What is cystoscopy?

Cystoscopy is a test that lets the healthcare provider view the urinary tract. This area includes the bladder, the urethra, and the openings to the ureters. Cystoscopy can help find problems with the urinary tract. This may include early signs of cancer, infection, narrowing, blockage, or bleeding.

For this test, a long, flexible, lighted tube (cystoscope) is put into the urethra and moved up into the bladder. The healthcare provider can look closely at the inside of the urethra and bladder. They can also wash the bladder. And they can reach the structures with special tools used through the scope.

During a cystoscopy, the healthcare provider may remove tissue to look at under a microscope. This is called a biopsy. Some problems can be treated during the test.

Why might I need a cystoscopy?

A cystoscopy may be advised if your healthcare provider thinks you have a problem of the urinary tract. For example, a structural problem may block the flow of urine. Or it might cause urine to flow back. If untreated, this may lead to problems.

Cystoscopy may also be used after surgery near the bladder. The provider can check for correct placement of stitches (sutures) and support devices.

Some health problems of the urinary tract that may be found during cystoscopy. They include:

• Bladder cancer or tumor

• Polyps or overgrowths of normal tissue

• Bladder stones. These are stones made of calcium or uric acid crystals. They can cause infection, inflammation, bleeding, and blockages in the urinary tract.

• Scarring and damage caused by frequent urinary tract infections (UTIs)

• Problems of the urinary tract that may be present at birth (congenital). These may lead to a backflow of urine or kidney problems.

• Urinary tract injury

Your healthcare provider may have other reasons to recommend a cystoscopy.

What are the risks of cystoscopy?

Complications of cystoscopy may include:

• Infection

• Bleeding

• Urinary retention because of irritation and swelling from the test

• Narrowing of the urethra because of scarring

• Poking a hole in the bladder with the cystoscope (bladder perforation)

There may be other risks depending on your specific health condition. Discuss any concerns with your healthcare provider before the test.

Urinary tract infection may interfere with a cystoscopy.

How do I get ready for a cystoscopy?

• Your healthcare provider will tell you about the test. Ask any questions you may have.

• You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if anything is not clear.

• The type of fasting (not eating or drinking anything) needed before the test will depend on the type of anesthesia used. Follow any directions you are given for not eating or drinking before the test. You may be given other instructions about a special diet to follow for a day or two before the test.

• Tell your healthcare provider if you are pregnant or think you may be.

• Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, iodine, tape, or anesthesia medicines (local and general).

• Tell your healthcare provider about all of the medicines you are taking. These include prescribed and over-the-counter medicines, herbs, vitamins, and supplements.

• Tell your healthcare provider if you have a history of bleeding disorders. Also tell them if you are taking any blood-thinning medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the test.

• If local anesthesia is used, you will be awake during the test. But you may be given medicine (sedative) to help you relax. You will need someone to drive you home afterward.

• Tell your healthcare provider if you think you have a urinary tract infection (UTI). A cystoscopy should not be done if you have a UTI. Your provider may check your urine for infection before doing the test. Signs of infection include frequent urination, pain or burning when passing urine, fever, and urine that looks dark, cloudy, or reddish in color and smells bad.

Based on your health condition, your healthcare provider may ask for other specific preparation.

What happens during cystoscopy?

You may have a cystoscopy as an outpatient. This means you go home the same day. Or it may be done during a hospital stay. Tests may vary, depending on your condition and your healthcare provider's practices.

Generally, a cystoscopy follows this process:

1. You will need to remove any clothing, jewelry, or other objects that may interfere with the test.

2. When you are asked to remove your clothing, you will be given a gown to wear.

3. An IV (intravenous) line may be started in your arm or hand.

4. Often an antibiotic is given before the test.

5. You may be given an IV sedative or anesthesia, depending on your situation and the type of scope that will be used. This will make you sleepy and not feel pain during the cystoscopy. If a sedative or anesthesia is given, your heart rate, blood pressure, breathing, and blood oxygen level will be closely watched during the test.

6. You will be positioned on an exam table on your back with your knees up and spread apart. Your feet will be placed in stirrups.

7. A numbing medicine in the form of a gel will be put into your urethra. This may be mildly uncomfortable until the area is numb.

8. Once the urethra is numb or the anesthesia has taken effect, the healthcare provider will put the cystoscope into the urethra. You may have some discomfort when this is done.

9. As the cystoscope is passed through the urethra, the healthcare provider will check the lining. The cystoscope will be moved up until it reaches the bladder.

10. Once the cystoscope is in the bladder, the healthcare provider may put sterile water or saline into the bladder to help expand it and make the lining of the bladder easier to see. While the bladder is being filled, you may have the urge to urinate or feel mild discomfort.

11. The healthcare provider will check the bladder for any problems. They may put a long, thin tool through the cystoscope to take out a piece of bladder tissue for testing. A urine sample may be taken from the bladder, too.

12. The cystoscope will be carefully removed after the test has been completed.

What happens after a cystoscopy?

After the test, you may be taken to a recovery room to be watched if sedation or anesthesia was used. Your recovery process will vary depending on the type of sedation that was given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Or you will be discharged to your home. Cystoscopy is most often done on an outpatient basis.

You may go back to your usual diet and activities unless your healthcare provider tells you otherwise.

You will be encouraged to drink extra fluids. The fluids dilute the urine and eases urinary discomfort, such as burning. Some burning with urination is normal after the test, but it should lessen over time. A warm sitz bath or tub bath may help ease urinary discomfort.

You may notice blood in your urine after the test. This is normal and should clear up over the next day or two.

Take a pain reliever for soreness or discomfort as advised by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Take only recommended medicines.

Take the antibiotic exactly as told.

Tell your healthcare provider if any of the following occur:

• Fever or chills

• Urinary frequency or urgency

• Inability to urinate

• Lower back pain

• Continued burning with urination or blood in the urine

Your healthcare provider may give you other instructions after the test, depending on your situation.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure