Cystoscopy

Test Overview

Cystoscopy is a test that allows your doctor to look at the inside of the bladder and the urethra using a thin, lighted instrument called a cystoscope .

The cystoscope is inserted into your urethra and slowly advanced into the bladder . Cystoscopy allows your doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be inserted through the cystoscope that allow your doctor to remove samples of tissue (biopsy) or samples of urine.

Small bladder stones and some small growths can be removed during cystoscopy. This may eliminate the need for more extensive surgery.

Why It Is Done

Cystoscopy may be done to:

• Find the cause of symptoms such as blood in the urine (hematuria), painful urination (dysuria), urinary incontinence, urinary frequency or hesitancy, an inability to pass urine (retention), or a sudden and overwhelming need to urinate (urgency).
• Find the cause of problems of the urinary tract, such as frequent, repeated urinary tract infections or urinary tract infections that do not respond to treatment.
• Look for problems in the urinary tract, such as blockage in the urethra caused by an enlarged prostate, kidney stones, or tumors.
• Evaluate problems that cannot be seen on X-ray or to further investigate problems detected by ultrasound or during intravenous pyelography, such as kidney stones or tumors.
• Remove tissue samples for biopsy.
• Remove foreign objects.
• Place ureteral catheters (stents) to help urine flow from the kidneys to the bladder.
• Treat urinary tract problems. For example, cystoscopy can be done to remove urinary tract stones or growths, treat bleeding in the bladder, relieve blockages in the urethra, or treat or remove tumors.
• Place a catheter in the ureter for an X-ray test called retrograde pyelography. A dye that shows up on an X-ray picture is injected through the catheter to fill and outline the ureter and the inside of the kidney.

How To Prepare

Tell your doctor if you:

• Are allergic to any medicines, including anesthetics.
• Have had bleeding problems or take blood-thinning medicine, such as aspirin or warfarin (Coumadin).
• Are or might be pregnant.

You will be asked to sign a consent form before the test. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

Cystoscopy can be performed with local, spinal, or general anesthesia. Discuss with your doctor which method is best for you and whether you should plan on staying overnight in the hospital. If you will not be staying in the hospital, arrange for someone to drive you home after the test.

• If a local anesthetic is used, you may eat and drink normally before the test.
• If a general or spinal anesthetic is used, do not eat or drink anything for at least 8 hours before the test.

You should empty your bladder just before the test. You may be given medicine to prevent a urinary tract infection that could be caused by the test.

How It Is Done

Cystoscopy is performed by a urologist, with one or more assistants. The test is done in a special testing room in a hospital or the doctor's office.

You will need to take off all or most of your clothes, and you will be given a cloth or paper covering to use during the test.

About an hour before the test, you may be given a sedative to help you relax. An intravenous (IV) needle may be placed in a vein in your arm to give you other medicines and fluids. You will lie on your back on a special table with your knees bent, legs apart, and your feet or thighs may be supported by stirrups. Your genital area is cleaned with an antiseptic solution, and your abdomen and thighs are covered with sterile cloths.

If a local anesthetic is used, the anesthetic solution or jelly is inserted in your urethra.

If a general anesthetic is used, you will be put to sleep either with a medicine given through an IV or by inhaling gases through a mask, or both methods may be used.

If a spinal anesthetic is used, the area on the back where the needle will be inserted is first numbed with a local anesthetic, then the needle is guided into the spinal canal and the anesthetic is injected. A spinal anesthetic may prevent movement of the legs until the anesthetic wears off.

After the anesthetic takes effect, a well-lubricated cystoscope is inserted into your urethra and slowly advanced into your bladder. If your urethra has a spot that is too narrow to allow the scope to pass, other smaller instruments are inserted first to gradually enlarge the opening.

After the cystoscope is inside your bladder, either sterile water or saline is injected through the scope to help expand your bladder and to create a clear view. A medicine may also be injected through the scope to reduce chances of infection. Tiny instruments may be inserted through the scope to collect tissue samples for biopsy; the tissue samples then are sent to the laboratory for analysis.

The cystoscope is usually in your bladder for only 2 to 10 minutes. But the entire test may take up to 45 minutes or longer if other X-ray tests are done at the same time.

If a local anesthetic is used, you may be able to get up immediately after the test. If a general anesthetic is used, you will stay in the recovery room until you are awake and able to walk (usually an hour or less). You can eat and drink as soon as you are fully awake and can swallow without choking. If a spinal anesthetic was used, you will stay in the recovery room until sensation and movement below your chest returns (usually about an hour).

How It Feels

Most people report that this test is not nearly as uncomfortable as they had expected.

If a general anesthetic is used, you will feel nothing during the test, but after the anesthetic wears off your muscles may feel tired and achy. Some people experience nausea after receiving a general anesthetic.

If a local anesthetic is used, you may feel a burning sensation or an urge to urinate when the instrument is inserted and removed. Also, when your bladder is irrigated with sterile water or saline, you may feel a cool sensation, an uncomfortable fullness, and an urgent need to urinate. Try to relax during the test by taking slow, deep breaths. Also, if the test is lengthy, lying on the table can become tiring and uncomfortable.

If a spinal anesthetic is used, you may find it uncomfortable to lie curled up on your side while the anesthetic is injected. You will probably feel a brief stinging sensation when the anesthetic is injected. You may feel tired and have a slight backache the day after the test.

Risks

Cystoscopy generally is a very safe test. If a general anesthetic is used, there are some risks of general anesthesia. There is no risk of loss of sexual function.

The most common side effect is a temporary swelling of the urethra, which may make it difficult to urinate. A catheter inserted in your bladder can help drain the urine until the swelling goes away. Bleeding sometimes occurs, but it usually stops on its own.

You may have a mild infection in the urinary tract after cystoscopy. This can usually be prevented or treated by taking medicine before and after the test. In rare cases, the infection can spread through the body, and in very rare circumstances, usually with seriously ill people, the infection can be life-threatening.

Another rare complication is a puncture of the urethra or bladder by one of the instruments, which requires surgery to repair.

After the test

After the test, you may need to urinate frequently, with some burning during and after urination for a day or two. Drink lots of fluids to help minimize the burning and to prevent a urinary tract infection.

A pinkish tinge to the urine is also common for several days after cystoscopy, particularly if a biopsy was performed. But call your doctor immediately if:

• Your urine remains red or you see blood clots after you have urinated several times.
• You have not been able to urinate 8 hours after the test.
• You have a fever, chills, or severe pain in your flank or abdomen. These may be signs of a kidney infection.
• You have symptoms of a urinary tract infection. These symptoms include:
  • Pain or burning upon urination.
  • An urge to urinate frequently, but usually passing only small quantities of urine.
  • Dribbling or leakage of urine.
  • Urine that is reddish or pinkish, foul-smelling, or cloudy.
  • Pain or a feeling of heaviness in the lower abdomen.

Results

Cystoscopy is a test that allows the doctor to look at the inside of the bladder and the urethra. Your doctor may be able to talk to you about some of the results right after the cystoscopy. The results of a biopsy usually take several days to be available.

What Affects the Test

A cystoscopy is usually not done if you have an infection of the bladder, prostate gland, or urethra.

What To Think About

Other X-ray tests, such as retrograde pyelography or cystourethrography, may also be done during cystoscopy. For more information, see the medical test Cystourethrography and Intravenous Pyelography (IVP).

References

Other Works Consulted

• Chernecky CC, Berger BJ, eds. (2004). Laboratory Tests and Diagnostic Procedures, 4th ed. Philadelphia: Saunders.

• Fischbach FT, Dunning MB III, eds. (2004). Manual of Laboratory and Diagnostic Tests, 7th ed. Philadelphia: Lippincott Williams and Wilkins.

• Handbook of Diagnostic Tests (2003). 3rd ed. Philadelphia: Lippincott Williams and Wilkins.

• Pagana KD, Pagana TJ (2006). Mosby’s Manual of Diagnostic and Laboratory Tests, 3rd ed. St. Louis: Mosby.

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