Cystoscopy: Types, Symptoms, Causes, Risk, Diagnosis & Recovery

Cystoscopy can be tailored to address specific needs, with different variations depending on the doctor's goals and the patient's condition. Here are some common types of cystoscopy:

Based on Cystoscope Type

1. Flexible Cystoscopy: This is the most common type, using a thin, bendable cystoscope that easily navigates the urethra's curves. It offers greater comfort for patients and is often preferred in outpatient settings.
2. Rigid Cystoscope: This type utilises a thicker, rigid cystoscope that provides a clearer, magnified view of the bladder. It might be used for procedures requiring more precise manipulation or where a larger working channel is needed for instruments. However, due to its rigidity, it can cause more discomfort.

Based on Procedural Techniques

1. Cystoscopy with Cystoscopy Fluid: During this procedure, sterile fluid is instilled into the bladder to distend it. This allows for better visualisation of the bladder wall and helps identify abnormalities.
2. Cystoscopy with Anesthesia: In some cases, local or general anaesthesia may be used. Local anaesthesia numbs the urethra and bladder area, reducing discomfort during the procedure. General anaesthesia induces sleep, making the patient unaware of the procedure altogether. The choice of anaesthesia depends on the complexity of the procedure, patient preference, and potential anxiety.

Based on Purpose

1. Diagnostic Cystoscopy: This is the primary type used to diagnose the cause of urinary tract problems. The doctor examines the bladder and urethra for any abnormalities such as inflammation, stones, tumours, or structural issues.
2. Cystoscopy with Minor Procedures: This type combines diagnostic evaluation with minor procedures performed through the cystoscope. Examples include:
   1. Bladder biopsy: A small tissue sample is taken from the bladder lining for further analysis under a microscope to diagnose conditions like bladder cancer.
   2. Removal of bladder stones: Small stones can be retrieved using instruments passed through the cystoscope.
   3. Treatment of urinary incontinence: Certain procedures can be done to improve bladder control, such as injecting bulking agents around the urethra for added support.
   4. Urethral dilation: In cases of urethral strictures, a balloon catheter is inserted to stretch the narrowed area and improve urine flow.

Several symptoms can indicate urinary tract problems that may warrant a cystoscopy. Here are some common symptoms and what they might suggest:

1. Frequent urination (micturition): This refers to needing to urinate more often than usual, typically more than eight times a day. It can be disruptive to daily activities and sleep (nocturia - frequent urination at night).

2. Urgent urination: Feeling a sudden and strong urge to urinate, with difficulty holding urine (urgency). This can be quite uncomfortable and lead to accidents if not reached a restroom quickly.

3. Burning or stinging sensation during urination (dysuria): This is a common symptom that can be quite uncomfortable and make urination difficult.

4. Pain in the lower abdomen or pelvis: This pain can be constant or come and go, and may worsen with urination. It can be a sign of bladder irritation or inflammation.

5. Gross hematuria: Visible blood in the urine, which can range from pink to red. This is a concerning symptom and requires immediate medical attention.

6. Microscopic hematuria: Blood in the urine that is too small to see with the naked eye and can only be detected with a urine test. While less alarming than gross hematuria, it still warrants investigation.

7. Pelvic pain: Pain in the lower abdomen or pelvis that may be constant or come and go. This pain can be unrelated to urination but sometimes worsens with it.

8. Difficulty urinating: This can manifest as hesitation or straining to start urination, or feeling like the bladder isn't emptying completely. It can be caused by blockage or weakness in the urinary tract.

9. Urinary incontinence: Leaking urine unintentionally. This can range from occasional dribbling to complete loss of bladder control. There are different types of incontinence, such as stress incontinence (leakage with coughing or exercise) and urge incontinence (leakage due to a sudden urge to urinate).

Urinary tract problems can stem from a variety of factors that disrupt the normal functioning of the urinary system. Here are some of the common causes:

1. Urinary Tract Infections (UTIs):  These are the most frequent culprits, particularly in women due to the shorter urethra allowing for easier bacterial entry. E. coli, a type of bacteria commonly found in the intestines, is a frequent offender in UTIs. Sexual activity, incomplete bladder emptying, and certain birth control methods can increase the risk of UTIs.

2. Bladder Stones:  Minerals dissolved in urine can crystallise and form hard deposits in the bladder. These stones can irritate the bladder lining, causing pain, blood in the urine, and difficulty urinating. Dehydration, certain dietary factors, and a history of UTIs can contribute to bladder stone formation.

3. Urinary Incontinence:  Loss of bladder control can be caused by several factors. Weakening of the pelvic floor muscles, which support the bladder and urethra, is a common culprit, especially after childbirth or with age. Neurological conditions like stroke, Parkinson's disease, and multiple sclerosis can also affect bladder control. Additionally, an enlarged prostate gland in men can obstruct the urethra and lead to incontinence.

4. Urethral Strictures:  Scarring or inflammation can narrow the urethra, the tube that carries urine from the bladder to outside the body. This narrowing can obstruct urine flow, causing difficulty starting urination, a weak stream, and incomplete emptying of the bladder. Urinary tract infections, injuries to the pelvis, and certain medical procedures can contribute to urethral strictures.

5. Bladder Cancer:  This is a less frequent cause of urinary tract problems, but blood in the urine can be a warning sign. Other symptoms of bladder cancer may include frequent urination, urgent urination, and pelvic pain. Smoking is a major risk factor for bladder cancer, along with exposure to certain chemicals and a family history of the disease.

While cystoscopy is a generally safe procedure, there are some factors that can increase the risk of complications. It's important to discuss these with your doctor before the procedure to ensure you understand the potential risks and benefits. Here are some key risk factors:

1. Urinary Tract Infection (UTI): If you have an active UTI, the procedure can worsen the infection and spread bacteria to the kidneys. Doctors typically recommend treating the UTI with antibiotics before scheduling a cystoscopy.

2. Bleeding Disorders: If you have a condition that affects blood clotting, such as haemophilia, you may be at higher risk for bleeding during or after the procedure.

3. Immunodeficiency: A weakened immune system can make you more susceptible to infections following cystoscopy.

4. Urethral Strictures: Narrowing of the urethra can make it difficult to insert the cystoscope and increase the risk of urethral damage. Your doctor will assess the severity of the stricture before deciding if cystoscopy is appropriate.

5. Previous Pelvic Surgery: Prior surgeries in the pelvic area, such as hysterectomy or prostate surgery, can alter the anatomy and make cystoscopy more challenging.

6. Medications like Blood Thinners: Taking medications that thin the blood, such as aspirin or warfarin, can increase the risk of bleeding during the procedure. Discuss with your doctor if you need to adjust your medication regimen before cystoscopy.

7. Age: Older adults may be more susceptible to complications due to weaker immune systems and other underlying health conditions.

8. Pregnancy: Cystoscopy is generally not recommended during pregnancy unless absolutely necessary due to the risk of miscarriage.

9. Anaesthesia Risks: If you receive local or general anaesthesia during the procedure, there are the inherent risks associated with anaesthesia use, such as allergic reactions or breathing difficulties.

Urinary tract problems can be quite bothersome, so taking steps to prevent them is ideal. Here are some key lifestyle practices that can significantly reduce your risk of developing UTIs and other urinary tract issues:

1. Drink Plenty of Fluids: This is the cornerstone of UTI prevention. Aim to drink eight glasses of water daily, or more if you sweat a lot during exercise or live in a hot climate. Water is the best choice, as sugary drinks and even some caffeinated beverages can irritate the bladder. Opt for water, clear broths, herbal teas, and diluted fruit juices to keep your body well-hydrated.

2. Don't Hold Urine In: When you feel the urge to urinate, go! Holding urine allows bacteria to multiply in the bladder, increasing the risk of infection. Aim to empty your bladder every 3-4 hours or whenever you feel the need.

3. Complete Emptying: After urinating, try to completely empty your bladder. Leaning forward slightly while urinating can help ensure all the urine is expelled. Incomplete emptying can leave stagnant urine in the bladder, creating a breeding ground for bacteria.

4. Wipe Front to Back: This is crucial to prevent bacteria from entering the urethra. Always wipe from front to back after using the toilet, especially after a bowel movement, to prevent bacteria from the anal area from contaminating the urethra.

5. Gentle Cleansing: Wash the genital area daily with mild soap and warm water. Avoid harsh soaps, douches, or feminine hygiene sprays, as these can disrupt the natural balance of bacteria in the vagina and urethra.

6. Cotton Underwear: Choose loose-fitting, breathable cotton underwear. Tight-fitting clothing can trap moisture and irritate the urethra, creating a favourable environment for bacterial growth.

7. Cranberry Products: While research is ongoing, some studies suggest that cranberry juice or cranberry supplements may help prevent UTIs. Cranberries contain compounds that may prevent bacteria from adhering to the bladder wall. However, talk to your doctor before starting any supplements, especially if you take blood thinners.

Cystoscopy is a valuable tool for diagnosing urinary tract problems, but it's not always the first step. Doctors typically follow a series of assessments to pinpoint the underlying issue. Here's a breakdown of the diagnostic process:

1. Medical History and Physical Examination:

• Detailed discussion: Your doctor will ask about your symptoms, frequency, severity, and any other urinary issues you've experienced. They may inquire about recent illnesses, sexual activity, medications you're taking, and family history of urinary problems.
• Physical examination: This may involve a pelvic exam for women or a rectal exam for men to assess any tenderness or abnormalities in the pelvic area.

2. Urinalysis:

• This is a simple test that analyses a urine sample for abnormalities. It can detect:
  • Presence of white blood cells: Elevated levels indicate possible infection.
  • Red blood cells: May signify infection, stones, or tumours.
  • Nitrates: Can suggest a bacterial infection.
  • Protein: High levels might indicate kidney or bladder problems.
  • Glucose: Presence of sugar in the urine can be a sign of diabetes.
  • Unusual bacteria: Can confirm a UTI.

3. Urine Culture:

• If a UTI is suspected, a urine culture is often performed. This test involves collecting a midstream urine sample and sending it to a lab to grow any bacteria present. The culture can identify the specific type of bacteria causing the infection, allowing for targeted antibiotic treatment.

4. Imaging Tests:

• Depending on the suspected cause of your urinary tract problems, additional imaging tests may be ordered:
  • Ultrasound: This painless procedure uses sound waves to create images of the bladder, kidneys, and ureters, helping to identify stones, tumours, or blockages.
  • X-ray: While less common, X-rays can sometimes reveal bladder stones or abnormalities in the urinary system.
  • CT scan: This detailed imaging test uses X-rays combined with a computer to create cross-sectional images of the urinary tract. It can provide a clearer picture of stones, tumours, or anatomical abnormalities.

5. Urodynamic testing:

• This specialised test series assesses how well your bladder and urethra store and release urine. It may involve:
  • Uroflowmetry: Measures the rate and volume of urine flow.
  • Cystometry: Evaluates bladder pressure and capacity during filling and emptying.
  • Leak point pressure: Determines the pressure at which urine leaks.

Cystoscopy is a relatively quick procedure, but it involves several distinct stages to ensure patient comfort and a successful examination. Here's a breakdown of the typical cystoscopy stages:

Pre-Procedure Preparation 

• Consultation: Your doctor will discuss your medical history, symptoms, and medications. They will explain the procedure, its benefits and risks, and answer any questions you may have.

• Informed Consent: You will be asked to sign an informed consent form after understanding the procedure and potential complications.

• Emptying the Bladder: You will likely be asked to empty your bladder before the procedure.

• Intravenous (IV) Line (Optional): In some cases, an IV line may be inserted in your arm to administer fluids or medications during the procedure.

• Anesthesia (Optional): Depending on the type of cystoscopy and your doctor's recommendation, you may receive local anaesthesia to numb the urethra, general anaesthesia to put you to sleep, or no anaesthesia at all.

Procedure 

• Positioning: You will be positioned on a urological table, lying on your back with your legs raised and supported in stirrups.

• Sterilisation: The doctor will clean and sterilise the genital area with an antiseptic solution.

• Cystoscope Insertion: The doctor will gently insert the lubricated cystoscope through the urethra and into the bladder. If using a flexible cystoscope, the doctor may guide it through the urethra's curves.

• Bladder Filling (Optional): For better visualisation, sterile fluid may be slowly instilled into the bladder through the cystoscope. You may feel pressure or fullness in your bladder as it fills.

• Visual Examination: The doctor will use the camera on the cystoscope to examine the lining of the urethra and bladder for any abnormalities, such as inflammation, stones, tumours, or blockages.

• Biopsy (Optional): If suspicious areas are identified, the doctor may use small instruments passed through the cystoscope to take tissue samples (biopsy) for further analysis.

• Minor Procedures (Optional): During a cystoscopy with minor procedures, the doctor may use instruments passed through the cystoscope to remove bladder stones, treat incontinence, or stop bleeding.

Post-Procedure Recovery

• Cystoscope Removal: The doctor will carefully remove the cystoscope and any remaining fluid from your bladder.

• Emptying the Bladder: You will likely be encouraged to urinate after the procedure. You may experience some burning or stinging during urination, which is usually temporary.

• Monitoring: Your vital signs and recovery will be monitored for a short period before discharge.

Recovery at Home

• Rest: Take it easy for the first 24-48 hours after the procedure.

• Drinking Fluids: Continue to drink plenty of fluids to help flush out any remaining bacteria or discomfort.

• Burning Sensation: You may experience burning or stinging during urination for a day or two. This is usually mild and can be managed with over-the-counter pain medication if needed.

• Blood in Urine: A small amount of blood in the urine after the procedure is normal. However, if you experience significant or persistent bleeding, contact your doctor.

• Follow-up Appointment: You will likely have a follow-up appointment with your doctor within a week to discuss the results of the cystoscopy and any further treatment plan.

Following a cystoscopy, it's normal to experience some discomfort and require some time for recovery. Here's what you can expect and how to ensure a smooth recovery process:

Immediately After the Procedure

• Rest: Take it easy for the rest of the day after your cystoscopy. Avoid strenuous activities or lifting heavy objects.

• Urinary discomfort: Burning or stinging during urination is common for 1-2 days. Drinking plenty of fluids can help alleviate this discomfort.

• Blood in the urine: You may notice some blood in your urine for a day or two after the procedure. This is usually nothing to worry about.

At Home Recovery

• Pain medication: Your doctor may prescribe pain medication to manage any discomfort you experience.

• Urinary frequency: You may urinate more frequently for a day or two as your bladder heals.

• Drinking fluids: Continue to drink plenty of fluids to help flush out any remaining blood or irritation.

• Burning sensation: Warm sitz baths can help soothe any burning sensation during urination.

• Diet: Avoid spicy or acidic foods that can irritate the bladder.

• Activity: Gradually resume your normal activities, but avoid strenuous exercise for a few days.

• Rest: Getting enough sleep allows your body to heal.

Monitoring and Follow-up

• Temperature: Monitor your body temperature for signs of infection (usually above 100.4°F or 38°C).

• Pain: Contact your doctor if you experience severe pain or persistent burning during urination.

• Bleeding: Inform your doctor if you notice excessive bleeding in your urine.

• Follow-up appointment: Attend your scheduled follow-up appointment with your doctor to discuss the results of the cystoscopy and any further treatment plan.

1. What is cystoscopy?
   Cystoscopy is a medical procedure that allows a doctor to look inside the bladder and urethra using a thin, flexible tube called a cystoscope.

2. Why is cystoscopy performed?
   Cystoscopy can be performed to diagnose and treat conditions affecting the bladder and urinary tract, such as bladder cancer, urinary tract infections, and urinary incontinence.

3. Is cystoscopy painful?
   Discomfort may be experienced during cystoscopy, but it is usually well-tolerated. Your doctor may use local anaesthesia to minimise discomfort.

4. How is cystoscopy performed?
   During cystoscopy, a cystoscope is inserted into the urethra and advanced into the bladder. The doctor may then examine the bladder lining and take tissue samples if necessary.

5. How long does a cystoscopy take?
   The procedure typically takes 5 to 20 minutes to complete, depending on the purpose and complexity.

6. Is cystoscopy an outpatient procedure?
   Yes, cystoscopy is usually performed on an outpatient basis, meaning you can go home the same day.

7. Are there any risks associated with cystoscopy?
   While rare, complications of cystoscopy may include urinary tract infections, bleeding, and perforation of the bladder.

8. How should I prepare for a cystoscopy?
   Your doctor will provide specific instructions, but typically, you may be asked to stop taking certain medications and to fast for a few hours before the procedure.

9. Can I drive myself home after a cystoscopy?
   It's recommended to have someone accompany you to drive you home after the procedure, as you may experience some discomfort or drowsiness.

10. Is anaesthesia used during cystoscopy?
    Depending on the situation, local anaesthesia, sedation, or general anaesthesia may be used to make you more comfortable during the procedure.

11. Can cystoscopy detect bladder cancer?
    Yes, cystoscopy is a common method for diagnosing bladder cancer. The doctor can visualise any abnormalities in the bladder lining and may take tissue samples for further examination.

12. Is cystoscopy safe during pregnancy?
    Cystoscopy is generally avoided during pregnancy unless it's necessary for urgent medical reasons due to the potential risks to the foetus.

13. What should I expect after a cystoscopy?
    You may experience some discomfort, such as a burning sensation during urination or mild blood in the urine, which should resolve within a day or two.

14. When can I resume normal activities after cystoscopy?
    Most people can resume normal activities, including work, within a day after cystoscopy, unless instructed otherwise by their doctor.

15. How often should cystoscopy be performed for monitoring bladder conditions?
    The frequency of cystoscopy for monitoring bladder conditions varies depending on the individual's medical history and the specific condition being monitored. Your doctor will advise you on the appropriate schedule.

16. Can cystoscopy detect urinary tract infections (UTIs)?
    While cystoscopy itself cannot diagnose UTIs, it can help identify any structural abnormalities or other conditions that may contribute to recurrent UTIs.

17. Are there any dietary restrictions before cystoscopy?
    Your doctor may recommend avoiding certain foods and drinks before cystoscopy, especially those that can irritate the bladder or affect urine colour.

18. Can cystoscopy be performed on children?
    Yes, cystoscopy can be performed on children, although the procedure may be modified depending on the child's age and size.

19. Is cystoscopy used to treat bladder stones?
    Cystoscopy can be used to diagnose bladder stones, but treatment typically involves other procedures such as lithotripsy or surgical removal.

20. What are the alternatives to cystoscopy?
    Alternatives to cystoscopy may include imaging tests such as ultrasound or CT scan, although these may not provide as detailed information as cystoscopy.

21. Can cystoscopy cause urinary retention?
    In rare cases, cystoscopy may cause temporary urinary retention, but this usually resolves quickly after the procedure.

22. How long does it take to receive cystoscopy results?
    The time it takes to receive cystoscopy results varies depending on the specific tests performed and the laboratory's processing time. Your doctor will inform you when to expect results.

23. Is cystoscopy used to diagnose sexually transmitted infections (STIs)?
    Cystoscopy itself is not used to diagnose STIs, but it may be part of a comprehensive evaluation if there are concerns about STIs affecting the urinary tract.

24. Can cystoscopy be performed if I have a urinary tract infection?
    Cystoscopy may be postponed if you have an active urinary tract infection, as it can increase the risk of complications and make interpretation of the results more difficult.

25. Is cystoscopy covered by insurance?
    In most cases, cystoscopy is covered by health insurance when deemed medically necessary. However, coverage may vary depending on your insurance plan and individual circumstances.

26. Can cystoscopy detect interstitial cystitis?
    While cystoscopy cannot definitively diagnose interstitial cystitis (IC), it may show signs such as bladder inflammation or pinpoint bleeding, which can support a diagnosis when combined with other findings and symptoms.

27. How soon can I eat after a cystoscopy?
    You can typically resume eating and drinking shortly after cystoscopy, unless your doctor advises otherwise.

28. Can cystoscopy be performed on patients with urinary retention?
    Cystoscopy may be performed on patients with urinary retention, although the procedure may need to be modified depending on the specific circumstances and underlying cause of the retention.

29. Is cystoscopy used to treat overactive bladder?
    While cystoscopy is primarily a diagnostic procedure, certain treatments such as bladder botox injections may be administered during cystoscopy for overactive bladder.

30. How soon can I resume sexual activity after cystoscopy?
    Your doctor will provide specific guidance, but generally, it's recommended to wait a few days after cystoscopy before resuming sexual activity.

31. Can cystoscopy cause urinary incontinence?
    While rare, cystoscopy may contribute to temporary urinary incontinence, particularly if the bladder is irritated during the procedure.

32. Is cystoscopy used to diagnose prostate problems?
    Cystoscopy is primarily used to evaluate the bladder and urinary tract, but it may provide some information about the prostate if there are related issues affecting urinary flow.

33. Can cystoscopy be performed under local anaesthesia?
    Yes, cystoscopy can be performed under local anaesthesia, although sedation or general anaesthesia may be used for certain situations or patient preferences.

34. Is cystoscopy used to diagnose kidney stones?
    Cystoscopy is not typically used to diagnose kidney stones, as they are usually detected using imaging tests such as CT scans or ultrasounds.

35. Can cystoscopy detect bladder polyps?
    Yes, cystoscopy can detect bladder polyps, which are abnormal growths in the bladder lining.

36. Is cystoscopy safe for older adults?
    Cystoscopy is generally safe for older adults, although considerations may be made for any underlying health conditions or medications they are taking.

37. Can cystoscopy cause urinary tract injury?
    While rare, cystoscopy can potentially cause urinary tract injury, such as bladder perforation, particularly if there are pre-existing abnormalities or the procedure is performed by an inexperienced operator.

38. Is cystoscopy used to diagnose urinary retention?
    Yes, cystoscopy can help diagnose urinary retention by evaluating the bladder and urethra for any structural abnormalities or blockages.

39. Can cystoscopy detect bladder diverticula?
    Yes, cystoscopy can detect bladder diverticula, which are pouch-like protrusions in the bladder wall.

40. Is cystoscopy used to diagnose urethral stricture?
    Yes, cystoscopy can help diagnose urethral stricture by visualising narrowing or blockages in the urethra.

41. Can cystoscopy detect bladder tumours?
    Yes, cystoscopy is commonly used to detect bladder tumours by visualising abnormal growths in the bladder lining.

42. Is cystoscopy used to treat urinary retention?
    While cystoscopy itself is primarily a diagnostic procedure, treatments such as bladder catheterization may be performed during cystoscopy to relieve urinary retention.

43. Can cystoscopy detect urinary fistulas?
    Yes, cystoscopy can help detect urinary fistulas, which are abnormal connections between the urinary tract and other organs or tissues.

44. Is cystoscopy used to diagnose neurogenic bladder?
    Cystoscopy may be part of the evaluation for neurogenic bladder, although other tests such as urodynamic studies are often needed for a comprehensive assessment.

45. Can cystoscopy detect bladder inflammation?
    Yes, cystoscopy can detect bladder inflammation, which may appear as redness, swelling, or other changes in the bladder lining.

46. Is cystoscopy used to diagnose bladder stones in dogs?
    Yes, cystoscopy can be used to diagnose bladder stones in dogs, similar to its use in humans.

47. Can cystoscopy cause bladder spasms?
    While rare, cystoscopy may cause bladder spasms, particularly if the bladder is irritated during the procedure.

48. Is cystoscopy used to diagnose bladder diverticulum?
    Yes, cystoscopy can be used to diagnose bladder diverticulum, a condition characterised by pouch-like protrusions in the bladder wall.

49. Can cystoscopy detect bladder tuberculosis?
    Yes, cystoscopy can help detect signs of bladder tuberculosis, such as ulcerations or abnormal tissue changes in the bladder lining.

50. Is cystoscopy used to diagnose bladder trauma?
    Yes, cystoscopy can be used to diagnose bladder trauma, such as injuries caused by accidents or medical procedures.