Flexible Cystoscopy

Cystoscopy is the internal telescopic examination of the bladder and urethra. It affords the best assessment of disease affecting the urethra or bladder lining and may be vital before a urological diagnosis can be reached (diagnostic cystoscopy). If performed under general anaesthetic it may be combined with biopsy or simultaneous treatment of strictures, stones, tumours or prostate enlargement.

Most diagnostic cystoscopies are performed under local anaesthetic only, on a day-visit basis. The local anaesthetic is delivered in lubricating jelly squirted up the urethra. The telescope is as flexible and as thin as a standard catheter. Cystoscopy is a brief procedure and is well tolerated. It is rarely painful, but mild discomfort may occur. This may be minimised by relaxing, breathing slowly and deeply, allowing the sphincter to open and the cytoscope to pass. Some patients prefer sedation or general anaesthesia for diagnostic cystoscopy.

For local anaesthetic cystoscopy:
Pre-operatively:

• urine sample to the laboratory 1 week prior to procedure, unless recently performed
• normal diet day of procedure

Post-operatively:

• some burning may occur with voiding, but this settles rapidly
• increase fluid intake to wash out the bladder
• there is no restriction on driving nor on normal activities, including sexual intercourse

For sedation and general anaesthetic cystoscopy, in addition to the above:
Pre-operatively:

• nil by mouth 4 hours prior to procedure

Post-operatively:

• stay 1 – 4 hours post-procedure (sedation – general anaesthetic)
• if other treatment has been performed, overnight stay may be required
• driving and normal activities are permitted from the day following the procedure

Although most cases proceed without particular difficulty, bleeding or infection occur in 2% of patients overall. Other complications are considered rare and extraordinary.

• Bleeding usually settles spontaneously, but rarely causes clots and urinary retention and requires catheterisation and bladder wash out.
• Bleeding and bladder washout are more common following treatment procedures.
• Infection may present as burning – frequency – urgency, requiring oral antibiotic treatment, or fevers, sweats and shivers for which admission to hospital for IV antibiotic is needed.
• Patients with underlying bladder obstruction may develop urinary retention requiring catheterisation
• There is a potential risk of allergic reaction to the lubricating jelly or agents used for cystoscope disinfection, which is estimated to be less than 1:40 000.