Background Information:

What are the other Names for the Procedure?

• Bladder Scope
• Cystourethroscopy
• Endoscopy of the Bladder

What is Cystoscopy surgical procedure?

• A Cystoscopy is an examination of the inside of the urinary bladder and urethra, using a medical instrument called a cystoscope
• During a Cystoscopy, a test called retrograde pyelogram is usually performed, which allows the physician to visually examine the inner linings of the bladder, urinary tract, and collect urine samples from within the bladder

What part of the Body does the Procedure involve?

A Cystoscopy involves the urinary bladder and urinary tract.

Why is the Cystoscopy surgical procedure Performed?

A Cystoscopy is performed for the following reasons:

• Hematuria (blood in urine)
• Urinary incontinence
• Recurring urinary tract infections
• Hereditary birth defects
• Formation of tumors within the bladder
• Formation of bladder or kidney stone deposits
• Remove abnormal tissue for biopsy

What are some Alternative Choices for the Procedure?

Cystoscopy remains a gold standard procedure to check for any abnormality inside the urinary bladder and urethra.

What are the Recent Advances in the Procedure?

Cystoscopy is the most advanced surgical treatment for providing information to the physician on the bladder and urinary tract. 

What is the Cost of performing the Cystoscopy surgical procedure?

The cost of Cystoscopy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Cystoscopy and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/003903.htm (accessed on June 19, 2013)

http://www.mayoclinic.com/health/cystoscopy/MY00140 (accessed on June 19, 2013)

http://www.urologyhealth.org/urology/index.cfm?article=77 (accessed on June 19, 2013)

http://kidney.niddk.nih.gov/kudiseases/pubs/cystoscopy/#whatisc (accessed on June 19, 2013)

http://www.surgeryencyclopedia.com/Ce-Fi/Cystoscopy.html (accessed on June 19, 2013)

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Cystoscopy surgical procedure:

How is the Cystoscopy surgical procedure Performed?

• A Cystoscopy is performed by the urologist, after anesthesia is administered to the individual
• The individual is placed in a lithotomy position. The patient lies flat on the back (supine), with feet raised and supported by foot rests, called stirrups
• A cystoscope is inserted into the urethra and is gradually advanced into the urinary bladder. The physician simultaneously examines the internal passage for any abnormality
• If there is any abnormal tissue, a biopsy is usually performed, using biopsy forceps, and the tissue is sent to the pathologist for analysis

Where is the Procedure Performed?

A Cystoscopy is usually performed in an out-patient surgery center facility, a physician’s clinic/office, or a hospital. Normally, the individual can go home once the procedure is completed. However, the physician may keep them overnight for observation, if necessary.

Who Performs the Procedure?

An urologist performs the procedure.

How long will the Procedure take?

A Cystoscopy usually takes about 20-45 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

A physician will request your consent for Cystoscopy procedure using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Cystoscopy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Cystoscopy surgical procedure?

Before a Cystoscopy procedure, the patient undergoes certain tests (determined by the urologist) such as:

• Routine blood and urine analysis
• X-ray of kidneys
• CT scan

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Cystoscopy?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• What are the alternatives to the procedure?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Cystoscopy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia or local anesthesia, with or without intravenous sedation, and occasionally spinal anesthesia is administered prior to the procedure.

How much Blood will you lose, during the Procedure?

Since Cystoscopy is a less invasive procedure, there is little or no blood loss involved.

What are the possible Risks and Complications during the Cystoscopy surgical procedure?

There are general factors that increase the risk of getting complications during the procedure, which include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk 
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

• Excessive bleeding
• Injury to the urinary tract
• Damage to the bladder
• Damage to the penis
• Swelling of the urethra and as a result, patient may have difficulty urinating. Sometimes, a catheter may need to be inserted and temporarily left in place, in order to facilitate urine drainage

What Post-Operative Care is needed at the Healthcare Facility after the Cystoscopy surgical procedure?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise. 

After the Cystoscopy surgical procedure:

What are the possible Risks and Complications after the Cystoscopy surgical procedure?

Post Cystoscopy, the following complications may arise:

• Excessive bleeding
• Injury to the urethra
• Urinary tract infection

What is the Prognosis after the Surgery?

The prognosis depends upon the findings of Cystoscopy investigation. Benign conditions (like polyps, stones, birth defects, etc.) tend to have a better prognosis when compared to cancers

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Worsening pain around the surgical wound
• Swelling and redness
• Bleeding or fluid drainage from the surgical wound
• Fever
• Dizziness
• Signs of infection
• Complications associated with prescription medications used in treatment
• Inability to urinate even after 8 hours following the procedure

What Post-Operative Care is needed at Home after the Cystoscopy surgical procedure?

At home, the following post-operative care is recommended, after a Cystoscopy procedure:

• Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
• Drink water in 8 ounce (about 240 ml) glasses, at least 8 times a day
• Avoid sex till complete healing has taken place (under advice by the physician)
• Avoid all activities that are physically strenuous, for a period of 2 weeks
• Complete the course of prescribed medication (under advice of the physician)
• If required, individuals may take nonprescription medication, such as acetaminophen, to relieve pain

How long does it normally take to fully recover, from the Procedure?

It takes about 1 to 2 weeks to fully recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision.
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Cystoscopy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility, physician’s office or hospital
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• Urologist

The patient is advised to inquire and confirm the type of billing, before the Cystoscopy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA