A cystoscopy is a common diagnostic procedure allowing a healthcare provider to examine the inside lining of the bladder and the urethra. This is achieved by inserting a thin, lighted tube called a cystoscope through the urethra and into the bladder. Apprehension is natural, particularly for men, because the instrument must navigate the entire length of the male urinary tract. While the procedure involves distinct sensations and discomfort, modern medical techniques ensure the process remains tolerable, with pain typically managed and brief.
Understanding the Procedure and Male Anatomy
The cystoscope is gently passed through the urethra, the tube that carries urine out of the body, to reach the bladder. For men, the procedure is anatomically more complex than for women because the male urethra is significantly longer, measuring approximately 7 to 8 inches (about 20 centimeters). This long passage is divided into several segments, including the prostatic urethra, which passes through the prostate gland.
The length and natural curves of the male urethra mean the instrument must travel a greater distance. The membranous urethra, a short segment located near the external sphincter, is the narrowest and least dilatable part of the tract. Navigating this sensitive, curved pathway and passing through the area surrounded by the prostate gland is the primary reason for potential discomfort. Conditions like an enlarged prostate or urethral strictures can further increase the challenge during the insertion.
Pain Mitigation Strategies Used During Insertion
Medical professionals employ specific strategies to ensure the procedure is well-tolerated. The primary step is the application of a sterile lubricating gel directly into the urethra. This gel often contains a local anesthetic, typically lidocaine, which numbs the lining of the urethra before the cystoscope is advanced.
The anesthetic gel is instilled into the urethra and requires several minutes to effectively numb the tissue. Studies suggest that using lidocaine gel, compared to plain lubricant, reduces the likelihood of experiencing moderate to severe pain. Cooling the lidocaine gel to a colder temperature may provide additional analgesic benefit. The use of flexible cystoscopes, which bend to follow the natural curves of the urethra, is also preferred for routine diagnostic procedures in men as they cause less discomfort than rigid scopes.
Expected Sensations and Subjective Discomfort
Despite the use of numbing gel, patients will experience distinct sensations during the cystoscopy, usually described as intense discomfort rather than severe pain. As the cystoscope is inserted, a feeling of pressure or fullness is common, especially as the instrument navigates the prostatic and membranous urethra. Passing the external urinary sphincter, an involuntary muscle, is often reported as the moment of sharpest, though very brief, sensation.
Once the cystoscope is in the bladder, sterile fluid is inserted to expand the organ and allow for a clear view of the lining. This filling process creates a strong, sudden urge to urinate, similar to when the bladder is completely full. The average pain reported by men during a flexible cystoscopy is mild to moderate, with most patients rating the experience as manageable discomfort. Letting the healthcare provider know about any discomfort can help them pause or adjust the pace of the procedure.
Managing Post-Procedure Discomfort
After the cystoscope is removed and the procedure is complete, some short-term discomfort is expected as the effects of the local anesthetic wear off. The most common side effect is a burning or stinging sensation during urination, medically known as dysuria. This irritation is due to the temporary trauma to the urethra and typically resolves within the first day or two.
Patients may also notice increased urinary frequency or urgency, along with minor spotting or a pink tinge to the urine, which is common and not usually a cause for concern. To manage these symptoms, drinking plenty of fluids, such as water, is recommended, as this helps to flush the bladder and dilute the urine, reducing irritation. Mild, over-the-counter pain relievers can be used, and applying a warm, damp washcloth to the urethral opening may also provide relief. If the burning sensation lasts longer than a couple of days, or if there is heavy bleeding, large blood clots, or a fever, a healthcare provider should be contacted immediately.