Cystoscopy

A diagnostic procedure in which the urethra and bladder interior are directly visualized with a thin flexible or rigid endoscope; allows biopsy or minor interventions when needed.

Indication

• Investigation of the etiology of visible or microscopic blood in the urine (hematuria)
• Unexplained recurrent urinary tract infections
• Suspected bladder tumor or follow-up after bladder cancer
• Unexplained lower urinary tract symptoms (frequency, urgency, painful urination)
• Suspected urethral stricture, bladder stone, or foreign body in the bladder
• Therapeutic applications such as ureteral stent placement/removal and removal of small polyps

Preparation

• Urine culture before the procedure may be needed to rule out active infection
• Blood thinners should be reviewed with the physician
• Fasting is not required for procedures performed under local anesthesia; if sedation is planned, fasting for 6 hours is needed
• The bladder is emptied before the procedure

How it's performed

1. The patient is placed supine with legs apart (lithotomy position) and the external genital area is cleaned with antiseptic
2. Local anesthetic gel is applied into the urethra; sedation or general anesthesia is used when needed
3. A flexible or rigid cystoscope is gently advanced through the urethra into the bladder
4. The bladder is distended with sterile fluid; the inner surface, ureteral orifices, and bladder neck are systematically examined
5. Biopsies may be taken from suspicious areas; small stones or polyps can be removed
6. At the end of the procedure the fluid is drained and the cystoscope withdrawn; the procedure typically takes 5-15 minutes

Post-procedure

• After a brief rest period, the patient can be discharged the same day (with local anesthesia)
• Generous fluid intake (2-2.5 liters per day) is recommended for the first 24-48 hours
• Mild burning and a pinkish color in the urine may last 1-2 days; this is expected
• Biopsy results are usually evaluated within 5-10 days
• Emergency evaluation is required for high fever, severe pain, or inability to urinate

Risks

• Urinary tract infection (approximately 1-3%)
• Transient mild blood or clots in the urine
• Burning during urination and a feeling of urgency (usually resolves within 24-48 hours)
• Rarely, minor injury to the urethra or bladder wall, or transient urinary retention
• Reactions related to anesthesia or sedation (when sedation is used)

FAQ

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