Cystoscopy

Why is a cystoscopy done?

To help with diagnosis

A cystoscopy may be done to help to find the cause of symptoms such as:

• Frequent urinary tract infections.

• Blood in urine (haematuria).

• Urinary incontinence.

• Unusual cells found in a urine sample.

• Persistent pain when passing urine.

• Difficulty in passing urine - which may be due to prostate enlargement or a narrowing (stricture) of the urethra.

Cystoscopy may also be done to monitor progress of conditions. For example, some people have a routine cystoscopy every now and then after treatment for a bladder tumour. This helps to detect any early recurrence which can be treated before it spreads further.

To treat certain conditions, or to do certain procedures

By using various instruments which are passed down the side channels a doctor can:

• Remove bladder stones. If a stone is lodged higher - in a ureter - the doctor may extend the cystoscope up into a ureter. The ureters are the tubes that drain urine from the kidneys to the bladder.

• Remove small lumps (polyps) or tumours from the lining of the bladder.

• Insert a small tube (stent) into a narrowed ureter. This helps the flow of urine if there is a narrowing.

• Perform a special X-ray of the ureters and kidneys. A doctor can inject a dye into the ureters up towards the kidney. This shows up on X-ray pictures and helps to show problems of the kidney or ureter.

• Remove the prostate gland (by using a special type of cystoscope which 'chips' away at the prostate gland bit by bit).

What is a cystoscope?

A cystoscope is a thin telescope which is passed into the bladder via the urethra, the tube that takes urine from the bladder to the outside of the body. There are two types. The cystoscope can be looked down but it also transmits pictures to a computer screen so they can be seen by other members of the team. Both types of cystoscope have side channels where various thin instruments can be passed down. For example a small sample (biopsy) may be taken from the bladder wall using an instrument which can pinch tissue and carry it back down the side channel.

Types of cystoscopy

A flexible cystoscope is the most commonly used. It is a thin, flexible, fibre-optic telescope which is about as thick as a pencil. As it is flexible, it passes easily along the curves of the urethra. The flexible tip can also be moved easily so that the whole of the bladder lining can be seen.

Flexible cystoscope

By Michael Reeve, via Wikimedia Commons

A rigid cystoscope is a thin, solid, straight telescope. It allows a greater variety of devices to pass down the side channels so can be used for a wider variety of procedures.

Diagram of a rigid cystoscope and how a cystoscopy is performed

Cystoscopy procedure

Cystoscopy is usually done as an outpatient procedure. This means people go home the same day and aren't required to stay overnight. It is usually done whilst awake. Some people are given a sedative to help them to relax.

The opening to the urethra (at the end of the penis, or the outside of the vagina) and the nearby skin will be cleaned. Some 'jelly' is then squirted into the opening of the urethra. The jelly usually contains a local anaesthetic to numb the lining of the urethra. This helps the cystoscope to pass into the urethra with as little discomfort as possible.

Male and female cystoscopy

By Cancer Research UK, via Wikimedia Commons

The cystoscope is then gently pushed up into the bladder and the lining of the urethra and bladder is carefully examined. Sterile water is passed down a side channel in the cystoscope to fill the bladder slowly. This makes it easier to see the lining of the bladder and the bladder wall. As the bladder fills it causes the feeling of a need to pass urine which may be uncomfortable.

The cystoscope is then gently pulled out. If a biopsy was taken, the sample would be sent away to be tested and looked at under a microscope. It can take several weeks for the report of the biopsy to come back to the doctor.

In some cases a general anaesthetic is given when a cystoscopy is done, particularly if a rigid cystoscope is used. In some cases a spinal anaesthetic is given which numbs all the lower half of the body.

How long does a cystoscopy take?

A cystoscopy takes about 5-10 minutes if it is just to look inside the bladder. It may last longer if a procedure is being performed - for example, taking a sample (biopsy) from the lining of the bladder.

Is a cystoscopy painful?

Cystoscopies are not usually painful, particularly as local anaesthetic is used to insert the cystoscope. They can be uncomfortable, especially when the bladder has been filled with water.

Complications of a cystoscopy

Most cystoscopies are done without any problem.

For the following 24 hours there may be a mild burning sensation when passing urine and a feeling of a need to pass urine more often than usual. The urine may also look pink due to mild bleeding, particularly if a biopsy was taken.

Occasionally, a urine infection develops shortly after a cystoscopy. This can cause a high temperature (fever) and pain on passing urine.

Rarely, the cystoscope may damage or perforate the bladder. After having a cystoscopy, medical advice should be sought if:

• Pain or bleeding is severe.

• Pain or bleeding lasts longer than two days.

• Symptoms of infection develop, such as a fever.

Preparing for a cystoscopy

There are not usually any particular preparations needed before a flexible cystoscopy. Usually it is possible to eat and drink as normal beforehand. There is no need to empty the bladder. A rigid cystoscopy normally requires a general anaesthetic so guidance will be given about when to stop eating and drinking and what to do.

After a cystoscopy

After a flexible cystoscopy, it is usual to need to empty the bladder urgently and then to go home without any need for additional support. After a rigid cystoscopy, a catheter may be used to empty the bladder and the normal advice would be given about having a general anaesthetic (to wait in the hospital for a few hours to recover, to be unable to drive home, to need support at home for 24 hours).