A cystoscopy is a medical procedure that allows a healthcare professional to visually examine the lining of the bladder and the urethra. The examination uses a thin, lighted instrument called a cystoscope, which has a camera lens on the end to magnify internal structures. This procedure is often recommended to investigate symptoms such as blood in the urine, persistent pelvic pain, recurring urinary tract infections, or difficulty with urination. The direct visualization offered by the cystoscope provides insight often more precise than standard imaging tests.
Preparing for the Cystoscopy
Preparation begins with a discussion about current medications, especially blood thinners like aspirin, which may need to be temporarily paused as directed by the doctor. Patients are asked to provide a urine sample upon arrival to check for an active urinary tract infection (UTI). If an infection is present, the procedure is typically postponed, and antibiotic treatment is necessary before the cystoscopy can be safely performed.
The type of anesthesia depends on the scope of the procedure. A flexible cystoscopy, commonly used for diagnosis in an office setting, usually requires only a local anesthetic gel applied to the urethra. If a rigid cystoscope is used for a more extensive examination, biopsy, or treatment, general anesthesia or sedation may be administered in an operating room. When sedation or general anesthesia is used, patients must arrange for a ride home and fast for eight hours before the appointment.
The Steps of the Examination
The examination begins with the patient lying on an examination table, often positioned on her back with knees bent and feet resting in stirrups. The healthcare team first cleanses the genital area with an antiseptic solution to minimize the risk of infection. A numbing jelly containing a local anesthetic is then applied directly into the urethral opening, which prevents pain and lubricates the instrument’s path.
The cystoscope is gently inserted into the urethra and carefully advanced toward the bladder. The female urethra is relatively short, making the passage of the scope into the bladder a quick step. Once the tip of the cystoscope is inside the bladder, sterile fluid, such as saline, is slowly introduced. This fluid expands the bladder walls, allowing the physician a clear and unobstructed view of the entire inner lining.
As the bladder fills, the patient may experience a sensation of fullness or a strong urge to urinate, which is a normal response. The physician systematically examines the bladder walls, looking for abnormalities such as stones, tumors, inflammation, or scarring. The cystoscope’s lens magnifies the view, and the images are often displayed on a video screen for inspection. If an area of concern is identified, small instruments can be passed through the scope to collect a tissue sample (biopsy) or perform minor therapeutic interventions.
Post-Procedure Care and Recovery
After the cystoscope is removed, the patient is monitored briefly, especially if sedation was administered. Recovery from a simple diagnostic cystoscopy is swift, with most people able to return to normal activities within one to two days. Increasing fluid intake, particularly water, is recommended for the next few days, as this helps flush the bladder and reduce irritation.
Patients should expect some temporary side effects immediately following the procedure. A mild burning sensation during urination is common and should subside within 24 to 48 hours. It is also normal to see small amounts of blood in the urine, making it appear pink or light red for a day or two. Over-the-counter pain relievers, such as acetaminophen, can be taken to manage discomfort.
While mild symptoms are expected, certain signs warrant immediate medical attention. Patients should contact their doctor if they experience any of the following:
- A fever of 100.4°F (38°C) or higher
- Shaking chills or lower back pain
- The inability to urinate
- Persistent heavy bleeding or the passage of blood clots
- A burning sensation during urination that lasts longer than three days
These symptoms can indicate a potential complication, such as an infection or significant injury, and require prompt evaluation.