Cystoscopy

Definition

Cystoscopy is a procedure to see the inside of the bladder and urethra.

Alternative Names

Cystourethroscopy; Endoscopy of the bladder

How the test is performed

Cystoscopy is performed with a cystoscope -- a specialized tube with a small camera on the end (endoscope). There are two types of cystoscopes:

• Standard, rigid cystoscope
• Flexible cystoscope

The way the cystoscope is inserted varies, but the test is the same. Which cystoscope your doctor uses depends on the purpose of the exam.

If the standard rigid cystoscope is used, you will lie on your back with your knees up and apart. If a flexible cystoscope is used, this position will not be necessary.

The procedure usually takes 5 - 20 minutes. The urethra is cleansed. A numbing medicine is applied to the skin lining the inside of the urethra, without using any needles. The scope is then inserted through the urethra into the bladder.

Water or salt water (saline) flows through the cystoscope to fill the bladder. As this occurs, you will be asked to describe the feeling. Your answer will reveal information about your condition.

As fluid fills the bladder, it stretches the bladder wall. This lets your health care provider see the entire bladder wall. You will feel the need to urinate when the bladder is full. However, it must remain full until the examination is complete.

If any tissue appears abnormal, a small sample can be taken (biopsy) through the cystoscope and sent to a lab for analysis.

How to prepare for the test

You should make arrangements for someone to take you home from the hospital.

How the test will feel

You may feel slight discomfort when the cystoscope is passed through the urethra into the bladder. You will feel an uncomfortable, strong need to urinate when your bladder is full.

You may feel a quick pinch if a biopsy is taken. After the cystoscope is removed, the urethra may be sore. You may have blood in the urine and a burning sensation during urination for a day or two.

Why the test is performed

• Check for cancer of the bladder or urethra
• Diagnose and evaluate urinary tract disorders
• Diagnose recurrent bladder infections
• Help determine the cause of pain during urination

Normal Values

The bladder wall should appear smooth. The bladder should be normal size, shape, and position. There should be no obstructions, growths, or stones.

What abnormal results mean

• Bladder stones (calculi)
• Bladder wall decompression
• Chronic urethritis
• Congenital (present at birth) abnormality
• Cysts
• Diverticula
• Irritable bladder
• Polyps
• Prostate abnormalities:
  • Bleeding prostate
  • Enlarged prostate
  • Obstructed prostate
• Traumatic injury of the bladder and urethra
• Tumors
• Ulcer
• Urethral strictures

What the risks are

There is a slight risk of excessive bleeding when a biopsy is taken.

Other risks include:

• Bladder infection
• Rupture of the bladder wall

Special considerations

You must be sure to drink 4 - 6 glasses of water per day after your cystoscopy.

You may notice a small amount of blood in your urine following this procedure. If the bleeding continues after you urinate 3 times, contact your health care provider.

Contact your health care provider if you develop any of these signs of infection:

• Chills
• Fever
• Pain
• Reduced urine output

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References

Carter HB, Chan DY. Basic instrumentation and cystoscopy. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 6.

French L, Phelps K, Pothula NR, Mushkbar S. Urinary problems in women. Prim Care. 2009 Mar;36(1):53-71, viii.