What is a cystoscopy?
The word comes from the Greek words kustis (bladder) and skopein (look), so it means “to look inside the bladder”. Because the tube that carries urine from the bladder to the outside (the urethra) is also visualized, it is also known as urethro-cystoscopy or cysto-urethroscopy. An older term is panendoscopy, from the Greek words pan (everything) and endo (inside), but it is often simply called a “scope”.
Why is a cystoscopy performed?
It is usually performed in patients who have
- blood in the urine (hematuria),
- recurrent bladder infections (cystitis),
- difficulty in passing urine, or
- total inability to pass urine (retention), or
- involuntary leakage of urine (incontinence).
How is cystoscopy performed?
There are two types of cystoscope: rigid and flexible (see the pictures). The instrument is about as thick as a pencil (6 to 7 mm in diameter) and about 40-50 cm long (there are smaller ones for children). It consists of a telescope containing a rod-lens (rigid) or fibre-optic (flexible) system. It is connected via a fibre-optic cable to a light source, which illuminates the inside of the bladder. The reflected light is collected via the lens system to an eyepiece, enabling the doctor to inspect the inside of the bladder. The tip of a flexible cystoscope can be bent in different directions by using a thumb control located near the eyepiece.
The cystoscope has a thin channel through which irrigation fluid (sterile water or salt solution) is passed into the bladder, making it easier to examine. A small camera can be placed on the eyepiece and the picture shown on a video monitor, so the patient can also see what the doctor sees.
If anything abnormal is seen inside the bladder, an instrument (forceps) can be passed through the cystoscope to take a biopsy (a small piece of tissue) for examination under a microscope to determine the diagnosis. If a bladder stone is seen, another type of forceps can be passed though the cystoscope to crush and remove the stone.
How should I prepare?
Flexible cystoscopy is performed under local anaesthesia. A lubricant gel containing a painkiller (lignocaine) is injected into the urethra. This takes away any pain, but you may still feel some discomfort, especially when the cystoscope is passed through the bladder neck, or if the bladder is overfilled with fluid. Rigid cystoscopy can be performed under local anaesthesia in women, but usually requires general or spinal anaesthesia in men.
Flexible cystoscopy in a man is performed with him lying flat on his back, but a woman will be asked to bend her knees and open her thighs so that the opening of the bladder tube can be reached. Rigid cystoscopy is performed with the patient lying on his back, his legs raised and placed in stirrups. Usually the procedure lasts about 15 to 30 minutes.
If the cystoscopy is going to be performed under general or spinal aeasthesia, you should not eat or drink for at least 6 hours before the procedure, and you should arrange for someone to take you home afterwards. You may be asked to provide a urine sample to be tested for infection, so do not empty your bladder an hour or two before the procedure. If there are signs of bladder infection, you may be given an antibiotic, so tell the doctor if you are allergic to any medicines. It is important to drink as much fluids as possible after the cystoscopy, so that the bladder and urethra are washed out.
What are the risks?
Cystoscopy is a sterile procedure, which means that the instruments are sterilized to kill all germs. The opening of the bladder tube is also cleansed with antiseptic solution before the cystoscope is inserted, so the risk of introducing germs into the bladder is minimized. However, bladder infection (cystitis) may occur after the procedure, especially if the bladder does not empty well, because germs multiply quickly in stagnant urine.
There is usually some burning or pain on passing urine, or blood in the urine for a day or two after the procedure, especially if a biopsy was taken. Sometimes it is necessary for the doctor to place a tube (catheter) in the bladder, which may be left in for a few days. If pain or bleeding continues for more than a day or two, or if you have any fever or chills, you should consult the doctor.
What are the limitations of the procedure?
Cystoscopy is a very reliable way of evaluating the bladder, and it is rare for a properly trained specialist (urologist) to miss the diagnosis of a serious condition such as bladder stones or cancer. Comparing rigid and flexible cystoscopy, the rigid cystoscope has the advantages in that it provides a better quality picture and allows the passing of larger instruments, but it may damage the bladder tube more easily. Flexible cystoscopy provides more comfort for the patient and can be performed without general anaesthesia, but its picture is not quite as good, and it can only take very thin forceps, so biopsies may be too small to make a diagnosis.