Cystoscopy is a procedure that allows your doctor to examine the lining of your bladder and the tube that carries urine out of your body (urethra). A hollow tube (cystoscope) equipped with a lens is inserted into your urethra and slowly advanced into your bladder.
There are two main types of cystoscopes: flexible and rigid. The type your doctor uses will depend on why the cystoscopy is being done.
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Why it's done
Cystoscopy is used to diagnose, monitor and treat conditions affecting the bladder and urethra. Your doctor might recommend cystoscopy to:
. Investigate causes of signs and symptoms. Those signs and symptoms can include blood in the urine, incontinence, overactive bladder and painful urination. Cystoscopy can also help determine the cause of frequent urinary tract infections. However, cystoscopy generally isn't done while you have an active urinary tract infection.
. Diagnose bladder diseases and conditions. Examples include bladder cancer, bladder stones and bladder inflammation (cystitis).
. Treat bladder diseases and conditions. Special tools can be passed through the cystoscope to treat certain conditions. For example, very small bladder tumors might be removed during cystoscopy.
. Diagnose an enlarged prostate. Cystoscopy can reveal a narrowing of the urethra where it passes through the prostate gland, indicating an enlarged prostate (benign prostatic hyperplasia).
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Your doctor might conduct a second procedure called ureteroscopy at the same time as your cystoscopy. Ureteroscopy uses a smaller scope to examine the tubes that carry urine from your kidneys to your bladder (ureters).
Preparing for a cystoscopy
. 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.
. The type of fasting (not eating or drinking anything) needed before the procedure will depend on the type of anesthesia used. Your healthcare provider will give you specific instructions regarding how long to fast. You may be given other instructions about a special diet to follow for a day or two before the procedure.
. If you are pregnant or think you might be, tell your healthcare provider.
. Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, iodine, tape, or anesthetic agents (local and general).
. Make sure your healthcare provider has a list of all medicines (prescribed and over-the-counter), herbs, vitamins, and supplements that you are taking.
. Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.
. If local anesthesia is used, you will be awake during the procedure, but you may be given a sedative. You will need someone to drive you home afterwards.
. If you think you have a urinary tract infection, tell your healthcare provider, because cystoscopy should not be done. Your healthcare provider may check your urine for infection before doing the procedure. (Signs of infection include things like frequent urination, pain or burning when passing urine, fever, and urine that looks dark, cloudy, or reddish in color and smells bad.)
Based on your medical condition, your healthcare provider may request other specific preparation.
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Risks and Complications
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.
. Pain: You might experience abdominal pain and a burning sensation when urinating. These symptoms are generally mild and gradually decrease after the procedure.
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
During Cystoscopy Procedure
Anesthesia during a cystoscopy
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.
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During the cystoscopy
A simple outpatient cystoscopy can take five to 15 minutes. When done in a hospital with sedation or general anesthesia, cystoscopy takes about 15 to 30 minutes.
Your cystoscopy procedure might follow this process:
. You'll be asked to empty your bladder. Then you'll lie down on a table on your back. You'll likely be positioned with your feet in stirrups and your knees bent.
. You may or may not need a sedative or anesthetic. If you receive a sedative, you'll feel sleepy and relaxed during the cystoscopy, but you'll still be aware. If you receive a general anesthetic, you won't be aware during the procedure. Both types of medication may be given through a vein in your arm.
. Your doctor will insert the cystoscope. A numbing jelly will be applied to your urethra to help prevent pain when the cystoscope is inserted. After waiting a few minutes for the numbing, your doctor will carefully push the cystoscope into your urethra, using the smallest scope possible. Larger scopes might be needed to take tissue samples or pass surgical tools into the bladder.
. Your doctor will examine your urethra and bladder. The cystoscope has a lens on the end that works like a telescope to magnify the inner surfaces of your urethra and bladder. Your doctor might place a special video camera over the lens to project the images onto a video screen.
. Your bladder will be filled with a sterile solution. The solution inflates the bladder and allows your doctor to get a better look inside. As your bladder fills, you may feel the need to urinate. You'll be encouraged to do so once the procedure is finished.
. Tissue samples might be taken. Your doctor might take tissue samples for lab testing, or perform various other procedures during the cystoscopy.
After Cystoscopy Procedure
What happens after a cystoscopy?
After the procedure, you may be taken to a recovery room for observation if sedation or anesthesia was used. Your recovery process will vary depending on the type of sedation that was given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. Cystoscopy is most often done on an outpatient basis.
You may go back to your usual diet and activities unless your healthcare provider tells you otherwise.
You will be encouraged to drink extra fluids, which dilutes the urine and reduces urinary discomfort, such as burning. Some burning with urination is normal after the procedure but should lessen over time. A warm sitz or tub bath may be urged to help ease urinary discomfort.
You may notice blood in your urine after the procedure. This is normal and should clear up over the next day or two.
Take a pain reliever for soreness or discomfort as advised by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.
You may be given an antibiotic to take after the procedure. This is to help prevent infection. Be sure to take the antibiotic exactly as instructed.
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.
Tell your healthcare provider if you have any of the following:
. Fever and/or chills
. Urinary frequency or urgency
. Inability to urinate
. Lower back pain
. Continued burning with urination or blood in the urine
Your healthcare provider may give you other instructions after the procedure, depending on your situation.
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Your doctor might be able to discuss the results immediately after your procedure.
Or, your doctor might need to wait to discuss the results at a follow-up appointment. If your cystoscopy involved collecting a biopsy to test for bladder cancer, that sample will be sent to a lab. When the tests are complete, your doctor will let you know the results.
Cystoscopy Procedure Cost
How much does cystoscopy cost in Iran?
The cost of cystoscopy in Iran starts from $300.