A cystoscopy is a medical procedure. It involves a doctor using an instrument called a cytoscope (a thin tube with a light and a small camera at the end) to look inside the bladder.
It is important in diagnosing conditions that affect the bladder and urinary system.
Why a cystoscopy?
A cystoscopy allows a doctor to see inside the bladder. It is often recommended for people who have blood in their urine. It can also be used to find and treat bladder cancer and bladder stones.
How to prepare for the procedure
Your preparation for a cystoscopy depends on the type of anaesthetic being used.
If you are going to have a general anaesthetic you must stop eating and drinking several hours before the procedure.
If you are going to have a spinal anaesthetic (an epidural) you must stop eating and drinking several hours before the procedure.
If you are having a local anaesthetic you can eat and drink as usual.
Ask your doctor about medications. You might need to stop taking medicines such as aspirin for a few days before the procedure. But don't stop any medications without asking your doctor first.
What happens during the procedure?
A cystoscopy is usually an outpatient procedure. You will be able to go home the same day.
During the cystoscopy, the cytoscope is inserted into the tube that carries urine out of the body (the urethra). It is moved into the bladder. Your urologist can then see images of the inside of the bladder on a screen.
- A flexible cystoscope will be used if the specialist only needs to look inside the bladder. If you have this procedure, you will probably receive a local anaesthetic gel or spray to numb the area.
- A rigid cystoscope will be used to take a sample of bladder tissue or treat the area by passing small surgical instruments down the tube. In this case you will probably have a general anaesthetic or an epidural (spinal anaesthetic).
A cystoscopy can be uncomfortable, but it is usually not painful.
Care after a cystoscopy
You might feel tired and sick after a cystoscopy. You might feel some pain in your groin.
You might also feel a burning sensation when you pass urine. You might see some blood in your urine. This will clear up within a few days.
What can go wrong
Serious complications after a cystoscopy are rare.
For a few days after a flexible cystoscopy, you may see blood in your urine and feel mild discomfort when passing urine.
With a rigid cystoscopy, you may have some difficulty controlling your bladder (incontinence) for the first few hours after the procedure, but this will usually settle. You may also have some discomfort, need to pass urine urgently or have blood in your urine for a few days.
Bleeding persists very rarely. If it does, discuss with your doctor.
There is also a small risk of developing a urinary tract infection. This can affect your urethra, bladder or kidneys.
If you experience any side effects, such problems with bleeding or passing urine or develop a fever, it is important to see your doctor as soon as possible.
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A cystoscope is a thin tube with a camera and light on the end. During a cystoscopy, a doctor inserts this tube through your urethra (the tube that carries urine out of your bladder) and into your bladder so they can visualize the inside of your bladder. Magnified images from the camera are displayed on a screen where your doctor can see them.
Your doctor might prescribe antibiotics before and after the procedure if you have a UTI or a weak immune system. You may also need to give a urine sample before the test. If your doctor plans to give you general anesthesia, you’ll feel groggy afterward. That means before the procedure, you’ll need to arrange a ride home. Plan to take time to rest at home after the procedure, as well.
Ask your doctor if you can continue taking any regular medications. Certain medications can cause excessive bleeding during the procedure.
The procedure might be performed in a hospital or doctor’s office. You will need some form of anesthesia, so talk to your doctor about your options before the procedure. These include:
Local anesthesia: Outpatient procedures generally involve local anesthesia. This means you’ll be awake. You can drink and eat normally on your appointment day and go home immediately after the procedure.
General anesthesia: General anesthesia means you’ll be unconscious during the cystoscopy. With general anesthesia, you may need to fast for several hours ahead of time.
Regional anesthesia: Regional anesthesia involves an injection in your back. This will numb you below the waist. You might feel a sting from the shot.
With either regional or general anesthesia, you will probably need to stay in the hospital for a few hours after the procedure.
Just before the cystoscopy, you need go to the bathroom to empty your bladder. Then, you change into a surgical gown and lie down on your back on a treatment table. Your feet may be positioned in stirrups. The nurse may provide you with antibiotics to help prevent a bladder infection.
At this point, you’ll be given anesthesia. If you get general anesthesia, this will be all that you are conscious of until you wake up. If you get a local or regional anesthetic, you may also be given a sedative to relax you. Your urethra will be numbed with an anesthetic spray or gel. You’ll still feel some sensations, but the gel makes the procedure less painful. The doctor will lubricate the scope with gel and carefully insert it into the urethra. This may burn slightly, and it may feel like urinating.
If the procedure is investigatory, your doctor will use a flexible scope. Biopsies or other surgical procedures require a slightly thicker, rigid scope. The bigger scope allows surgical instruments to pass through it.
Your doctor looks through a lens as the scope enters your bladder. A sterile solution also flows through to flood your bladder. This makes it easier for your doctor to see what’s going on. The fluid might give you an uncomfortable feeling of needing to urinate.
With local anesthesia, your cystoscopy may take less than five minutes. If you’re sedated or given general anesthesia, the entire procedure may take 15 to 30 minutes.
It’s normal to have a burning sensation while urinating for two to three days after the procedure. You may need to urinate more frequently than usual. Don’t try to hold it, as the blood in your bladder could clot and create a blockage.
Blood in the urine is also common after the procedure, especially if you had a biopsy. Drinking lots of water helps ease the burning and bleeding.
Some people develop more serious complications, including:
Swollen urethra (urethritis): This is the most common complication. It makes urination difficult. If you can’t urinate for more than eight hours after the procedure, contact your doctor.
Infection: In rare cases, germs enter your urinary tract and cause infection. Fever, strange smelling urine, nausea, and lower back pain are all symptoms of infection. You might need antibiotics.
Bleeding: A few people suffer from more serious bleeding. Call your doctor if this happens.
You should also call your doctor if you:
- develop a fever higher than 100.4ºF (38ºC)
- have bright red blood or clots of tissue in your urine
- are unable to void, even though you feel the need
- have persistent stomach pain
Give yourself time to rest. Drink lots of fluids and stay close to the bathroom. Holding a damp, warm washcloth over your urethra can help relieve any pain. If your doctor gives you permission, take pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil).
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If you were given general anesthesia, have someone stay with you. after the procedure. You may feel sleepy or dizzy. Don’t drink alcohol, drive, or operate complex machinery for the rest of the day.
If you had a biopsy done, you’ll need time to heal. Avoid heavy lifting for the next two weeks. Ask your doctor when it’s safe to have sexual intercourse.
Your doctor might have your results immediately, or it could take a few days. If you had a biopsy, you’ll have to wait for lab results. Ask your doctor when to expect any news.
This information will help you get ready for your cystoscopy (sis-TOS-koh-pee) and other related procedures at Memorial Sloan Kettering (MSK). It describes cystoscopies done in the operating room.
About Your Cystoscopy
A cystoscopy is a procedure that lets your healthcare provider look at your urethra, bladder, and the openings to your ureters (the tubes that carry urine from your kidneys to your bladder) (see Figure 1). It’s done to look for problems in your urinary tract and bladder, such as a blockage in your urethra or tumors in your bladder.
A cystoscopy is done using a thin, hollow, lighted tool called a cystoscope. Your healthcare provider will put the cystoscope into your urethra and slowly move it into your bladder. Small surgical tools can be put through the cystoscope to remove stones, fulgurate (burn off) small growths, or take small samples of tissue for a biopsy.
Other procedures
During your cystoscopy, you may also have 1 or more of the following procedures:
- Transurethral resection of a bladder tumor (TURBT). During a TURBT, your healthcare provider will remove a bladder tumor using a tool that goes through the cystoscope.
- Ureteroscopy (YER-eh-ter-OS-koh-pee). During a ureteroscopy, your healthcare provider will put a thin tool called a ureteroscope through your urethra, bladder, and ureter. This procedure is done to see if there’s anything blocking or getting in the way of the flow of urine.Figure 2. Parts of your kidney
- Retrograde pyelogram. During a retrograde pyelogram, your healthcare provider will guide small, thin, catheters (flexible tubes) up to your kidneys through your ureters. They’ll inject contrast media through the catheters into your kidneys. Then, they’ll take x-rays of your renal pelvis and ureters (see Figure 2). The contrast media makes these areas stand out so your healthcare provider can see them better. This procedure is done to see if there’s anything blocking or getting in the way of the flow of your urine.
- Removal of stones or blood clots from your bladder.
- Placement, replacement, or removal of ureteral stents. The stents will keep your ureters open. That helps urine flow from your kidneys to your bladder. If your kidney function has improved, your healthcare provider may decide to remove the stent(s) and you may not need a replacement.
- Botox bladder injections. During a Botox bladder injection, your healthcare provider will use a needle to inject Botox into your bladder. Botox is a drug used medically to treat muscle problems that lead to spasms. The Botox injection will help reduce bladder spasms and incontinence. Incontinence is leakage of urine (pee) or stool (poop) that you can’t control.
Before Your Procedure
Ask about your medications
Tell your healthcare provider what medications you’re taking, including prescription and over-the counter medications, patches, creams, and herbal supplements. You may need to stop taking some of them before your procedure.
If you take medication to thin your blood, ask the healthcare provider who prescribes it for you when to stop taking it. Blood thinners are used to treat blood clots or to prevent a heart attack or stroke. Examples include:
- aspirin
- warfarin (Coumadin®)
- dalteparin (Fragmin®)
- heparin
- tinzaparin (Innohep®)
- enoxaparin (Lovenox®)
- clopidogrel (Plavix®)
- cilostazol (Pletal®)
- dabigatran (Pradaxa®)
- apixaban (Eliquis®)
Tell your healthcare provider if you’ve had an allergic reaction to contrast media in the past.
Arrange for someone to take you home, if needed
If you’re having anesthesia (medication to make you sleep during your procedure), you must have a responsible care partner take you home after your procedure. Make sure to plan this before the day of your procedure.
If you don’t have someone to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s usually a charge for this service, and you’ll need to provide transportation.
7 days before your procedure
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your procedure. These things can cause bleeding.
If your healthcare provider gives you other instructions, follow those instead.
For more information, read Herbal Remedies and Cancer Treatment.
2 days before your procedure
The Day Before Your Procedure
Note the time of your appointment
A staff member from the Admitting Office will call you after 2:00 p.m. the day before your procedure. If your procedure is scheduled for a Monday, they’ll call you on the Friday before.
The staff member will tell you when to arrive at the hospital for your procedure. They’ll also tell you where to go. This will be one of the following locations:
- Presurgical Center (PSC) on the 2nd Floor
1275 York Avenue (between East 67th and East 68th Streets) New York, NY 10065M elevator to the 2nd floor
- Presurgical Center (PSC) on the 6th Floor
1275 York Avenue (between East 67th and East 68th Streets) New York, NY 10065B elevator to the 6th floor
If you don’t get a call by 7:00 p.m., please call 212-639-5014.
- Do not eat anything after midnight the night before your procedure. This includes hard candy and gum.
- Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
- Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.
The Day of Your Procedure
Things to remember
- Take a shower with soap and water. You can brush your teeth and rinse your mouth.
- Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
- Don’t wear any metal objects. Remove all jewelry, including body piercings.
- Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
- Bring only the money you may want for small purchases (such as a newspaper).
MSK’s parking garage is on East 66th Street between York and 1st avenues. If you have questions about prices, call 212-639-2338.
To reach the garage, turn onto East 66th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital.
There are other parking garages located on:
- East 69th Street between 1st and 2nd avenues.
- East 67th Street between York and 1st avenues.
- East 65th Street between 1st and 2nd avenues.
What to expect
Your nurse will place an intravenous (IV) line in your vein. The IV line will be used to give you anesthesia (medication to make you sleep) before and during your procedure.
Once you’re asleep, your healthcare provider will do the cystoscopy and any other procedures you’re having. They may put a urinary (Foley) catheter into your bladder at the end of your cystoscopy to help drain your urine into a bag.
Your procedure will take up to 1 hour.
After Your Procedure
In the hospital
When you wake up, you’ll be in the Post Anesthesia Care Unit (PACU). A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. They’ll also check your urine output to make sure your flow of urine isn’t blocked.
You may still have the urinary catheter in your bladder. It may be removed before you’re discharged or a few days after your procedure.
- If your catheter is removed before you go home, you must urinate before you’re discharged.
- If you go home with the catheter in place, your nurse will show you how to care for it before you go home.
Your nurse will explain your discharge instructions to you and your caregiver before you go home.
At home
- You may need to take medication(s) at home, such as antibiotics to prevent infection or medications to relieve discomfort. Follow the instructions your healthcare provider gives you.
- Don’t drive for 24 hours after your procedure.
- Ask your healthcare provider when you can go back to work.
- Drink 8 (8-ounce) glasses of liquids every day for the first 2 weeks after your procedure. Avoid drinking liquids after 8:00 p.m. so you don’t have to go to the bathroom during the night.
- Be sure to get plenty of rest.
Changes when you urinate
You’ll most likely have blood in your urine (hematuria) after your procedure. This should go away within 1 week.
You may also urinate more often than usual and have pain or burning when you urinate. These symptoms can last for 3 to 4 weeks, but they should slowly get better as you heal. Drinking lots of liquids will also help.
If these changes don’t get better or if they get worse, call your healthcare provider. You may have a urinary tract infection (UTI).
Urinary catheter
You may feel a strong urge to urinate while the catheter is in place. This happens because the small inflated balloon that keeps it in place may make your bladder feel full. Relaxing and letting the urine flow will decrease this urge.
Biopsy or tumor removal
If you had a biopsy or a tumor removal, you’ll have a scab inside your bladder. The scab will loosen within a month. If it loosens before the wound is completely healed, it may cause bleeding. If this happens, rest and drink more liquids. Most bleeding will stop within 3 to 4 hours, but it’s best to rest that day to help stop the bleeding.
Call your healthcare provider if the bleeding doesn’t stop or if you can’t urinate.
Urinary stents
- You may feel the stents. They usually feel like pain in your kidney (your side or middle to upper back). The pain may be worse when you urinate or exercise. Your healthcare provider may give you medication to help with the pain.
- Drink plenty of liquids while you have the stents.
Activity
- If you need to go on car trips that are longer than 1 hour for 1 week after your procedure, talk with your healthcare provider.
- Don’t lift objects heavier than 10 pounds (4.5 kilograms) for 2 weeks after your procedure.
- Don’t do strenuous exercise, such as tennis, jogging, or exercise programs, for 2 weeks after your procedure.
- You can walk and climb stairs right away after your procedure.
Follow-up care
If you had ureteral stents placed during your procedure, call your healthcare provider’s office to schedule a follow-up appointment. The stents will need to be changed every 3 to 6 months, or as instructed by your healthcare provider.
When to Call Your Healthcare Provider
Call your healthcare provider if you have:
- Continuous bright red blood or blood clots in your urine
- Bleeding (pink urine) for more than 1 week that isn’t getting better
- Pain or burning when you urinate for more than 3 days that isn’t getting better
- Frequent urination for more than 3 days that isn’t getting better
- A fever of 101 °F (38.3 °C) or higher
- Shaking chills
- Pain in your lower back
- An inability to urinate