Demystifying the Cystoscopy: A Guide to What Happens Before, During, and After

Have you been scheduled for a cystoscopy and don't know what to expect? You're not alone! This blog post will be your one-stop guide to understanding this procedure. We'll delve into everything you need to know before your cystoscopy, from what to expect during the prep process to what happens in the doctor's office. We'll also address common concerns and offer tips for a smooth recovery.

So, take a deep breath, and let's navigate this together! By the end of this post, you'll feel informed and prepared for your cystoscopy.

Cystoscopy is a vital diagnostic tool used by urologists to examine the inside of the urethra and bladder. Whether you're facing recurrent urinary tract infections, bladder control issues, or potential cancer diagnoses, a cystoscopy can provide critical insights. 

Understanding Cystoscopy

Cystoscopy involves using a cystoscope, a pencil-sized tube equipped with a light and camera, to inspect the urethra and bladder. This procedure helps diagnose and sometimes treat various urinary tract problems, including bladder stones, painful urination (dysuria), frequent urinary tract infections, hematuria (blood in urine), and bladder control issues like incontinence or urinary retention.

Why You Might Need a Cystoscopy

Your healthcare provider may suggest a cystoscopy for several reasons:

1. Bladder Stones:  To identify and possibly remove stones in the bladder.
2. Dysuria:  To investigate the cause of painful urination.
3. Frequent UTIs:  To determine the underlying issues causing recurrent infections.
4. Hematuria:  To find the source of blood in the urine.
5. Bladder Control Problems:  To assess issues like incontinence or urinary retention.
6. Cancer Diagnoses:  To check for bladder or urethral cancer.
7. Other Issues:  To evaluate conditions like enlarged prostate, urinary fistulas, or urethral strictures.

Pre-Cystoscopy Preparations

Proper preparation can significantly ease your cystoscopy experience. 

Here’s what to expect:

1. Emptying Your Bladder:  Before the procedure, you will need to empty your bladder. You will then be asked to lie on your back on an examination table, with your feet in stirrups and knees bent. This position allows the urologist to access the urethra easily.
2. Anesthetic or Sedative:  Not all cystoscopies require anesthesia, but if yours does, you might receive a local anesthetic to numb the area around your urethra or a sedative to help you relax. In some cases, general anesthesia or spinal anesthesia might be used, especially for rigid cystoscopies. If anesthesia is involved, you’ll need to avoid eating or drinking for a few hours beforehand.
3. Examination of Bladder and Urethra:  Once you are prepped, the urologist will apply a numbing ointment or jelly to the urethra to minimize discomfort during the insertion of the cystoscope. The cystoscope is then gently pushed into the urethra. This instrument has a lens that magnifies the internal structures and projects them onto a video screen for detailed examination. The bladder is filled with a sterile solution to improve visibility, which might give you a sensation of needing to urinate. During this phase, the doctor may also take tissue samples for lab testing.

Types of Cystoscopies

There are two primary types of cystoscopies:

1. Flexible Cystoscopy:  This type uses a thin, flexible tube with a camera and is typically performed under local anesthesia. It is mainly used for diagnostic purposes to check for bladder symptoms.
2. Rigid Cystoscopy:  This involves a straight, non-flexible tube with a camera and is used for both diagnostic and treatment purposes. Procedures such as removing bladder stones or tumors might require a rigid cystoscopy. This type can be done under general anesthesia or spinal anesthesia.

Preparing for a Flexible Cystoscopy

1. Local Anesthetic:  You will receive a numbing agent, typically in the form of a gel or ointment, applied around the urethra. This local anesthetic minimizes discomfort and pain during the insertion of the flexible cystoscope, making the procedure more tolerable.
2. Dietary Restrictions:  There are generally no special dietary restrictions for flexible cystoscopy. You can eat and drink normally on the day of the procedure, which helps maintain your energy levels and comfort. Don't forget to listen closely and follow any special advice from your healthcare provider.

Preparing for a Rigid Cystoscopy

1. General or Spinal Anesthetic:  If your procedure involves general or spinal anesthesia, you’ll likely have a pre-operative assessment about a week before the cystoscopy. During this assessment, a nurse or anesthesiologist will take measurements such as your blood pressure and possibly conduct other tests to ensure you are fit for anesthesia. This assessment helps to plan for a safe administration of anesthesia during your procedure.
2. Fasting:  Before a rigid cystoscopy, especially if you will be under general anesthesia, you will need to fast. This means not eating or drinking anything for several hours before the procedure. Specific fasting instructions will be provided by your healthcare provider, which is crucial to follow to prevent complications during anesthesia.
3. Transportation:  Arrange for someone to drive you to and from the procedure, and stay with you for 24 hours afterward. This is particularly important if you have received general anesthesia, as its effects can impair your ability to drive or perform certain tasks safely. Having someone with you ensures that you have support in case you experience any side effects from the anesthesia.

What to Expect Post-Cystoscopy

Post-procedure, you might experience some discomfort, including:

1. Painful Urination:  A burning sensation while urinating is common for a few days.
2. Abdominal Pain:  Some mild belly pain can occur.
3. Blood in Urine:  Your urine may be slightly blood-tinged initially.
4. Frequent Urination:  You might feel the urge to urinate more frequently.

These symptoms are generally mild and should subside within a few days. increasing your fluid intake can improve these symptoms.

A cystoscopy is a relatively quick and straightforward procedure essential for diagnosing and treating various urinary tract issues. Most people can return to their daily routine immediately after a flexible cystoscopy. However, those who undergo a rigid cystoscopy or receive sedation may need a day to recover fully.

Despite some discomfort during the procedure, cystoscopies have a low risk of post-procedure complications. If you experience severe pain, persistent bleeding, or any other concerning symptoms post-procedure, contact your healthcare provider promptly.

Preparing for your cystoscopy by understanding the procedure, following pre-operative instructions, and knowing what to expect afterward can help ensure a smooth and successful experience.