What Is a Cystoscopy?

What to expect when undergoing this test

A cystoscopy is an interventional procedure that provides an immediate view of the interior of the bladder and/or urethra, the tube that carries urine from the bladder to outside the body. The test is used for diagnosis and treatment of medical conditions that affect these organs. A thin tube (cystoscope) is inserted into the urinary opening, threaded through the urethra, and into the bladder. A small camera attached to the cystoscope relays live video feed to a monitor, which can be viewed by your doctor.

what to expect during a cystoscopy
Illustration by Emily Roberts, Verywell

Purpose of Test

A cystoscopy can be used to investigate symptoms that involve the urethra or the bladder. You may need to have a cystoscopy to determine the cause of concerns such as:

  • Blood in the urine
  • Painful urination
  • Urinary retention (inability to urinate)
  • Recurrent bladder infections
  • Frequent urination
  • Pelvic pain

However, this invasive procedure is typically done after an abnormality of the urethra or bladder has been discovered on an X-ray, magnetic resonance imaging (MRI), or a computed tomography (CT) scan, which are non-invasive tests. Cystoscopy provides your doctor with a different view that can help lead to a diagnosis.

Upon visualizing the inside of your urethra and bladder, your doctor may be able to identify structural abnormalities, areas of inflammation, growths, or ulcerations and diagnose a number of conditions on sight, including:

  • Interstitial cystitis
  • Bladder stones
  • Ulcerations inside the urethra or bladder
  • Growths or cancer
  • Prostate enlargement
  • Urethral strictures (regions of urethral narrowing)

If a diagnosis cannot be made based on appearance alone, your doctor may obtain a sample of abnormal tissue for biopsy during the procedure so that it can be evaluated. (A cystoscope is often equipped with a tool that can quickly this sample.) If you have a biopsy, this does not necessarily mean that you have cancer. Biopsy is used to examine areas of infection, inflammation, and benign growths as well.

If a cystoscopy is being done for therapeutic reasons, it may be to visualize the bladder or urethra to allow for the removal of small growths, bladder stones, or to treat urethral strictures.

Limitations

A cystoscopy cannot identify every problem involving the bladder or urethra. For example, it often does not find the cause of urinary incontinence or neurogenic bladder. A cystoscopy also is not useful in diagnosing kidney disease.

Risks and Contraindications

In most cases, a cystoscopy is a safe, common procedure without complications. Rare complications can occur, such as an infection or injury. Complications related to general anesthesia are not common and can include respiratory or cardiac problems.

Before the Test

If you are going to have a cystoscopy, your doctor will discuss the procedure with you ahead of time. You may or may not need a biopsy or treatment during your procedure, and that will dictate if you have it done at your doctor's office or elsewhere. Your doctor and medical team will discuss your specific situation with you and explain the plan, as well as what you need to do to prepare. For example, you may be asked to avoid urinating for about half an hour prior to the test so that your doctor can send a urinalysis.

Location

The level of anesthesia that will be used, if it is used at all, will mainly dictate where your procedure is done. This decision depends on how complicated your condition is and the findings of your preliminary tests. Most cystoscopy procedures are performed in your doctor's office with local anesthesia. But if she anticipates that your procedure may take longer than average or may involve painful or extensive removal of tissue or repair of strictures, you will likely need to have your cystoscopy done under general anesthesia in a hospital or surgical center.

Timing

You should expect to spend about an hour or so at the doctor's office if you are having a simple procedure done there. If you are having a cystoscopy under general anesthesia, anticipate spending approximately half a day at the hospital or surgical center.

The cystoscopy itself generally takes about 10 to 30 minutes to perform. The time can vary based on the reason you're getting the test done and what is discovered during the procedure. Your medical team can give you a more specific estimate based on your symptoms and preliminary imaging tests.

What to Wear

You will be asked to wear a gown for the procedure, so you can wear anything you want on the day of the test.

Food and Drink

If you are having general anesthesia, you will be asked to abstain from food and drink for about six to eight hours prior to your procedure.

Cost and Health Insurance

As with most tests, your insurance may require a pre-authorization request. The staff at the facility where your cystoscopy will be done will take care of this, but you can check with them and your insurance company ahead of time to confirm. You may need to pay a co-pay, and you can verify the amount with your health insurance carrier in advance.

If you are paying for the procedure completely out of pocket, you should expect to pay several hundred dollars for a simple diagnostic procedure and several thousand dollars for a procedure that includes a biopsy or therapeutic treatment.

What to Bring

You should bring your order form (if provided), your health insurance card, a form of personal identification, and payment to cover the co-pay or the cost of the procedure, as applicable. If you will be getting general anesthesia, you should also make sure that you have someone who can drive you home after your procedure.

During the Test

You will meet with the urologist, who is the doctor who will perform your test. You will have other team members involved in your care as well, and these may include a surgical assistant, a nurse, and an anesthesiologist or anesthetist.

You will likely have more people involved in your procedure if you are having it done in an operating room, and fewer people if you are having it done in a doctor's office.

Pre-Test

Prior to your test, you will be asked to fill out several forms. These will include an agreement to pay for the test or to authorize your health insurance to pay for it, a patient privacy form, and a consent form stating that you understand the purpose and risks of the procedure.

You will then be asked to undress from the waist down, put on a gown, and empty your bladder. When your medical team is just about ready to perform the test, you will lie down on an exam table and place your feet in stirrups.

Local anesthetics used for a cystoscopy are typically in the form of a gel or other jelly-like substance. If you are to receive this, it will be inserted into the urethra. The doctor will wait a few minutes for the anesthetic to effectively numb the area before inserting the cystoscope.

If your procedure will be done under general anesthesia, you will have an IV placed in your arm or hand, and the anesthetic will be injected. You will also be hooked up to oxygen level and heart rate monitors, which will be checked throughout the procedure.

Throughout the Test

The cystoscope will then be inserted into the urinary opening. It will make its way to your bladder, with your doctor's help, via the urethra. Both may be of interest to your doctor, who will pause at times to view them on the monitor.

Your doctor may use a flexible cystoscope or a rigid cystoscope, which are generally the same size. There are advantages to each. For example, rigid cystoscopes tend to have a better camera and allow your doctor to have more control for removal of a mass or a stone, while flexible cystoscopes tend to produce less discomfort. Your cystoscopy may involve a white or a blue light to visualize the bladder and urethra. Blue light cystoscopy may be better for detecting bladder cancer.

A solution of saline or sterile water will be inserted into your bladder via the cystoscope, once in position. The solution expands the bladder, allowing your doctor to get a more detailed view. You may feel some pressure at this point.

If your doctor finds an abnormal growth, a biopsy may be done during your cystoscopy. While your doctor may have anticipated the need for this in advance, the decision to perform a biopsy may also be made in the moment. It only takes seconds for your doctor to obtain a tissue sample, and you may feel a slight pinch or a cramping sensation during the biopsy.

If you need to have a procedure to remove a mass or a bladder stone or to expand a stricture, it will be performed at this time. This is generally planned in advance.

At the end of the cystoscopy—which generally takes half an hour or less, unless a biopsy or treatment is being performed—your doctor will remove the cystoscope and you should not need any stitches or bandages.

Post-Test

As long as you are feeling fine, you will be discharged once your team verifies that you are able to empty your bladder. You will be directed to a restroom or provided with a bedpan; ask for assistance, if needed.

If you had general anesthesia, it will take an hour or so for you to feel awake. Staff will make sure that you can walk without assistance before allowing you to head home with someone who can drive you.

If a tissue sample was collected, it will be sent to a lab for testing.

After the Test

After the procedure, you may experience a slight burning sensation when you urinate and see a small amount of blood in your urine. You may also feel the need to urinate frequently, even though the amount you produce each time may be low. This is normal and can be expected for up to 24 hours after the procedure.

Managing Side Effects

If you experience significant bleeding, incontinence, urinary retention, or if you see blood clots in your urine, call your doctor promptly. If you develop fevers, chills, or if your urine appears cloudy, you may have a urinary infection, and you should call your doctor.

Interpreting Results

Your test results are based on your doctor's observation of your bladder and urethral anatomy during the test, as well as the biopsy results (if applicable). Your doctor may discuss the results with you during the test itself or immediately afterward, or she may schedule a follow-up appointment later to discuss the results and next steps in detail.

Follow-Up

The follow-up plan depends on your results. If you have a urethral stricture, for example, this may need to be repaired with a procedure. If you have an enlarged prostate, this can be treated with medication or surgery. And if you have a benign mass, it may need to be removed if it is causing symptoms. If it is discovered that you have cancer of the bladder, you may need to have chemotherapy, radiation, or surgery, or a combination of these treatments.

A Word From Verywell

Conditions that affect the bladder or urethra can be very uncomfortable, causing pain, or discomfort with urination, and even in between urinating. Having an interventional procedure may also briefly cause additional discomfort. In general, cystoscopy is well tolerated with few, if any complications. Once diagnosed, medical conditions that involve the bladder or urethra can be effectively treated.

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