Cystoscopy

Fig 1: Cystoscopy procedure.

What are the indications for a cystoscopy?

Cystoscopy is needed for a range of problems including:

• Blood in the urine

• Recurrent urinary tract infections.

• Urinary symptoms such as poor flow, frequency, urgency, incontinence

• Abnormalities of the wall of the bladder requiring a biopsy. 

• If you have had bladder cancer, to check if the cancer hasn’t recurred

• If you have a ureteric stent, to remove the stent.

What pre-operative work up is needed?

Your urologist will organise any necessary urine and blood tests and imaging scans at your consultation prior to your procedure.

If you take any blood thinning medication such as warfarin, plavix (clopidogrel) or anticoagulants, you should discuss with your urologist if these need to be stopped before your procedure. 

Please ensure you return any admission forms given to you to be filled out back to the hospital.

What happens on the day of the procedure?

You will be given fasting instructions prior to your admission (usually for 6 hours prior to the procedure). You should bring a list of your medications, any recent scans or reports with you to the hospital. After you are admitted from the admission lounge, your urologist will see you to discuss the surgery. An anaesthetist will see you to discuss the anaesthetic (either general or alternative options) before you are taken to the operation theatre.  

What does this procedure involve?

After a general anaesthetic, you will be given injection of antibiotics before the procedure to reduce risk of infection. Cystoscopy involves inspection of the bladder and urethra with a telescope passed along the urethra (waterpipe). A flexible (bendy) or a rigid cystoscope may be used. A flexible cystoscopy may be performed under local anaesthetic only but a rigid cystoscopy generally requires a general anaesthetic.

Your urologist may take a small biopsy of an abnormal area and cauterise the biopsy site. Other adjunct procedures may also be carried out as necessary, which your urologist will discuss with you prior – such as instillation of medication (e.g. intravesical BOTOX), stretching of the waterpipe (urethral dilatation) or bladder (hydrodistention) or putting dye into the tubes draining urine from the kidneys (retrograde studies).

Occasionally a catheter may be left in your bladder overnight, which is usually removed the following morning. However, most patients go home on the same day as their procedure, provided they have passed urine satisfactorily

Are there any risks or side-effects of a cystoscopy?

• Mild burning on passing urine for a few days 50-100%

• Blood in the urine for a few days after the procedure 10-20%

• Infection of the bladder requiring antibiotic treatment 2-5%

• Temporary insertion of a bladder catheter 2-5%

• Major anaesthetic or cardiovascular problems  - rare

What can I expect after discharge when I get home?

There are no external wounds or dressings after this procedure. You should drink lots of fluid for the first 24 to 48 hours, to flush out any blood or debris in your bladder and reduce the risk of infection. You can return to usual activities, driving and work when you are comfortable enough and when your GP is satisfied with your progress.

If you take any blood thinning medications, which were stopped prior to your procedure, you should resume these only after discussion with your urologist.   

If you develop a fever, frequent passage of urine, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP or the urologist immediately.

What follow-up will I need?

Your urologist will generally see you in the clinic in the next 4 weeks or alternatively as discussed with you prior to the procedure.