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Cystoscopy – Bladder Examination Explained

Cystoscopy is an endoscopic examination of the bladder and urethra. It allows direct visual assessment of the bladder lining and is used to diagnose and treat a range of urological conditions.

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Things worth knowing about "Cystoscopy"

Cystoscopy is an endoscopic examination of the bladder and urethra. It allows direct visual assessment of the bladder lining and is used to diagnose and treat a range of urological conditions.

What is Cystoscopy?

Cystoscopy is a diagnostic and therapeutic procedure in which a thin, optical instrument called a cystoscope is inserted through the urethra into the urinary bladder. This allows a urologist to directly visualize the inner walls of the bladder and urethra. It is one of the most common urological procedures and can be performed on an outpatient or inpatient basis.

When is Cystoscopy Performed?

Cystoscopy is indicated for a variety of urological complaints and conditions. Common indications include:

Blood in the urine (haematuria) – to identify the underlying cause
Suspected bladder tumours or bladder cancer
Recurrent urinary tract infections
Investigation of bladder stones
Follow-up monitoring after bladder cancer treatment
Evaluation of urinary incontinence or voiding dysfunction
Assessment of urethral strictures (narrowing of the urethra)

How is the Procedure Performed?

Before the procedure, the urethra is numbed using a local anaesthetic gel. In some cases – particularly for more complex interventions – a short general anaesthetic or regional anaesthesia may be used.

The cystoscope is available in two forms: rigid and flexible. The flexible cystoscope is commonly used for outpatient examinations as it is more comfortable for the patient. The rigid cystoscope offers better options for surgical interventions.

During the procedure, the bladder is filled with sterile irrigation fluid to improve visibility. The examination itself typically takes only a few minutes.

Diagnostic and Therapeutic Applications

Cystoscopy is not only used for diagnosis but also enables direct therapeutic interventions, including:

Taking tissue samples (biopsy) for histological analysis
Removal of small bladder polyps or superficial bladder tumours
Removal of bladder stones
Placement of ureteral stents
Treatment of urethral strictures

Risks and Side Effects

Cystoscopy is a safe procedure; however, as with any medical intervention, certain risks may occur:

Temporary burning or discomfort during urination after the procedure
Minor traces of blood in the urine
Urinary tract infection (minimised by sterile technique)
In very rare cases: injury to the urethra or bladder

After the procedure, patients are advised to drink plenty of fluids to flush the urinary tract and reduce the risk of infection.

Preparation and Aftercare

Special preparation is usually not required for outpatient cystoscopy. Patients should inform their urologist about any medications they are taking – particularly blood thinners. Mild discomfort during urination may occur after the procedure but typically resolves within a few days.

References

European Association of Urology (EAU): EAU Guidelines on Bladder Cancer and Urological Infections. www.uroweb.org (2023).
Wein, A.J. et al. (eds.): Campbell-Walsh-Wein Urology. 12th edition. Elsevier, Philadelphia 2021.
National Institute for Health and Care Excellence (NICE): Bladder Cancer: Diagnosis and Management. NICE Guideline NG2 (2015, updated 2022). www.nice.org.uk

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