What is a cystoscopy? Cystoscopy or cystourethroscopy is a direct endoscopic operation in which the urologist looks at the details of the inside of the bladder and urethra. Why is a cystoscopy done? Often due to the presence of hematuria or urethral obstruction, or any abnormality of the bladder and its mucosal surface, it is the most common test used by urologists. What should I tell my doctor before a cystoscopy? Are you taking any medications, especially aspirin or blood-thinning medications What medications are you allergic to If you are pregnant What to do before cystoscopy? Infectious disease testing (endoscopes are designed to be sterilized for repeated use) Blood clotting tests, routine blood work, urine routine Stop any medications you are currently taking as prescribed by your doctor Reduce your diet as appropriate prior to the exam The entire procedure, including waiting and preparation, can sometimes take 1-2 hours Follow your doctor’s instructions How is a cystoscopy performed? Cystoscopy is often performed on an outpatient basis. Before the procedure, the patient’s bladder is emptied and the patient is then placed on the examination table on his or her back with the legs spread apart (called a cystostomy position). The doctor will inject a liquid or gel-like local anesthetic into the urethra and then perform the examination, which usually takes 5-10 minutes to operate. In developed foreign countries, the procedure is also performed under general anesthesia to avoid pain. The cystoscope is inserted through the urethra into the bladder and can be a long, thin, rigid metal mirror (more commonly used) or a flexible mirror that can be curved. Fluid (saline) is injected during the endoscopic exploration to expand the bladder for easier visualization. What will a cystoscopy reveal? A normal bladder wall is smooth and has what is called a normal range of volume, shape and position, and there should not be any obstruction. There is also the opening of the ureter and whether it is abnormal or spurting blood, etc. For any mucosal surface abnormality, the doctor will remove a small piece of tissue for pathological examination. Sometimes the doctor will also insert a thin tube (catheter) into the opening of the ureter and retain urine or inject contrast (retrograde contrast). What will I feel after the cystoscopy? After the exam, the patient’s urethra may be sore and may have burning discomfort for up to 48 hours, and the urine may be bloody, usually disappearing in half a day to a day. Drinking more water will reduce the pain and bloody urine. If the pain persists, a fever develops, or if the blood and urine are thick, notify your doctor promptly. What happens to the test results? The doctor will issue a formal report after the test and will discuss the results with the patient or family at some point. If a tissue biopsy was performed during the test, the results will be available in about a week. A cystoscopy is sometimes the basis for further tests or treatment. It has been more than 100 years since the birth of the cystoscope as the first endoscope that could look directly into the body. With improvements in endoscopy and technology, cystoscopy has become the most commonly used minimally invasive test in urology. You have nothing to fear if needed. However, this operation is invasive and requires a preoperative examination and a brief preparation, which should be fully communicated with your doctor.