Cystoscopy

Cystoscopy

What is a Cystoscopy?

A cystoscopy is a procedure that involves the insertion of a cystoscope (hollow tube with a lens attached) to examine the bladder and urethra. The cystoscope provides a visual of the inside of your urethra and bladder. Your urologist may recommend a cystoscopy to diagnose, monitor or treat your condition. 

There are two types of cystoscopy:

  • Rigid Cystoscopy — A rigid cystoscopy involves a cystoscope that does not bend. You will be put under general anaesthesia or spinal anaesthesia (the lower half of your body will be numbed) during this procedure.
  • Flexible Cystoscopy — A thin, bendy cystoscopy will be used. Local anaesthesia will be administered and you will be conscious during this procedure.

When would a urologist recommend cystoscopy?

To investigate, diagnose and monitor a condition

  • A cystoscopy can be carried out to investigate and diagnose urinary conditions. It is important to note that a cystoscopy is not generally recommended if you have an active UTI.
  • It is used to diagnose urinary conditions such as bladder cancer, bladder stones, cystitis or benign prostatic hyperplasia, among others. 
  • A cystoscopy can often be recommended to monitor your condition. For example, if you have had bladder cancer, tests may be run to check for any new tumours after bladder cancer treatment.
  • It can also be used to assess for any postsurgery complications such as midurethral sling migration or bladder erosions.
  • In rare conditions, it can also be used to diagnose gynecological conditions such as fistula (abnormal connections between the gynecological organs and the urinary organs) or endometriosis (abnormal endothelial tissues found outside the uterus, in this case, inside the bladder).

To treat a condition

  • Miniature surgical tools can also be used through the scope, allowing your urologist to remove small bladder tumours or small bladder stones.
  • It can also be used to help in the insertion of a urinary catheter (urine tube) during difficult situations.

Why would I need a Cystoscopy?

Your urologist will generally recommend a cystoscopy to rule out and investigate the possibility of underlying conditions. Common situations are:

  • Blood in the urine (haematuria)
  • Painful urination
  • Abnormal urine colour (eg, sediments or dark urine)
  • When a bladder biopsy is needed
  • To monitor the condition of patients who previously had bladder cancer

A cystoscopy can also be used to remove small foreign bodies or stones.

How do I prepare for a Cystoscopy?

  • You may be asked to stop eating or drinking a few hours before a rigid cystoscopy if it is to be under general or spinal anaesthesia. However, for a flexible cystoscopy that is not necessary. 
  • You may also be asked to empty your bladder prior to the procedure.
  • Your urologist may prescribe antibiotics before and after your cystoscopy. 

What can I expect during a Cystoscopy?

First, you will be brought to a private examination room. If you have any questions or concerns, be sure to let your urologist know so that they can provide a more comfortable experience. 

  • You will be asked to lie on your back and your feet will be placed in stirrups (for females).
  • Your genital area will be cleansed and a local anaesthetic jelly will be applied. 
  • Your bladder will be filled with a sterile saline solution for better visualisation. You may experience the sensation of needing to pee.
  • The cystoscope is inserted through the urethra and into the bladder to examine their inner lining and to check for any structural abnormalities. 
  • Biopsy samples may be taken during the procedure for further testing. Small tumours may also be removed, if present. 
  • The saline solution is drained from the bladder, or you will be asked to empty your bladder in the restroom. 

A standard cystoscopy procedure takes about 3-5 minutes.

Are there any side effects to a Cystoscopy?

  • Although rare, a cystoscopy may cause an infection in the bladder or urethra. However, antibiotics prescribed and a sterile, well-controlled examination help prevent this. 
  • You may experience slight blood in your urine, but this is not a cause for worry and will subside in 1-2 days. 
  • You may also experience mild abdominal pain or a burning sensation during urination.

What can I expect after a Cystoscopy?

You will be allowed to go home within the same day. Your urologist will schedule a follow-up appointment and discuss the findings once the lab results are obtained. 

You may experience discomfort or a burning sensation during urination. However, this will subside within 1-2 days. Over this period of time, you will also be advised to drink plenty of fluids (at least 2-3 litres).

Please contact your urologist immediately if you experience the following after your procedure:

  • Bright red blood in your urine
  • Heavy blood clots in your urine
  • Persistent fever 
  • Chills
  • Difficulty or inability to pass urine

Summary

A cystoscopy is generally a safe procedure, and serious complications are rare. A cystoscopy can be uncomfortable but is a useful procedure for diagnosing and treating urinary problems. If you experience symptoms of any urinary issues, please consult your urologist for a proper diagnosis and treatment.

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Dr. Fiona Wu 2

Dr Fiona Wu
Consultant Urologist

MBBS (S'pore), MRCS (Edin), MMED (Surg),
MMED (Clinical Investigation),
FRCS (Urol) (RCPSG), FAMS (Urology)

Dr Fiona Wu is an experienced Consultant Urologist and is the Medical Director of Aare Urocare.

Prior to her private practice, Dr Fiona Wu spent 15 years in public service. She was a Consultant in the Department of Urology at National University Hospital (NUH), Alexandra Hospital and Ng Teng Fong General Hospital. She was also the Programme Director of Surgery-in-Training at NUH and a core faculty member of postgraduate junior doctors. 

Dr Wu’s clinical interests lie in Female Urology, Neuro-urology, Urinary Incontinence, Reconstructive Urology and Voiding Dysfunction. She believes in treating incontinence in a holistic way using minimally invasive methods. She worked closely with the gynaecology and colorectal departments to treat complex pelvic floor conditions and continues to do so in her own practice. 

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