urine sample
How does a patient prepare for a cystoscopy?
Before the procedure is recommended, the urologist will ask about the patient’s medical history, current prescription and over-the-counter medications, and allergies to medications, including anesthetics. The urologist will explain what the patient can expect after the procedure.
The patient may need to give a urine sample to test for a urinary tract infection (UTI). If the patient has a UTI, the urologist may treat the infection with antibiotics before performing a cystoscopy.
The urologist or nurse may ask the patient to drink plenty of liquids, and to urinate immediately before the procedure.
What happens during a cystoscopy procedure?
The cystoscopy procedure usually takes about 30 minutes and is done on an outpatient basis. The urologist will recommend that the patient empty his or her bladder before the procedure begins. The step-by-step process may be similar to this:
- The patient will be lying on an exam table. The urologist may place some gel or a local anesthetic in the patient’s urethra to aid in reducing any discomfort while the procedure is taking place.
- The urologist will gently insert the cystoscope through the urethra into the bladder. The patient may feel discomfort or a pressure sensation. The cystoscope is a long, thin tube with a lens on one end that the urologist looks through or, on a camera-equipped scope, visualizes on a monitor. The other end of the cystoscope that is inserted into the urethra has a tiny lens with a light that allows the urologist to look inside the urethra and bladder. There are two types of cystoscopes. One has a flexible insertion tube, while the other is stiff.
- Once the cystoscope is inserted, the urologist will need to instill some sterile water or a normal saline solution from the cystoscope into the bladder. The water/saline fills and stretches the bladder so the urologist can get a better view of the bladder wall.
- As the liquid enters the bladder, the patient may again feel some discomfort as well as the urge to urinate. If necessary, the urologist can remove some of the liquid from the bladder during the procedure. Once the procedure is over, the urologist may drain the patient’s bladder, or ask the patient to use the bathroom to urinate before he or she leaves the office.
During the brief procedure, the urologist examines the lining of the urethra as the cystoscope passes through it and then into the bladder. Once the cystoscope reaches the bladder, the urologist examines the lining of the bladder. During the procedure, the urologist can remove a bladder stone or take a biopsy if needed.
Sometimes a monitor is set up in the doctor’s office so that both the urologist and patient can watch the procedure as it is taking place.
What does the urologist look for during a cystoscopy?
The urologist will be looking for anything that appears unusual. The bladder wall should be smooth, and there should not be any blockages in the lower urinary tract. During a cystoscopy, the urologist is able to see:
- Bladder stones: A small stone-like mass that forms from minerals in the urine. It usually forms when urine does not completely leave the bladder and the minerals in the urine crystallize. If not treated, they can cause pain and lead to blood in the urine. A stone can also cause a blockage so that urine cannot leave the bladder.
- Abnormal tissue, polyps, tumors, or cancer in the urethra or bladder
- Stricture, or a narrowing of the urethra: This could be a symptom of an enlarged prostate in men or of scar tissue in the urethra.
During the cystoscopy, can the urologist treat some problems?
During a cystoscopy, the urologist may be able to treat minor problems such as bleeding in the bladder or blockage in the urethra. The urologist may also use a cystoscopy to:
- Remove a small stone in the bladder or urethra.
- Remove or treat abnormal tissue, polyps, and certain tumors.
- Inject medication into the urethra wall or the bladder to treat urinary leakage.
Results and Follow-Up
What happens after the cystoscopy procedure?
Typically, a cystoscopy is done in the urologist’s office and afterwards most patients go home the same day as the procedure. Sometimes after a cystoscopy procedure, the patient may:
- Feel a burning or soreness around the urethra.
- Feel slight burning while urinating.
- Notice small flecks of blood in the urine.
- Feel mild discomfort in the bladder area or kidney area when urinating.
- Need to urinate frequently or urgently.
These problems should not last more than a day after the procedure. If pain persists, bloody urine lasts longer than 48 hours, or the patient develops a fever, the patient should call the doctor.
Occasionally, the patient may have an increase in urinary frequency for the first 24 hours after the procedure. There may be also a change in the color of the urine (it may be darker, or look pink or red due to mild bleeding). This is common, especially if a biopsy was taken.
After the procedure, the urologist may recommend that the patient:
- Drink 16 ounces of water each hour for 2 hours after the procedure.
- Take a warm bath to help ease the burning feeling.
- Place a warm, damp washcloth over the urethral opening to relieve discomfort.
- Take an over-the-counter pain medicine.
If necessary, the urologist may prescribe an antibiotic to take for a couple of days after the procedure to prevent an infection. If you have severe pain, chills, or fever (these could be signs of an infection), it is important to call the urologist’s office and explain the symptoms.
What are the risks of cystoscopy?
Every patient is different, and the urologist will take into consideration each patient’s specific medical history when explaining possible complications from the procedure. Although minimal, the risks of cystoscopy may include:
- Urinary tract infections (UTI)
- Abdominal pain
- Burning or discomfort during urination
- Possible injury to the urethra or bladder
- Narrowing of the urethra because of scar tissue formation
- Trouble urinating due to swelling of surrounding tissues
If any of the following symptoms occur after a cystoscopy, you should call the urologist right away:
- Inability to urinate and the discomfort of a full bladder
- Burning or discomfort during urination that lasts more than 2 days
- Bright red urine or blood clots in the urine
- Severe discomfort