Robert Wood Johnson University Hospital
 

Cystoscopy

Cystoscopy

(Cystourethroscopy)

Procedure overview

What is cystoscopy?

Cystoscopy is a diagnostic procedure that allows the doctor to directly examine the urinary tract, particularly the bladder, the urethra, and the openings to the ureters. Cystoscopy can assist in identifying problems with the urinary tract, such as early signs of cancer, infection, strictures (narrowing), obstruction, and bleeding.

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.

Internally, a healthy urinary tract appears pink and smooth, with a moist mucosal lining. Some medical conditions may change the appearance of the lower urinary tract or cause bleeding. Other conditions may cause narrowing of the urethra, making it difficult for urine to empty from the bladder. Additionally, some diseases of the bladder may cause changes in its size, shape, position, and stability. Cystoscopy allows the doctor to examine these structures in great detail, take pictures, and obtain a biopsy. It may be used to perform therapeutic procedures if necessary, such as removal of stones.

Other related procedures that may be used to diagnose problems of the urinary tract include kidney, ureters, and bladder (KUB) X-ray, computed tomography (CT scan) of the kidneys, cystometry, cystography, retrograde cystography, and pyelogram (antegrade, intravenous, or retrograde). Please see these procedures for additional information.

How does the urinary system work?

Illustration of the anatomy of the urinary system, front view
Click Image to Enlarge

The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood.

The urinary system keeps the chemicals, such as potassium and sodium, and water in balance by removing a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys.

Urinary system parts and their functions:

Reasons for the procedure

A cystoscopy may be recommended when a disorder of the urinary tract is suspected. Urinary tract disorders may include 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.

Some medical conditions involving the urinary tract include, but are not limited to, the following:

There may be other reasons for your doctor to recommend a cystoscopy.

Risks of the procedure

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

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Urinary tract infection may interfere with a cystoscopy.

Before the procedure:

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.

Illustration of cystoscopy
Click Image to Enlarge

Generally, a cystoscopy follows this process:

  1. You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure.
  2. If you are asked to remove clothing, you will be given a gown to wear.
  3. An intravenous (IV) line may be inserted in your arm or hand.
  4. 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.
  5. 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.
  6. 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.
  7. A topical anesthetic gel will be inserted into your urethra using a special catheter. This may be mildly uncomfortable until the area is numb.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. The cystoscope will be carefully removed from the urinary tract after the procedure has been completed.

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. 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 usually done on an outpatient basis.

You may resume your usual diet and activities unless your doctor advises you differently.

You will be encouraged to drink extra fluids, which 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 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:

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American Urological Association

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

National Institutes of Health (NIH)

National Kidney Foundation

National Library of Medicine

 

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