Cystoscopy- Frequently Asked Questions

We receive numerous questions from patients regarding Cystoscopy. Many patients are scared to undergo this particular procedure and often stop going to the doctor once Cystoscopy is advised. Therefore, let us learn a little more about Cystoscopy in this article.

What is Cystoscopy?

A cystoscopy is a procedure done by a urologist, a doctor specializing in the urinary system, to look at the inside of the bladder and the urethra. the urologist uses a scope to look at the inside of the bladder and also it's lining and in the urethra. The procedure may also be done to remove a bladder stone, take tissue for biopsy or to place a catheter inside.

When is Cystoscopy done?

Cystoscopy is done to check for any problems in the bladder and its lining. It is recommended for the following issues:

• Frequent urinary tract infections (UTIs)
• Hematuria, or blood in the urine
• Urinary frequency, or urinating more than 10 times a day
• Urinary urgency, or the sudden, strong urge to urinate
• Urinary retention, or when the bladder does not empty completely
• Urinary incontinence, or urine leakage
• Pain or burning before, during, or after urination
• Trouble starting the flow of urine, completing urination, or both
• Abnormal cells found in a urine sample

What is Cystoscopy with Hydrodistension?

Under general or regional anesthesia, this procedure uses a cystoscope to look inside the bladder after slowly stretching it with fluid (hydrodistention). This allows the physician to see changes inside the bladder that is typical of IC, including the presence of pinpoint-sized red marks on the bladder wall, also called glomerulations or petechial hemorrhages. This procedure also allows doctors to see Hunner’s lesion's(patches), which are present in a small number of people with IC.

Is Cystoscopy with Hydrodistention mandatory for the diagnosis of Interstitial Cystitis?

There is a huge dispute regarding this. A section of the medical practitioners believes that cystoscopy is not mandatory and IC should be diagnosed by following the process of elimination. Whereas another segment strongly believes that without Cystoscopy it is impossible to diagnose Interstitial Cystitis, especially it is required to check if the patient has Hunner's Lesion.

The American Urological Association’s guidelines for IC consider cystoscopy with hydrodistention under anesthesia to be a third-line treatment for IC. This means that less invasive therapies should be attempted prior to this procedure. It may reduce pain and discomfort in some IC patients, which can last 3 to 6 months. However, not everyone benefits from this procedure, and it may take up to several weeks to notice any symptom improvement. 

How is Cystoscopy done?

The cystoscopy procedure usually takes about 30 minutes and is done on an outpatient basis. The urologist will recommend that the patient empty his or her bladder before the procedure begins. The step-by-step process may be similar to this:

1. The patient will be lying on an exam table. The urologist may place some gel or a local anesthetic in the patient’s urethra to aid in reducing any discomfort while the procedure is taking place.
2. The urologist will gently insert the cystoscope through the urethra into the bladder. The patient may feel discomfort or a pressure sensation. The cystoscope is a long, thin tube with a lens on one end that the urologist looks through or, on a camera-equipped scope, visualizes on a monitor. The other end of the cystoscope that is inserted into the urethra has a tiny lens with a light that allows the urologist to look inside the urethra and bladder. There are two types of cystoscopes. One has a flexible insertion tube, while the other is stiff.
3. Once the cystoscope is inserted, the urologist will need to instill some sterile water or a normal saline solution from the cystoscope into the bladder. The water/saline fills and stretches the bladder so the urologist can get a better view of the bladder wall.
4. As the liquid enters the bladder, the patient may again feel some discomfort as well as the urge to urinate. If necessary, the urologist can remove some of the liquid from the bladder during the procedure. Once the procedure is over, the urologist may drain the patient’s bladder, or ask the patient to use the bathroom to urinate before he or she leaves the office.

During the brief procedure, the urologist examines the lining of the urethra as the cystoscope passes through it and then into the bladder. Once the cystoscope reaches the bladder, the urologist examines the lining of the bladder. During the procedure, the urologist can remove a bladder stone or take a biopsy if needed.

How the patient may feel after the procedure?

Typically, a cystoscopy is done in the urologist’s office and afterward most patients go home the same day as the procedure. Sometimes after a cystoscopy procedure, the patient may:

• Feel a burning or soreness around the urethra.
• Feel slight burning while urinating.
• Notice small flecks of blood in the urine.
• Feel mild discomfort in the bladder area or kidney area when urinating.
• Need to urinate frequently or urgently.

These problems should not last more than a day after the procedure. If pain persists, bloody urine lasts longer than 48 hours, or the patient develops a fever, the patient should call the doctor. If necessary, the urologist may prescribe an antibiotic to take for a couple of days after the procedure to prevent an infection. If you have severe pain, chills, or fever (these could be signs of an infection), it is important to call the urologist’s office and explain the symptoms.