Cystoscopy

Cystoscopy is a medical procedure that provides an up-close, detailed look at the inside of the bladder and urethra (the tube that transports urine from the bladder when you urinate). This procedure can help with diagnosing certain bladder or urinary problems, from frequent urinary tract infections to bladder cancer.

Why might your doctor recommend a cystoscopy?

A cystoscopy can help your doctor find the cause of urinary symptoms. The procedure can be used to treat certain problems too, like a blockage in the urethra that is disrupting the flow of urine. Reasons a cystoscopy may be recommended include:

Recurring urinary symptoms or infections

A doctor may recommend cystoscopy to diagnose the cause of frequent urinary tract infections (UTIs).

A cystoscopy may also be able to identify the cause of the following urinary symptoms:

• Blood in the urine
• Frequent urination (urinating eight or more times a day)
• Unintentional urination or urine loss (urinary incontinence)
• Pain/burning while urinating
• Difficulty starting or completing urination
• An urgent need to urinate
• Difficulty emptying the bladder

Checking on abnormal areas in the bladder or urethra that may indicate cancer

During a cystoscopy, the doctor can check for any abnormal areas that may indicate cancer. If they see anything suspicious, like a growth or tumor, they can remove a small piece of the tissue and bring it to a lab where it can be tested for cancer. This is also known as a biopsy.

Delivering a treatment to the bladder or removing abnormal tissue

During a cystoscopy, a doctor may be able to treat certain bladder problems like:

• Leakage of urine: An injection into the urethra or bladder wall during the procedure can help treat urinary leakage (incontinence).
• Kidney or bladder stones: If there are kidney or bladder stones in the bladder, your doctor can remove them during a cystoscopy.
• Tumors and polyps: The procedure may include removing or treating abnormal tissue, polyps and sometimes tumors.

Preparing for the test

In general:

• Before the procedure, you’ll be asked about your medical history, any prescriptions or over-the-counter medications you’re taking (including vitamins, herbs or supplements), and if you have any allergies to medications (especially anesthetics).
• You may be asked to drink plenty of liquids leading up to the procedure and will need to urinate right before it begins.
• You may also need to stop taking certain medications like blood-thinning medications (even aspirin) for some time prior to the procedure.
• If you’re going under general anesthesia (which puts you to sleep) for the test, then your doctor will likely tell you not to eat or drink anything for several hours beforehand.

Depending on the medical facility's policy, you may also need to arrange for a ride home after the procedure.

During the test

A cystoscopy may be performed at a variety of medical facilities, including the doctor’s office, an outpatient center or a hospital.

The procedure itself will take roughly five to 20 minutes. It can take longer if the doctor needs to take a tissue sample or remove something from inside the bladder.

Once you’re lying on your back (men may be able to stay in a seated position), your doctor will either apply medicine to numb the skin around the urethra or give you general anesthetics through an IV line to put you to sleep. Some patients may also be given a sedative to help them relax.

After you’re appropriately numbed or sedated, your doctor will slowly insert the cystoscope into the urethra, examining the lining of the urethra as they move the instrument up into your bladder.

The cystoscope has an eyepiece for the doctor to look through on one end and a tiny light and camera or video lens on the other. Some cystoscopes are “flexible” while others are “rigid.” The type of cystoscope used will depend on what needs to be done during the procedure.

Water or salt water will then flow up through the cystoscope and fill the bladder, stretching it out and enabling the doctor to see the entire bladder wall. This sensation may make you feel like you need to pee.

During the procedure, your doctor may be looking for things like:

• Stones (solid masses that can form in the kidney or bladder)
• Blockages
• Abnormal tissue, polyps, tumors or signs of cancer

A healthy bladder should be normally shaped, sized and positioned in the body. The bladder wall should also appear smooth. 

If something in the bladder needs to be removed, tested or treated, the doctor can insert long, thin instruments through the cystoscope. For example, they may use a tweezer-like instrument to remove a bladder stone or collect a sample of abnormal-looking tissue that needs to be tested for cancer.

Following the test

Typically, patients can go home shortly after the procedure. If you were asleep during the test, you may need to wait a few hours and have someone pick you up from the facility when you're discharged.

To relieve any discomfort, you may be advised to take a warm bath or hold a warm, damp washcloth over the affected area, along with drinking plenty of water and taking over-the-counter pain relievers, if necessary.

In the day following the procedure, you may notice some symptoms like:

• A slight burning sensation while urinating
• Traces of blood in the urine
• Urgent or frequent urination

Monitor symptoms and call your doctor if you experience these or other symptoms (particularly severe bleeding or pain) and they last longer than 24 hours after the procedure.

Possible complications

Cystoscopy is generally considered a safe procedure. However, there is a slight risk of:

• Excess bleeding if a biopsy was taken
• Bladder infection
• Rupture of the bladder wall

Severe pain, fever or chills may be signs of an infection and warrant immediate medical care.