Cystoscopy

Introduction

A cystoscopy is a medical procedure used to examine the inside of the bladder.

It's carried out using a cystoscope, a thin, fibreoptic tube that has a light and a camera at one end.

The cystoscope is inserted into the urethra and is moved up into the bladder (the urethra is the tube that carries urine from the bladder, out of the body). The camera relays images to a screen where they can be seen by the urologist (specialist in treating bladder conditions).

There are two types of cystoscope:

• Flexible cystoscope – a thin, flexible tube used when the only purpose of a cystoscopy is to look inside your bladder
• Rigid cystoscope – a thin, straight metal tube that's used for passing small surgical instruments down through the cystoscope to remove a tissue sample or to carry out treatment

Most cystoscopies are performed as outpatient procedures, so you'll be able to go home on the same day.

What is a cystoscopy used for?

A cystoscopy can be used to investigate and treat symptoms and conditions that affect the bladder and urinary system. For example, it can be used to:

• Check for abnormalities in the bladder
• Remove a sample of bladder tissue for further testing (a biopsy) in cases of suspected cancer
• Treat certain bladder conditions, such as removing small bladder stones

The results of a cystoscopy are usually available to discuss within a few days. However, if a biopsy is necessary it may take several weeks for the results to become available.

Is a cystoscopy painful?

You shouldn't feel any serious pain as a flexible cystoscopy is usually carried out using a local anaesthetic gel or spray to numb the urethra. A rigid cystoscopy is usually done under general anaesthetic (where you are asleep), or a spinal anaesthetic (epidural) that numbs all feeling below your spine.

However, for some people the procedure may feel uncomfortable and you may have mild side effects afterwards, such as muscle pain, nausea and blood in your urine.

You may also feel a burning sensation when passing urine for a few days after the procedure.

Complications of a cystoscopy

It's rare to experience serious complications after a cystoscopy, but you should contact Dr. B C Shah if you're having difficulty passing urine for more than eight hours after the procedure. You may have a swollen urethra.

There's also a small risk of developing a urinary tract infection (UTI) that affects your urethra, bladder or kidneys. You should see Dr. B C Shah if you experience symptoms of infection such as a high temperature (fever) of 38ºC (100.4ºF) or above.

Why a cystoscopy is needed

A cystoscopy can be used to investigate problems with your bladder or urinary system, or it may be used as part of a medical procedure.

Investigating symptoms

You may need to have a cystoscopy if you experience symptoms that suggest there's something wrong with your bladder. For example:

• Urinary incontinence – the involuntary passing of urine
• Blood in your urine (haematuria)
• Persistent pelvic pain
• Pain or a burning sensation when you pass urine (dysuria)
• Frequently needing to urinate
• Having a sudden urge to urinate
• Not being able to pass urine or only being able to pass urine intermittently (‘stop-start’)
• Having a feeling that your bladder isn't completely empty after passing urine

Investigating conditions

A cystoscopy may also be needed if you have a condition that affects your urinary system, such as a bladder tumour or a blocked urethra (the tube that carries urine from the bladder out of the body).

Other conditions that a cystoscopy may be used to detect or monitor include:

• Serious or repeated infections
• Polyps (non-cancerous growths)
• Enlarged prostate – where the prostate becomes enlarged
• Bladder stones
• A narrowed or blocked urethra (urethral stricture)
• Problems with the ureters (the tubes that connect the kidneys to the bladder)

Carrying out procedures

Dr. B C Shah can carry out a number of medical procedures using surgical instruments that are passed down the side channels of the cystoscope. These include:

• Removal of a stone from the bladder or ureter
• Obtaining a urine sample from each of the ureters to check for an infection or tumour
• Removing a sample of tissue for testing in cases of suspected bladder cancer (biopsy)
• Inserting a stent (a small tube) into a narrowed ureter to help the flow of urine
• Injecting dye into the ureters up towards the kidneys which will be highlighted on an X-ray and will help identify problems, such as a blockage or a kidney stone

How a cystoscopy is performed 

Before your appointment to have a cystoscopy, you will be sent information and instructions to follow. 

If you're having a local anaesthetic you can eat and drink normally on the day of the appointment.

If you're having a spinal anaesthetic (epidural) or general anaesthetic, you won't be able to eat or drink for several hours before the procedure. Details of the exact number of hours will be included in the information leaflet that's sent to you.

Most prescription medication can be taken as usual on the day of your appointment. However, you may not be able to take aspirin, warfarin or ibuprofen, because they could cause excessive bleeding during the procedure.

If you're taking one of these medications, contact Dr. B C Shah for advice before your appointment. You may have to temporarily stop taking the medication.

The cystoscopy procedure

In most cases, a cystoscopy can be performed on an outpatient basis, which means that you will be able to go home on the same day.

When it's time for you to have the procedure, you'll be asked to empty your bladder by going to the toilet, before changing into a surgery gown. You may also be given an injection of antibiotics to reduce your risk of developing a bladder infection.

If you are having a local anaesthetic, an anaesthetic gel or spray will be applied to your urethra to numb it. If you're having an epidural or general anaesthetic, you will be given an injection of anaesthetic.

The cystoscope is lubricated with a special gel before being gently inserted into your urethra and passed into your bladder. Sterile water will be pumped through the cystoscope to expand your bladder. This enables Dr. B C Shah to get clearer view inside your bladder.

The cystoscope is usually kept in your bladder for between two and 10 minutes.

What to expect during a cystoscopy

People are often concerned that having a tube inserted into their urethra and up into their bladder will be painful. A cystoscopy isn't usually painful but it may sometimes be uncomfortable.

If you're having a cystoscopy under a local anaesthetic, you may feel a burning sensation and an urge to urinate when the cystoscope is inserted into and then removed from your urethra.

You may also feel an uncomfortable sensation of fullness and a need to urinate when water is pumped into your bladder to expand it.

If you're having an epidural, you may feel a brief stinging sensation when the needle is inserted into your back, and you may experience some mild back pain after the procedure has been completed.

If you're having a general anaesthetic, you won't feel any pain during the procedure. However, you may experience mild symptoms of muscle pain and nausea after the cystoscopy.

Results

In some cases, the urologist will be able to discuss the results of your cystoscopy and any associated implications with you as soon as you recover from the anaesthetic. However, it can sometimes take a few days for the results to become available. If a biopsy (tissue sample) was taken, it may take several weeks for the results to come back.

Recovering from a cystoscopy

The type of anaesthetic that's used will affect how long it takes to recover from a cystoscopy. It is also normal to experience some side effects for a few days afterwards.

Anaesthetic

If you have a local anaesthetic before having a cystoscopy, you will be able to go home as soon as the procedure has finished.

If you have a spinal anaesthetic (epidural) or general anaesthetic, it usually takes one to four hours to recover from its effects, so you'll need to arrange for someone to accompany you home.

After having a spinal or general anaesthetic, you should rest for the 24 hours following the procedure. Avoid driving, operating complex or heavy machinery and drinking alcohol during this period of time.

Side effects

Most people will experience a burning pain when passing urine during the first few days after a cystoscopy. This is normal and should stop within a few days.

Having blood in your urine or bleeding from your urethra is also common in the first few days after a cystoscopy, particularly in cases where the procedure is used to carry out a biopsy. Drinking plenty of water to avoid dehydration can help to ease both of these symptoms.

You should only be concerned about bleeding if:

• Your urine becomes so bloody that you can't see through it
• You notice clots of tissue in your urine
• It lasts for more than a few days

If any of these occur, you should contact Dr. B C Shah for advice .

Risks of a cystoscopy 

A cystoscopy is usually a safe procedure and serious complications are rare. Occasionally, there may be problems passing urine or an infection may develop.

Swollen urethra

A swollen urethra can make it difficult to pass urine. The urethra is the tube through which urine is passed from the bladder, out of your body when you urinate. However, the swelling should pass within a few days.

If you're unable to pass urine for more than eight hours after having a cystoscopy, you should contact hospital staff.

Damage to the urethra is slightly more common after a procedure where a rigid cystoscope needed to be used instead of a flexible cystoscope. You may need to have a catheter (thin tube) inserted through your urethra for a few hours afterwards to drain your bladder.

Urinary tract infections

Urinary tract infections (UTIs) are an infection of your urethra, bladder or kidneys. Symptoms of a UTI can include:

• A burning sensation when urinating that lasts longer than two days
• a high temperature (fever) of 38ºC (100.4ºF) or above
• Unpleasant smelling urine
• Nausea
• Vomiting
• Pain in your lower back or side

Contact Dr. B C Shah as soon as possible if you have any of the above symptoms. Most UTIs can be successfully treated with antibiotics.