Cystoscopy

Test Overview

A cystoscopy is a procedure that lets a doctor look inside your bladder and urethra. The urethra is the tube that carries urine from the bladder to outside the body.

The doctor uses a thin, lighted tool called a cystoscope. With this tool, the doctor can look for kidney or bladder stones. The doctor can also look for tumors, bleeding, or infection.

If you are in a clinic and you are awake, you may get gel to numb your urethra. This makes the procedure more comfortable. Then the doctor puts the cystoscope into your urethra and moves it into your bladder. Next, the doctor fills your bladder with liquid. This helps the doctor see better. It may cause you to feel pressure in your bladder area for a short time.

If you are in the hospital, you may get medicine to make you sleep during the procedure. While you are asleep, the doctor can take samples of tissue. These will be checked for cancer and other problems. This is called a biopsy. If you have a biopsy, you may have a small amount of blood in your urine for several days. You may also need a catheter. It's a tube that drains urine from your bladder. Your doctor will take it out at your follow-up visit.

Why It Is Done

Cystoscopy may be done to:

• Find the cause of many urinary system problems. Examples include blood in the urine, pain when you urinate, incontinence, frequent urinary tract infections, and blockages in the urinary tract.
• Remove tissue samples for testing (biopsy).
• Remove a foreign object.
• Insert a stent. This helps urine flow from the kidneys to the bladder.
• Treat certain problems. The test can be used to remove stones or growths, help stop bleeding in the bladder, or remove a blockage.
• Inject a dye that is used for a special type of X-ray of the ureter and kidney.

How To Prepare

Procedures can be stressful. This information will help you understand what you can expect if you will be having this done in a hospital. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Talk to your doctor about the types of anesthesia and which type is best for you.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

How It Is Done

Before the test

The test is done in a hospital or the doctor's office.

You'll need to take off all or most of your clothes. You'll have a cloth or paper covering to use during the test.

If you are having this done in a hospital, you may get a sedative to help you relax about an hour before the test. An intravenous (I.V.) needle may be placed in your arm to give you other medicines and fluids.

You will lie on your back on a table. You may have your knees bent, legs apart. Your feet or thighs may be placed in stirrups. Your genital area is cleaned with an antiseptic solution. Your belly and thighs are covered with sterile cloths.

For this test, you will have one of three kinds of anesthesia.

• Local anesthetic. This anesthetic is inserted in your urethra.
• General anesthetic. You are put to sleep either with medicine through an IV or with gases inhaled through a mask. Sometimes both methods are used.
• Spinal anesthetic. The doctor or nurse first numbs the area on your back where the needle will be inserted. Then the needle is guided into the spinal canal and the anesthetic is injected. You may not be able to move your legs until the medicine wears off.

During the test

After the anesthetic takes effect, the cystoscope, or scope, is inserted into your urethra and moved into your bladder. If your urethra has a spot that is too narrow, other smaller tools are inserted first. They will gradually make it large enough for the scope.

Next, the doctor puts either sterile water or salt water (saline) into your bladder to make it larger and to create a clear view. The doctor may also put in medicine to reduce chances of infection.

The doctor can also insert tiny tools through the scope to collect tissue samples for biopsy. The tissue samples are sent to the lab to be checked.

After the test

If a local anesthetic is used, you may be able to get up right after the test. If a general anesthetic is used, you will stay in the recovery room until you are awake and able to walk. (This usually takes 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 feeling in your legs has returned. (This usually takes about an hour.)

How long the test takes

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

How It Feels

If you are put to sleep with a general anesthetic, you won't feel anything during the test. After the anesthetic wears off, your muscles may feel tired and achy. The medicine gives some people an upset stomach.

If a local anesthetic is used, you may feel a burning sensation or an urge to urinate when the cystoscope is inserted and removed. When sterile water or saline is put in your bladder, 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 takes a long time, lying on the table can become tiring and uncomfortable.

If a spinal anesthetic is used, you will probably feel a brief sting when the medicine is injected. The day after the test, you may feel tired and have a slight backache or headache.

Most people report that this test is not nearly as uncomfortable as they thought it would be.

Risks

Cystoscopy is generally a very safe test. General anesthesia has some risks.

The most common side effect is a short-term swelling of the urethra. This can make it hard 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 the test. 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 cases, 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 tools. This puncture could require a catheter or even another surgery to repair.

Results

Your doctor may be able to talk to you about some of the results right after the test. The results of a biopsy usually take several days.

Normal:

• The urethra, bladder, and openings to the ureters are normal.
• There are no polyps or other abnormal growths, swelling, bleeding, narrow areas (strictures), or structural problems.

Abnormal:

• There is narrowing of the urethra because of previous infections or an enlarged prostate gland.
• There are bladder tumors (which may or may not be cancerous), polyps, ulcers, urinary stones, or inflammation of the bladder walls.
• Problems in the structure of the urinary tract present since birth (congenital) are seen.
• In a woman, pelvic organ prolapse is present.