A cystoscopy is a common outpatient procedure that allows a physician, usually a urologist, to visually examine the inside lining of the bladder and the urethra. The procedure utilizes a thin, lighted instrument called a cystoscope, which is inserted through the urethra and advanced into the bladder. This diagnostic tool is often recommended to investigate symptoms such as blood in the urine, frequent urinary tract infections, or painful urination. It is also used to diagnose or monitor conditions like bladder stones, strictures, or abnormal growths within the urinary tract. Preparing properly for this examination helps ensure accurate results and a smooth experience.
Pre-Procedure Medical Requirements
A primary step in preparing is a thorough review of all current medications with the prescribing physician. It is important to discuss blood-thinning medications, such as aspirin or other anti-inflammatory drugs, as these may need to be temporarily stopped several days before the procedure to minimize the risk of bleeding. Any necessary adjustments to diabetes medications must also be discussed with a doctor, especially if fasting is required for sedation or general anesthesia.
The presence of a urinary tract infection (UTI) can prevent the procedure from being performed safely, so a urine sample is typically collected beforehand to screen for active infection. If a UTI is detected, the cystoscopy may be postponed until the infection has been treated with antibiotics. In cases where there is a higher risk of infection, the physician may proactively prescribe a prophylactic antibiotic regimen to be started before the examination.
Specific instructions regarding eating and drinking depend on the type of anesthesia planned for the cystoscopy. For a common flexible cystoscopy performed with only local anesthetic gel, patients can usually eat and drink normally on the day of the procedure. However, if the procedure is rigid, or if sedation or general anesthesia is required, the patient will need to fast, typically stopping all food and drink for several hours prior to the appointment. Before the procedure begins, patients are usually asked to empty their bladder completely.
Logistical Arrangements for Procedure Day
Planning the logistics for the day of the procedure is just as important as the medical preparation. If any form of sedation or general anesthesia is administered, it is mandatory to arrange for a responsible adult to drive the patient home afterward. These medications impair judgment and coordination, making it unsafe to operate a vehicle or use public transport alone.
Patients should choose comfortable, loose-fitting clothes, preferably a two-piece outfit, for easy removal and access during the examination. Although a hospital gown will likely be provided, wearing comfortable clothing helps reduce pre-procedure stress. Additionally, patients should plan to arrive well before the scheduled appointment time to complete necessary administrative tasks, such as finalizing consent forms and checking in with insurance information. It is advisable to plan for some rest time after returning home, even if the procedure is brief, to allow the body to recover fully.
The Procedure Itself
Once in the procedure room, the patient is positioned on an examination table, often with the knees bent and feet resting in stirrups. The area around the urethral opening is gently cleaned with an antiseptic solution. A lubricating jelly that contains a local anesthetic, such as lidocaine, is then applied directly into the urethra. This gel numbs the passage to minimize discomfort and provides lubrication for the scope’s insertion.
The cystoscope, a thin, flexible or rigid tube with a light and lens, is then gently inserted through the urethra and slowly guided into the bladder. Patients typically feel a sensation of pressure or the urge to urinate as the scope passes through the urethra and as the bladder is filled with a sterile solution, such as saline. The fluid is introduced through the scope to gently inflate the bladder, allowing the physician a clear, unobstructed view of the bladder wall.
The visual examination is usually brief, lasting only about 5 to 15 minutes for a routine flexible cystoscopy. If the physician identifies an area of concern, they may use specialized instruments passed through the scope to take a small tissue sample, known as a biopsy. After the examination is complete, the fluid is drained, and the cystoscope is carefully removed.
Managing Immediate Post-Procedure Symptoms
In the hours following the cystoscopy, patients can expect a few side effects. The most frequent symptom is a mild burning or stinging sensation during urination, which is a result of the urethral passage being irritated by the scope. Patients may also notice that their urine appears lightly pink or has blood for the first 24 to 48 hours.
To help flush the bladder and minimize irritation, increasing fluid intake is recommended. Drinking water or other non-caffeinated fluids helps dilute the urine, which reduces the burning sensation. Over-the-counter pain relievers such as acetaminophen are safe for managing mild discomfort. However, patients should avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) unless instructed by their doctor, as these can increase the risk of bleeding.
Patients should contact their healthcare provider immediately if they experience signs of complication:
- A fever of 100.4°F (38°C) or higher, which may signal an infection.
- Passing continuous bright red blood or large blood clots.
- Severe abdominal pain.
- The inability to urinate.
- Pain and burning that persists beyond 48 hours.