Cystoscopy
These instructions apply to flexible cystoscopy in the Ambulatory Care Clinic at Richmond Hospital, Delta Hospital, UBC Hospital and False Creek Surgical Centre.
Why do patients need cystoscopy?
Cystoscopy is one of the most commonly performed minor procedures in urology. It can be done for diagnostic purposes or to perform minor procedures in the lower urinary tract (bladder and urethra). Cystoscopy allows for direct visualization of the inside of the bladder and urethra. In males, the prostatic urethra can be evaluated, but the prostate tissue itself cannot - therefore cystoscopy is not a test to check for prostate cancer. We have the latest fully digital cystoscopes which are flexible and thin to minimize patient discomfort. As such, our patients experience minimal discomfort with flexible cystoscopy. Patients with infections or urethral strictures are more likely to experience discomfort or pain. The use of Narrow Band Illumination capability may be used to increase the detection of bladder cancers.
Cystoscopy provides information on the anatomic and functional status of the urinary tract. We will sometimes compliment the results of cystoscopy with urodynamics. The most common diagnostic indications for cystoscopy are:
Hematuria (blood in the urine).
Urinary dysfunction: slow stream, urinary frequency, incontinence, etc.
Surveillance (rechecks) for bladder cancer.
Minor procedures such as retrieval of ureteral stents, removal of small stones, urethral dilation and removal of small bladder tumours can also be performed.
How do I prepare for cystoscopy?
There is NO SPECIAL PREPARATION for your flexible cystoscopy. You do not need to fast or stop any medications prior to your cystoscopy. You can and should eat as you normally would prior to your cystoscopy. You do not need to stop blood thinners or anti platelet medications. You should empty your bladder when you arrive at the hospital for your cystoscopy so your ability to empty the bladder (the post-void residual) can be assessed.
How is cystoscopy done?
The test itself should take 5 minutes or less, but you will need to arrive early to register at admitting and change for the procedure. The total time at the hospital is usually 1 hour.
You will change into a gown to keep your regular clothes dry because the sterile water we use to fill the bladder which may spill. The steps are:
Enter the cystoscopy suite.
Lie flat on your BACK (face looking up at the ceiling).
Women will need to assume the 'frog leg' position (similar to when you have a pap smear): feet together, knees bent. We will ask you to let your knees fall outward to introduce the scope.
You can view the entire procedure as it is being done on one of the video monitors - or not, it’s up to you.
The cystoscope will be introduced into the urethra. The diameter of the scope is roughly half the size of the urethra so there should not be any difficulty inserting it unless the urethra is abnormally tight.
In order to minimize discomfort, we recommend you take long, slow deep breaths and relax the pelvic floor - let it go just as if you were urinating. This will allow the cystoscope to pass through the urinary sphincter more easily. The natural response is to tense up but this is the exact opposite of what you want to do.
The urethra and bladder will be inspected.
You may be given a single dose antibiotic if you are thought to be at increased risk of infection.
If your urethra is tight, we may need to dilate the urethra so the scope can be advanced into the bladder. In the rare case where dilation is required you are likely to be administered an antibiotic as prophylaxis against infection.
What are the risks of cystoscopy?
While cystoscopy is a minor procedure there are inherent risks associated with this test as there are for any test. These risks include:
Discomfort is expected in all patients; some patients experience pain. After their cystoscopy many patients volunteer that the anxiety they experienced in anticipation of the procedure was not justified but a few will have more pain than they expected. Having said that, with rare exception we discourage doing cystoscopy in the operating room with sedation or a general anesthetic as the risks of the sedation, the time off work and exponentially higher costs are difficult to justify. We will undertake cystoscopy in the operating room under exceptional circumstances but over 99% of patients tolerate flexible cystoscopy in ambulatory care with minimal issues and this is considered the standard of care for this procedure.
Urinary tract infection. The risk of infection following cystoscopy in an anatomically normal urinary tract is ≤1%. If you are at increased risk of a urinary tract infection (elderly, prior infection with cystoscopy, abnormal anatomy such as inability to empty the bladder) you will be administered a single dose of prophylactic antibiotic at the time of the cystoscopy or provided a prescription for antibiotic. If you develop burning, urinary frequency, fever, pain or think you have an infection you should seek medical care.
Bleeding. Blood in the urine may occur following cystoscopy, especially in males with enlarged prostates or any patient with abnormal anatomy. More common in patients who are taking blood thinners or anti platelets. Most bleeding is self limited and can be addressed by drinking more fluids, urinating frequently to minimize the risk of clot formation and rest.
Urinary retention. An inability to urinate may occur in males who have pre-existing obstruction from the prostate. Any kind of instrumentation (including cystoscopy or catheterization) may precipitate an inability to urinate. This is an uncommon side effect. Proceed to emergency is you are unable to urinate following cytsocopy.
Other: as with any procedure, there may be rare events that occur. These include fainting (vasovagal episodes) and transient incontinence.
Patients should not anticipate any permanent disability following cystoscopy and the vast majority return to normal function immediately or within a few hours. Most patients may resume normal activities immediately following the cystoscopy.
What to expect after your cystoscopy
You should be able to resume to full normal activities immediately after your cystoscopy. Most people have some mild discomfort the first few times they urinate after the procedure and nothing more. The following MAY occur and should be considered normal:
Mild discomfort the first few times you urinate after the procedure. Expected to resolve within one day and frequently within hours of the cystoscopy.
Blood in the urine. If you required a urethral dilation or biopsy of the bladder, you may have more blood which should settle in 1-2 days
You should not have:
Heavy bleeding, or bleeding which persists more than a few days.
Fever.
Persistent pain with urination including pressure in the area of the bladder or flank pain.
If you have these symptoms, you may have a bladder infection. These occur in 1% or fewer of patients undergoing cystoscopy. Seek medical attention if you have any of these symptoms.