What is cystoscopy?

Cystoscopy is a procedure that lets a healthcare provider look at the urinary tract. It can help find early signs of cancer, infection, narrowing, blockage, and bleeding.

This procedure uses a long, thin, flexible, lighted tube called a cystoscope. This is put into the urethra and moved up into the bladder. The cystoscope lets the healthcare provider look closely at the inside of the urethra and bladder.

During a cystoscopy, the healthcare provider may remove tissue for further exam (biopsy). Some problems may be treated during the procedure.

Why might I need a cystoscopy?

A cystoscopy may be advised if your provider thinks you may have a urinary tract problem. This includes a blockage or urine backflow. If untreated, these problems may lead to complications.

Some health problems of the urinary tract that may be found during cystoscopy include:

• Polyps, overgrowths of normal tissue, or a mass that’s often not cancer

• Bladder stones. These are calcium crystals that can lead to infection.

• Inflammation, bleeding, and urinary tract blockages

• Benign prostatic hypertrophy. This is an enlargement of the prostate gland that most often happens in men older than age 50. It's not cancer. The prostate wraps around the urethra. When it’s enlarged, it presses on the urethra and interferes with normal passage of urine. If left untreated, the enlarged prostate can block the urethra completely.

• Cancer or a tumor of the bladder or prostate gland

• Scarring and damage caused by frequent urinary tract infections

• Birth defects that may lead to urine backflow or kidney problems

• Urinary tract injury

Your healthcare provider may have other reasons to recommend a cystoscopy.

What are the risks of cystoscopy?

Complications linked to cystoscopy include:

• Infection

• Bleeding

• Urinary retention because of irritation and swelling from the procedure

• Poking a hole in the bladder with the cystoscope (bladder perforation)

• Scar tissue in the urinary tract

There may be other risks depending on your specific health condition. Discuss any concerns with your healthcare provider before the procedure.

A urinary tract infection may interfere with a cystoscopy.

How do I get ready for a cystoscopy?

• Your healthcare provider will explain the procedure and you can ask questions.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if anything is not clear.

• Fasting before the procedure will depend on the type of anesthesia used. Your healthcare provider will give you specific instructions about how long to fast. You may be given other instructions about a special diet you should follow for a day or two before the procedure. Follow any directions you are given for not eating or drinking before the procedure.

• Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, iodine, tape, or anesthesia.

• Check that your healthcare provider has a list of all medicines you are taking. This includes prescription and over-the-counter medicines, herbs, vitamins, and supplements.

• Tell your healthcare provider if you have a history of bleeding disorders. Or if you are taking any blood-thinning (anticoagulant) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop taking 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 afterward.

• If you think you have a urinary tract infection, tell your healthcare provider. In that case, a cystoscopy should not be done. Your healthcare provider may check your urine for infection before doing the procedure. Signs of infection include things such as 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 health condition, your healthcare provider may ask for other specific preparation.

What happens during cystoscopy?

A cystoscopy may be done on an outpatient basis. This means you go home the same day. Or it may be done 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 remove any clothing, jewelry, or other objects that may interfere with the procedure.

2. You will be asked to remove your clothing and you will be given a gown to wear.

3. An IV (intravenous) line may be started in your arm or hand.

4. 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 used, your heart rate, blood pressure, breathing, and blood oxygen level will be watched during the procedure.

5. You will lie on an exam table on your back. You may need to keep your knees up and spread apart. Your feet may be placed in stirrups.

6. A numbing medicine will be put through the end of your penis and into your urethra using a syringe or soft, thin tube (catheter). This may be mildly uncomfortable until the area is numb.

7. Once the urethra is numb or the anesthesia has taken effect, the healthcare provider will put the cystoscope into the end of your penis and through the urethra. You may have some discomfort when this is done.

8. As the cystoscope is passed through the urethra, the healthcare provider will check the lining. The provider will move the cystoscope up until it reaches the bladder.

9. Once the cystoscope is in the bladder, the healthcare provider may put sterile water or saline into the bladder. This helps to expand it and make the bladder lining easier to see. While the bladder is being filled, you may have the urge to urinate. Or you may feel mild discomfort.

10. The healthcare provider will check the bladder for any problems. 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.

11. 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 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. This 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 help ease the 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 as advised by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Take only recommended medicines.

You may be given an antibiotic to take after the procedure. This is to help prevent infection. Take it exactly as instructed.

Tell your healthcare provider if you have any of the following:

• Fever 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 particular situation.

Next steps

Before you agree to the test or 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 you will have to pay for the test or procedure