Overview of Cystoscopy
Cystoscopy, or cystourethroscopy, is a procedure usually performed by a urologist that allows the physician to see the inside of the lower urinary tract (urethra, prostate, bladder neck, and bladder). Cystoscopy can be used to detect abnormalities of the lower urinary tract or to assist in transurethral surgery (e.g., prostate surgery).
In this procedure, a cystoscope (thin, telescope-like tube with a light and tiny camera attached) is inserted into the bladder through the urethra (tube that carries urine from the bladder out of the body).
Cystoscopy may be used to evaluate and diagnose the following conditions:
- Bladder cancer
- Blood in the urine (hematuria)
- Chronic pelvic pain
- Frequent urinary tract infections (UTIs)
- Interstitial cystitis
- Painful urination
- Urinary blockage (e.g., enlarged prostate [BPH], narrowing of the urinary tract [stricture], polyps, tumors)
- Urinary incontinence or overactive bladder
- Urinary stones
The physician uses the cystoscope to visualize changes in the lining of the urinary tract. Abnormalities that can be detected include the following:
- Diverticula (sacs caused by abnormal holes in the urethra)
- Ectopic (displaced) ureter
- Fistula (abnormal passage)
- Trabeculation (strands of connective tissue)
- Ureterocele (ballooning of the lower end of the ureter)
Cystoscopy may be performed in a physician's office, under local anesthesia, or as an outpatient procedure, under sedation and regional or general anesthesia. Before undergoing the cystoscopy, patients should inform their physician if they are taking any medications, especially blood thinners (e.g., aspirin, ibuprofen, warfarin [Coumadin, Jantoven, generics]).
If regional or general anesthesia is being used, patients are instructed to fast for at least 4 hours before the procedure. If local anesthesia is being used, a topical anesthetic (e.g., lidocaine) is introduced prior to the procedure to numb and lubricate the urethra.
During the procedure, the cystoscope, which can be flexible or rigid and is about half the diameter of the urethra, is slowly inserted into the urethra to the bladder. A camera may be attached to the cystoscope to allow images to be viewed on a monitor. The physician examines the urethra and introduces a sterile liquid (e.g., water, saline) into the bladder to improve the view of the bladder wall. As the bladder fills, the patient may experience an uncomfortable urge to urinate.
Additional instruments can be passed through the cystoscope to allow the urologist to perform procedures, such as stone removal, bladder biopsy, resection of a bladder or prostate tumor, and cauterization (application of a small electrical charge to minimize bleeding).
In some cases, the physician uses another instrument called a ureteroscope to allow visualization of the ureter (tube that carries urine from the kidney to the bladder). This procedure, which is called ureteroscopy, may be used to diagnose and treat urinary stones higher in the urinary tract. Ureteroscopy usually is performed under regional or general anesthesia.
Cystoscopy usually takes from a few minutes to about 20 minutes to perform. If the physician removes a stone, or sample of tissue (biopsy), the procedure may take longer. After the procedure, fluid is drained from the bladder and a catheter (thin, flexible tube) may be left in the bladder.
Side effects, which are usually mild and resolve within a couple of hours to days, include burning during urination and blood in the urine (hematuria). When local anesthesia is used, patients usually can go home immediately following the procedure; when regional or general anesthesia is used, patients require a recovery period (usually 1 to 4 hours).
Complications are rarely serious and may include the following:
- Adverse reaction to anesthesia
- Excessive bleeding
- Formation of scar tissue, which can result in narrowing of the urethra (stricture)
- Infection (fever, chills, severe pain, vomiting)
- Tear or perforation of the urethra, bladder, or ureter
- Testicular pain and swelling (may indicate infection)
- Urinary retention (inability to urinate), usually as a result of swelling, bladder distention, or anesthesia
Rarely, complications such as acute urinary retention occur following cystoscopy. This condition is a medical emergency and requires prompt medical attention.