What is a cystoscope?

Similar to endoscopes for other organs such as panendoscopes for examining the stomach and small intestine, and colonoscopes for examining the rectum and colon, a cystoscope is used to inspect the urethra and bladder.

Physicians insert the cystoscope through the urethra into the bladder and then inject warm saline to provide clear visibility of the bladder mucosa for a thorough examination.

What are the differences between flexible and rigid cystoscopes?

Cystoscopes can be categorized into traditional rigid cystoscopes and newer flexible cystoscopes.

• Rigid cystoscope: Local anesthetic is used to alleviate urethral pain; however, patients may still experience discomfort, especially male patients due to the longer and larger angle of the male urethra.

• Flexible cystoscope: Local anesthetic gel is used to reduce urethral discomfort, resulting in minimal discomfort in most cases. Importantly, the flexible cystoscope’s bendable scope allows for detailed examination, reducing the likelihood of missing lesions.

Under what circumstances would a physician arrange a cystoscopy?

• To understand the cause of hematuria (blood in urine): To confirm the presence of bladder tumors, stones, prostate enlargement, or blood flowing from the kidneys. Some bladder tumors may not be visible on ultrasound or CT scan and require cystoscopy for diagnosis. When necessary, the physician may take bladder mucosal biopsies for further examination.

• To understand the cause of urinary obstruction: Is it due to urethral stricture, prostate enlargement, bladder fibrosis, urethral or bladder diverticula?

• To understand the cause of refractory overactive bladder syndrome: Are there bladder tumors or stones?

• Postoperative follow-up for malignant urothelial tumors

• Further investigation of suspicious lesions detected on ultrasound using cystoscopy

• Removal of ureteral stents

What are the risks of undergoing a cystoscopy? What precautions should be taken after a cystoscopy?

• A small number of patients may experience urinary tract infections, which are usually mild.
• Immediately after a cystoscopy, patients may experience mild urethral discomfort and see light pinkish urine, which typically improves after urinating a couple of times.
• Drinking more water can help alleviate these discomforts.
• If there is fever or persistent hematuria, it is advisable to seek evaluation and treatment at the emergency department.

Conclusion: Cystoscopy is an important tool for urologists and often helps patients identify the cause of their illness.