Cystoscopy (Bladder Endoscopy)

What is cystoscopy?

Cystoscopy, also called Cystourethroscopy, is a diagnostic procedure that allows the doctor to directly examine the urinary tract. A cystoscopy may be recommended when a disorder of the urinary tract is suspected, including structural problems that can lead to a blockage of urine flow or a back flow of urine. If untreated, structural problems may lead to potentially serious complications. Cystoscopy may also be performed after gynecologic surgical procedures near the bladder to check for proper placement of sutures and support devices.

A long, flexible, lighted tube, called a cystoscope, is inserted into the urethra (the tube that allows urine to pass outside the body) and advanced into the bladder. In addition to allowing visualization of the internal urethra and bladder, the cystoscope enables the doctor to irrigate, suction, and access these structures with surgical instruments. The urologist can also instill substances into the bladder using the cystoscope. During a cystoscopy, the doctor may remove tissue for further examination (biopsy) and possibly treat any problems that may be detected. The cystoscope can also be used to instill saline or water into the bladder.

What will happen during the procedure?

A cystoscopy may be performed on an outpatient basis or as part of your stay in the hospital. Procedures may vary, depending on your condition and your doctor's practices. Generally, a cystoscopy follows this process:

• You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
• If you are asked to remove clothing, you will be given a gown to wear.
• An intravenous (IV) line may be inserted in your arm or hand.
• You may receive an IV sedative or anesthetic, depending on your specific situation and the type of scope used. If a sedative or anesthetic is given, your heart rate, blood pressure, breathing, and blood oxygen level will be continuously monitored during the procedure.
• In some cases, a special blue dye may be given through the IV line about 10 to 15 minutes before the procedure. This allows time for the dye to go into the kidneys where it mixes with urine. Seeing the blue-colored urine pass from the ureters into the bladder helps the doctor check for blockage.
• You will be positioned on the examination table on your back with your knees up and spread apart. Your feet will be placed in stirrups.
• A topical anesthetic gel will be inserted into your urethra using a special catheter. This may be mildly uncomfortable until the area is numb.
• Once the urethra is numb and/or anesthesia has taken effect, the doctor will insert the cystoscope into the urethra. You may experience some discomfort during the cystoscope insertion.
• As the cystoscope is passed through the urethra, the doctor will inspect the mucosal layer for any abnormalities or obstructions. The cystoscope will be advanced until it reaches the bladder.
• Once the cystoscope is in the bladder, the doctor may instill sterile water or saline to help expand the bladder for better visualization. While the bladder is being filled, you may have the urge to urinate or feel mild discomfort.
• The doctor will examine the entire bladder for any abnormalities. A small device may be passed through the cystoscope to collect a tissue sample for a biopsy. A urine sample from the bladder may be obtained.
• The cystoscope will be carefully removed from the urinary tract after the procedure has been completed.

Are there any risks?

As with any invasive procedure, complications can occur. Complications related to cystoscopy include, but are not limited to, the following:

• Infection
• Bleeding
• Urinary retention
• Bladder perforation

What happens after the procedure?

After the procedure, you may be taken to the recovery room for observation if sedation or anesthesia was used. Your recovery process will vary depending on the type of sedation that is given. You will be encouraged to drink extra fluids, which dilute the urine and reduce 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 recommended to help alleviate urinary discomfort. You may notice blood in your urine for a period of time after the procedure. The amount of blood reduces gradually over one to two days. Take a pain reliever for soreness or discomfort as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications. You may be given an antibiotic to take after the procedure. Be sure to take the antibiotic exactly as ordered. Notify your doctor to report 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