What to expect on the day of your cystoscopy

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Written by: Dr. Carrie Aisen

Dr. Carrie Aisen, a San Diego-based urologist who focuses on evidence-based medicine, shares what to expect on the day of your cystoscopy.

A cystoscopy is done to visually inspect the bladder and the urethra (for males, it also inspects the prostate where the urethra travels through it.) It is typically a small flexible tube that is passed through the urethra (the tube where the urine travels out). The bladder is the organ that stores the urine and the urethra is where the urine passes to leave the body.

Unless your doctor gives you specific instructions, you do not need to do anything to prepare for your cystoscopy. It is completely normal to be nervous about something that is new to you, but this is a procedure that a urologist does often in the office. My patients typically tell me after the procedure that it was not at all as bad as they thought it would be. It might be uncomfortable but it should not hurt. Easier said than done, but anything that you can do to relax will make the procedure more comfortable. If you tighten your muscles you will be pushing against the camera as it passes through the urethra. If it is okay with your doctor's office, you can try putting in one ear bud to listen to your favorite calming music and do a few deep breaths as they are starting the procedure.

You will be brought to the exam or procedure room where you are told to undress from the waist down. Females are typically placed in stirrups or positioned in a frog leg position. Males lay flat on their backs.

The procedure itself typically takes a few minutes and then the doctor will go over the results with you. Sometimes additional procedures can be done at the same time such as small biopsies.

After the procedure it is normal to have some UTI-like symptoms such as, burning with urination, urgency, frequency, and possibly some blood in the urine. But it is very rare to get a UTI from the cystoscopy.

To manage these symptoms you can try staying well hydrated, taking over the counter pain relief (NSAIDS if you are okay taking this type of medication), or consider trying over the counter phenazopyridine if the burning is very bothersome and you tolerate this medication. It’s recommended to ask your doctor which might be best for you after the procedure.

Typically, any symptoms should clear up in a few days. Most patients find drinking a lot of water sufficient and they do fine as long as they know to expect these symptoms. If you have fevers, cannot urinate, or are having heavy bleeding – you should call your doctor or go to the emergency room as these are not normal reactions after the cystoscopy.

The day of your procedure your doctor will review any symptoms they may expect you to have after the procedure, and will cover what is normal and what is not.If any questions or concerns come up, it is always best to call your doctor’s office as they know your case personally and can advise you on any questions or concerns.

There is a small risk of developing a UTI after a cystoscopy. Studies that have looked at the risk of infection after a cystoscopy have shown that, as long as a patient does not have symptoms of a UTI when they have a procedure, the risk is very low. Even patients who have bacteria in the urine without symptoms of an active UTI, are unlikely to develop a symptomatic UTI after the procedure (1).

The American Urology Association states that routine cystoscopy does not require antibiotics in healthy adults in the absence of infectious signs and symptoms due to the very low risk of developing a UTI after this procedure (2).

Your doctor will give you recommendations based on your personal situation. If you are concerned you have a UTI after the procedure, it is very important to give a urine culture because the normal post procedure symptoms can be very similar to symptoms of a UTI.

Have more questions? Write them down as you think of them and bring the list to your doctor’s visit to make sure you don’t forget to ask!

This article is not intended to replace medical advice given to you by your doctor.

Sources

1. Herr H. W. (2015). The risk of urinary tract infection after flexible cystoscopy in patients with bladder tumor who did not receive prophylactic antibiotics. The Journal of urology, 193(2), 548–551. https://doi.org/10.1016/j.juro.2014.07.015

2. Lightner DJ, Wymer K, Sanchez J et al: Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol 2020; 203: 351.