Cystoscopy

Reviewed by Mr John Macfarlane, consultant urological surgeon

What is a cystoscopy?

A cystoscopy is a telescopic inspection of the bladder and the urethra, which is the passageway that takes the urine to the outside.

It is performed either as an aid to diagnosis of lower urinary tract symptoms; or as part of a treatment plan relating to a specific condition, eg bladder tumour or stones.

There are two types of cystoscope (the instrument used).

Rigid cystoscope: this is a solid straight telescope, which has been in use for many years. It is used alone with a high intensity light source and a separate channel to allow other instruments to be attached.

Flexible cystoscope: this is more commonly used particularly for diagnosis and for the follow up of most bladder tumours. It is a fibre optic instrument that can bend easily and has a manoeuvrable tip that makes it easy to pass along the curves of the urethra.

How is a cystoscopy examination performed?

A flexible cystoscope can be passed along the urethra without an anaesthetic but the doctor may lubricate the urethra with some jelly squeezed from a disposable tube.

By manoeuvering the tip, the doctor can view all the corners of the bladder. An attached camera will allow a view of the bladder to be projected on to a TV monitor. A rigid cystoscope is usually used with a general or local anaesthetic.

A much wider range of instruments can be employed with this instrument making it easier to take biopsies, remove bladder stones or burn (cauterise) bladder tumours.

What does cystoscopy do?

As the instrument is passed into the patient, the doctor will carefully examine the urethra, which is much longer in the male.

As the cystoscope is advanced, the doctor is looking for any narrowing of the urethra and for evidence of obstruction on passing through the prostate (in men).

Once inside the bladder, the lining (mucous membrane) is carefully inspected for polyps (usually non-dangerous growths), bulges (diverticulae), tumours, wounds or stones (calculi).

The mucous membrane is looked at as a whole, and checked to see if it is irritated or pale, or if there are coatings on it that shouldn't be there.

The capacity of the bladder and any deformities are assessed. The openings of the ureters into the bladder (urinary passages from the kidneys) are inspected.

The link to the urethra (bladder neck) is also looked at carefully. The doctor will have discussed other procedures he may consider necessary.

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