What is Cystoscopy?

Cystoscopy is a a urologic diagnostic test to check the interior of the urethra and bladder with the use of a special endoscopic device (cystoscope). Cystoscope is a fine instrument which is inserted into the bladder through the urethra. It has an eyepiece for having direct overview of the bladder, while at the same time it can be connected to a special camera depicting the image on the screen and recording it into a DVD. The cystocope is connected with an illumination source and usually has two side channels –one for infusing normal saline and the other one for passing down fine instruments allowing the physician to perform some invasive procedures.

There are two types of cystoscopes: flexible and inflexible. The inflexible cystoscope is straight, metallic and has been used for quite several years now. The flexible cystoscope has been used for only a few years. It is thinner and moves more easily through the curves of the urethra. The flexible cystoscope has practically the same indications as the inflexible one, but is better tolerated specifically by male patients causing less pain.

When is Cystoscopy performed?

Cystoscopy is mainly performed for diagnostic and, less frequently, for invasive purposes.

The most common diagnostic indications are:

  • to investigate symptoms, such as blood presence in the urine (hematuria), painful urination (dysuria), urinary incontinence, urgency and retention.
  • to investigate relapsing UTIs (Urinary Tract Infections) or UTIs not responding to treatment.
  • to diagnose problems causing urinary tract obstruction (stone in the urethra, tumor, prostatic hypertrophy).
  • to evaluate findings identified in other diagnostic tests, such as UltraSound (U/S), CT scan and IntraVenous Urography (IVU).
  • to monitor patients who have undergone TransUrethral Removal of Bladder Tumors (TURBT), so as to timely diagnose any potentially occurring relapse.

The most common invasive medical procedures performed with Cystoscopy are:

  • for taking biopsies from bladder lesions
  • for removing stone/s from the urinary tract
  • for removing foreign bodies
  • for placing special catheters (stents) into the urether, which facilitate urine flow from the kidney if there is any obstacle.

For treating problems such as bladder hemorrhage.

What preparation is needed for Cystoscopy?

In case you are to undergo Cystoscopy, you should inform your physician about the following:

  • if you have allergy or sensitivity to any medications (antibiotics, topical anaesthetics, antiseptics)
  • if you suffer from any disease causing blood coagulation disorders
  • if you take any drugs affecting blood coagulation and causing hemorrhage, such as aspirin (Salospir, Aspirin), clopidogrel (Plavix, Iscover), ticlopidine (Ticlid, Ticlodone), acenocoumarol (Sintrorn), warfarin (Panwarfin), prasugrel (Effient) , dabigatran (Pradaxa), low molecular weight heparin (LMWH) injections
  • if you are pregnant
  • if you have some urinary tract disorder that may make the procedure of Cystoscopy difficult to be conducted (urethral strictures, hypospadias etc)

Cystoscopy is usually performed with local anaesthesia. In more rare cases, it is conducted with spinal or general anaesthesia. In such a case, ask your physician to provide you detailed instructions related to taking drugs on the examination day, as well as about when to interrupt food and fluid intake.

How is Cystoscopy performed?

Cystoscopy is performed by the Urologist, usually in a specially prepared room at the Outpatient Clinic. You will first be asked to get undressed from the waist down and given a hospital gown to put on. In some cases, a venocatheter may be placed. Then you will be asked to lie on your back on a special table in a gynaecological position (knees elevated and legs apart).  Your physician will clean thoroughly your genitals with a gentle antiseptic solution and then cover the region with sterile paper sheets.

A special anaesthetic lubricating gel will be squeezed into the urethra. The tip of the cystoscope will then carefully be inserted into the urethra until reaching the bladder. Should the urethra get too narrow at some point preventing the cystoscope from passing through, there may be need for gradual dilation with the use of finer instruments.  Once the cystoscope has passed all the way through the bladder, your bladder will be filled up with normal saline through the cystoscope.  In this way, the bladder walls will be stretched so that all details can be seen clearly. In case you feel intense urge to urinate, you should inform the physician. The overall preparation and examination procedure takes about half an hour.

The use of flexible cystoscope, particularly in men, makes the procedure better tolerable. Cystoscopy can also be performed on a plain examination bed. In some special cases, there may be need for spinal or general anaesthesia. You will have been informed in advance and should follow carefully the preparation instructions given by your physician. In case of local anesthesia, you may get up immediately after the completion of the procedure. In case of spinal or general anaesthesia, you will have to remain in the recovery room and the Anaesthesiologist will give you instructions about when to get up and eat.

Most patients report that Cystoscopy was not as painful as they had expected. Your physician’s experience in combination with your optimal cooperation will contribute to the smooth performance of the examination.  You should be aware that there may be a mild burning sensation while urinating, as well as small amounts of bloods in the urine. These problems, however, should not last longer than 24 hours.

How are results of Cystoscopy interpreted?

Cystoscopy may show that everything is normal. If not, your physician will inform you about any pathological findings and give you instructions about what to do next as treatment, what to avoid and when to visit again. You should definitely contact your physician if within the next days any of the following occurs:

  • intense pain while urinating
  • severe hemorrhage
  • shivering/ shaking fever
  • If you cannot urinate although you feel a strong urge to do so
  • UTI symptoms (burning sensation while urinating, urinary frequency, heavy feeling in lower abdomen).