A cystoscopy is a medical procedure used to look directly inside the bladder and the urethra, the tube that carries urine out of the body. A specialized, thin instrument called a cystoscope, equipped with a light and a camera, is gently inserted to allow a urologist to examine the urinary tract lining. This examination is commonly performed to investigate symptoms such as visible blood in the urine, recurrent urinary tract infections (UTIs), or issues with bladder control. Cystoscopy is generally an outpatient procedure, meaning the patient typically goes home the same day.
Necessary Preparation Beforehand
Before the procedure, patients receive specific instructions regarding medications, especially blood thinners like aspirin, which may need to be temporarily stopped to reduce bleeding risk. If the procedure involves sedation or general anesthesia, fasting (usually eight hours without food) is required. Diagnostic cystoscopy performed under local anesthesia typically has no restrictions on eating or drinking.
Patients are often asked to provide a urine sample upon arrival to check for active infection, which may postpone the procedure. The bladder is usually emptied right before the procedure begins, though a partially full bladder may be requested if the doctor needs to evaluate bladder capacity. Patients must also understand the informed consent form, ensuring awareness of the procedure’s steps, benefits, and potential risks.
Detailed Steps of the Examination
The cystoscopy begins with the patient positioned on an exam table, typically lying on their back with knees bent and feet resting in stirrups, similar to a gynecological examination. Anesthesia choice depends on the scope’s type and the procedure’s complexity; a simple diagnostic exam often uses a local anesthetic gel applied directly to the urethra. More involved procedures, such as those including a biopsy or stone removal, may require moderate sedation or general anesthesia.
The area around the urethral opening is cleaned with an antiseptic solution before the numbing gel is applied. The local anesthetic needs a few minutes to take effect, desensitizing the urethra to minimize discomfort during insertion. The urologist then gently inserts the lubricated cystoscope through the urethra and advances it into the bladder. Since the female urethra is short and relatively straight, scope insertion is generally quicker than in males.
Once the cystoscope is inside the bladder, sterile fluid, such as saline or water, is infused to distend the bladder walls. This expansion smooths the lining, allowing the urologist a clear and detailed view of the entire inner surface and the ureteral openings. As the bladder fills, the patient may feel a strong urge to urinate or mild pressure. The doctor carefully examines the lining for abnormalities, such as inflammation, stones, polyps, or signs of cancer.
The cystoscope has working channels that allow for minor interventions. Small instruments can be passed through the scope to take a tissue sample (biopsy), remove a small bladder stone, or inject dye to check kidney function. After the examination or intervention is complete, the fluid is drained, and the cystoscope is carefully removed.
What to Expect During Recovery
Patients can typically return home the same day, especially if only local anesthesia was used. Mild discomfort is common, including a slight burning sensation when urinating (dysuria) caused by urethral irritation. This burning and the frequent urge to urinate usually resolve within one to two days.
Patients may notice a small amount of blood in their urine, often appearing pink or slightly blood-tinged for the first day or two. This bleeding should not be heavy or contain large clots. Drinking plenty of fluids is strongly encouraged following the procedure, as this helps flush the bladder and minimize infection risk. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can manage any discomfort as advised by the provider.
Most individuals can resume normal daily activities within 24 to 48 hours. However, patients should contact their doctor immediately if they develop a fever or chills, experience persistent severe pain, or are completely unable to urinate. These symptoms may signal a complication, such as a urinary tract infection or severe bleeding, requiring prompt medical attention.