Cystoscopy

What is a cystoscopy?

A cystoscopy is a common investigation performed by urologists using an instrument called a cystoscope. A cystoscope is a thin telescope, usually with an attached camera, which is passed into the bladder via the urethra. The urethra is the tube that takes urine from your bladder to the outside of your body.

Using the cystoscope, the surgeon can see images from the camera displayed on a monitor. The cystoscope also has side ports where thin instruments can be inserted. For example, the surgeon may take a small sample or biopsy from the lining of the bladder by using a thin instrument which is passed down a side port.

When is a cystoscopy required?

A cystoscopy can help to diagnose the cause of symptoms such as:

• frequent urinary tract infections
• blood in your urine (haematuria)
• 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 stricture or narrowing of the urethra).

A cystoscopy is often found to be normal. However, this helps to rule out certain causes of symptoms. Cystoscopy may also be used to monitor progress of conditions. For example, some patients have a routine surveillance cystoscopy after treatment for a bladder tumour. This helps to detect any early recurrence of the tumour which can be treated before it spreads further.

A cystoscopy is also frequently performed during the following procedures:

• to remove a stone from the bladder or, if a stone is lodged higher in a ureter, the surgeon may pass a wire into a ureter to access the ureters before using a finer telescope called a ureteroscope to visualise the ureters (the two ureters are the tubes that drain urine from the kidneys to the bladder)
• to obtain a urine sample from the ureters to check for infection or tumour which may involve one or both of the kidneys
• to remove small polyps or tumours from the lining of the bladder
• to insert a stent (a small tube or drain) into a narrowed or blocked ureter to help the flow of urine
• to perform a special x-ray of the ureters and kidneys. A surgeon can inject a dye into the ureters up towards the kidney. This shows up on x-ray pictures and helps to identify problems within the kidneys or ureters
• to remove the prostate gland by using a special type of cystoscope which ‘chips' away at the prostate gland in small sections at a time.

What happens during a cystoscopy?

Cystoscopy is usually performed as an outpatient procedure or day surgery admission. For the comfort of patients, it is usually done under a general anaesthetic, particularly if a rigid cystoscope is used.

In theatres, the opening to your urethra (at the end of the penis or the outside of the vagina) and the nearby skin will be cleaned. A numbing jelly is placed into the opening of the urethra to numb the lining of the urethra. This helps the cystoscope to pass into the urethra with as little discomfort as possible.

The cystoscope is gently moved up into the bladder. The surgeon will look carefully at the lining of the urethra and bladder. Sterile water is passed down a side port in the cystoscope to fill your bladder slowly. This makes it easier for the surgeon to see the lining of the bladder.

A routine cystoscopy is generally a short procedure. It may take longer if the surgeon performs additional tasks, such as taking a sample or biopsy from the lining of the bladder. If a biopsy is taken, the sample is sent away to be tested and examined under a microscope. It can take several days for the biopsy report to come back to the surgeon. Your surgeon will discuss the results and further treatment at a follow up appointment in the consulting rooms about a week after the procedure.

After the cystoscopy

Most cystoscopies are performed without any problems. For the next 24 hours you may have a mild burning feeling when you pass urine, and feel the need to urinate more often than usual. Your urine may look blood stained, particularly if a biopsy was taken. Occasionally, a urine infection develops shortly after a cystoscopy. This can cause a fever and high temperature, and pain or discomfort when you pass urine. A rare complication of the procedure involves damage to the bladder or ureters.

You should contact your surgeon if pain or bleeding is severe, if pain or bleeding lasts longer than 1 week or if you develop symptoms of infection, such as a fever.