Cystoscopy

Page last reviewed: 13/07/2011

A cystoscopy is a medical procedure used to examine the inside of the bladder. It is performed using a piece of equipment called a cystoscope.

Cystoscope

A cystoscope is a thin, fibreoptic tube that has a light source and a camera at one end.

The cystoscope is inserted into the urethra and is moved up into the bladder. The urethra is a tube that runs from the bladder, and urine passes through it. The camera at the end of the cystoscope relays images to a screen, where they can be seen by the urologist (specialist in treating bladder conditions).

Uses of cystoscopy

A cystoscopy can be used to:

  • check for abnormalities in the bladder, such as a kidney stone or a blockage
  • remove a sample of bladder tissue for further testing (a biopsy) in cases of suspected cancer
  • treat certain bladder conditions, such as removing small bladder stones

Types of cystoscope

There are two main types of cystoscope:

  • flexible cystoscope: a thin, flexible tube about the size of a drinking straw
  • rigid cystoscope: a thin, straight metal tube about the size of a pen

Flexible cystoscopes are used when the only purpose of a cystoscopy is to look inside the bladder.

Rigid cystoscopes are used in situations where it may be necessary to pass small surgical instruments down through the cystoscope to remove a tissue sample or to carry out treatment.

A flexible cystoscopy is usually performed using a local anaesthetic gel or spray to numb the urethra.

A rigid cystoscopy is usually performed under a general anaesthetic (where you are put to sleep) or a spinal anaesthetic (epidural) that numbs all feeling below the spine.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Biopsy

A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

Urethra

The urethra is a tube that carries urine from the bladder to the outside of the body.

Cystoscopy

A cystoscopy is a procedure to view the inside of the bladder using a thin instrument with a light and a tiny telescope (cystoscope), which is inserted into the urethra.

Bladder

The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.

Page last reviewed: 13/07/2011

Investigating symptoms

A cystoscopy may be necessary if you experience symptoms that suggest there is something wrong with your bladder, such as:

  • urinary incontinence (the involuntary passing of urine)
  • blood in your urine (haematuria)
  • persistent pelvic pain
  • pain or a burning sensation when you pass urine (dysuria)
  • frequently needing to urinate
  • having a sudden urge to urinate
  • not being able to pass urine or only being able to pass urine intermittently ('stop-start')
  • having a feeling that your bladder has not been completely emptied after passing urine

Investigating conditions

A cystoscopy may be required if you have a condition that affects your urinary system, such as a bladder tumour or a blocked urethra (tube that drains the bladder when you urinate).

Other conditions that a cystoscopy may be used to detect or monitor include:

  • serious or repeated infections
  • polyps (non-cancerous growths)
  • enlarged prostate
  • cancerous growths (tumours) in the bladder
  • bladder stones
  • a narrowed or blocked urethra (urethral stricture)
  • problems with the ureters (the tubes that connect the kidneys to the bladder)

Procedures

An urologist (specialist in treating bladder conditions) can carry out a number of procedures using a variety of different surgical instruments that can be passed down the side channels of the cystoscope. These include:

  • removal of a stone from the bladder or ureter
  • obtaining a urine sample from each of the ureters to check for an infection or tumour
  • removing a sample of tissue for testing in cases of suspected bladder cancer (biopsy)
  • inserting a stent (small tube) into a narrowed ureter to help the flow of urine
  • injecting a dye into the ureters up towards the kidneys, and then taking an X-ray to help identify any problems, such as a blockage or a kidney stone

Glossary

Cystoscope
A cystoscopy is a procedure to view the inside of the bladder using a thin instrument with a light and a tiny telescope (cystoscope), which is inserted into the urethra.
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Urine sample
Urinalysis (UA) is when a urine sample is tested commonly to check for any signs of infection or protein or sugar levels.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Incontinence
Incontinence is when you pass urine (urinal incontinence), or stools or gas (faecal incontinence), because you cannot control your bladder or bowels.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Kidneys
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.
Urethra
The urethra is a tube that carries urine from the bladder to the outside of the body.

Page last reviewed: 13/07/2011

Preparation

Before you attend your cystoscopy appointment, you will be sent information explaining what type of anaesthetic you will need to have during the procedure.

If you are having a local anaesthetic, you can eat and drink normally on the day of the appointment.

If you are having a spinal or general anaesthetic, you will be told not to eat and drink for several hours before the procedure. Exactly how many hours will be explained in the information leaflet sent to you.

Any prescription medication can be taken as usual on the day of your appointment. However, an exception may be made if you are taking aspirin, warfarin or ibuprofen, because these could cause excessive bleeding during the procedure.

If you are taking one of these medications, contact the hospital or unit for advice before your appointment. You may have to temporarily stop taking the medication.

The day of the procedure

In most cases, a cystoscopy can be performed on an outpatient basis, which means you can go home on the same day.

When it is time for you to have the procedure, you will be asked to empty your bladder by going to the toilet, before changing into a surgery gown. You may also be given an injection of antibiotics to reduce your risk of developing a bladder infection.

If you are having a local anaesthetic, an anaesthetic gel or spray will be applied to your urethra to numb it. If you are having a spinal or general anaesthetic, you will be given an injection of anaesthetic.

The cystoscope will be lubricated with a special gel, before being gently inserted into your urethra and passed up into your bladder. Sterile water will be pumped through the cystoscope to expand your bladder. This allows the cystoscope to get a clearer view of the inside of your bladder.

The cystoscope is usually kept in your bladder for 2-10 minutes.

Is a cystoscopy painful?

People are often concerned that having a tube inserted into their urethra and up into their bladder will be painful. A cystoscopy is often painless, although it may sometimes be uncomfortable.

If you are having a cystoscopy under a local anaesthetic, you may experience a burning sensation, and an urge to urinate when the cystoscope is inserted into and then removed from your urethra.

You may also feel an uncomfortable sense of fullness and a need to urinate when water is used to expand your bladder.

If you are having a spinal anaesthetic, you may feel a brief stinging sensation when the needle is inserted into your back, and you may experience some mild back pain after the procedure has finished.

If you are having a general anaesthetic, you will feel no pain during the procedure. However, you may experience some mild symptoms of muscle pain and nausea after the cystoscopy has been completed. 

Results

In most cases, the urologist will be able to discuss the results of your cystoscopy and any associated implications with you as soon as you recover from the anaesthetic. If a biopsy (sample of tissue) was taken, it may take several weeks for the results to come back.

Glossary

Cystoscope
A cystoscopy is a procedure to view the inside of the bladder using a thin instrument with a light and a tiny telescope (cystoscope), which is inserted into the urethra.
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Local anaesthetic
A local anaesthetic is a drug that is injected by needle or applied as a cream, which causes a loss of feeling in a specific area of the body.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Numb
Numbness refers to a lack of sensation in a part of the body.
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Urethra
The urethra is a tube that carries urine from the bladder to the outside of the body.

Page last reviewed: 13/07/2011

If you have a local anaesthetic during a cystoscopy, you can go home as soon as the cystoscopy has been completed.

If you have a spinal or a general anaesthetic during a cystoscopy, it will usually take one to four hours to recover from the effects of the anaesthetic. You will also need somebody to accompany you home.

If you were given a spinal or general anaesthetic, you should rest for the 24 hours following the procedure and avoid driving, operating complex or heavy machinery and drinking alcohol during this time.

In the first few days after a cystoscopy, most people will experience a burning pain when passing urine. This is normal and should stop within a few days.

Having blood in your urine or bleeding from your urethra is also common in the first few days after a cystoscopy, particularly in cases where the cystoscopy is used to carry out a biopsy.

Drinking plenty of water (usually six pints a day) can help to ease both of these symptoms.

Only be concerned about bleeding if:

  • your urine becomes so bloody that you cannot see through it
  • you notice clots of tissue in your urine

If this happens, contact hospital staff for advice (you will be given a contact telephone number for this purpose).

Glossary

Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Fever
A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37C (98.6F).
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Cystoscopy
A cystoscopy is a procedure to view the inside of the bladder using a thin instrument with a light and a tiny telescope (cystoscope), which is inserted into the urethra.

Page last reviewed: 13/07/2011

A cystoscopy is usually a safe procedure and serious complications are rare.

The most common complication of a cystoscopy is that your urethra will become swollen, which can make it difficult to pass urine. However, the swelling should pass within a few days.

If you are unable to pass urine for more than eight hours after having a cystoscopy, you should contact hospital staff. A catheter (thin tube) may be needed to help drain your bladder.

Another common complication of a cystoscopy is a urinary tract infection (UTI), which is an infection of your urethra, bladder or kidneys.

Symptoms of a UTI can include:

  • a burning sensation when urinating that lasts longer than two days
  • a high temperature (fever) of 38C (100.4F) or above
  • unpleasant smelling urine
  • nausea
  • vomiting
  • pain in your lower back or side

Contact your GP or hospital staff as soon as possible if you experience any of the above symptoms. Most UTIs can be successfully treated with antibiotics.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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