What is cystoscopy?

Indications and Procedures

Cystoscopy is indicated in patients for whom visual inspection of the urethra, bladder mucosa, and ureteral orifices is likely to yield a diagnosis. This includes patients who have hematuria (blood in the urine), incontinence, and irritative bladder symptoms for whom all obvious causes have been ruled out. In addition, patients who have undergone difficult abdominal or pelvic surgery may receive cystoscopy to verify that the bladder and the ureters, the tubes that carry urine from the kidneys to the bladder, are intact.

Cystoscopy is performed with the patient in a supine position with legs in stirrups. The cystoscope consists of a small metal tube, through which distension medium is passed. The light source, which enables visualization, also passes through this tube. The cystoscope can be attached to a video screen, or the clinician can visualize the urethral and bladder mucosas directly through the cystoscope. The cystoscope may be angled at 0 degrees, 30 degrees, or 70 degrees to facilitate visualization of different parts of the bladder. The procedure involves passing the cystoscope into the urethra and then the bladder under direct visualization. Cystoscopy is performed in a systematic fashion to ensure complete coverage of the urethral and bladder mucosas. Abnormal areas can be biopsied. The ureteral orifices can be visualized using the cystoscope, and the presence of urine flow from the orifices confirms patency (lack of obstruction) of the ureters.

Uses and Complications

Cystoscopy can be used to diagnose a variety of benign and malignant conditions of the lower urinary tract. Among the benign conditions commonly found through cystoscopy are endometriosis of the bladder, interstitial
cystitis, foreign bodies, and anatomic abnormalities such as fistulas (communicating tracts between the bladder and another organ such as the bowels) or diverticula (small outpouchings of the bladder or urethra). By filling the bladder with distension fluid during cystoscopy, it is also possible to perform limited bladder function tests. Malignant conditions that may be found on cystoscopy include bladder cancers and cancers of adjacent pelvic organs, such as the cervix, which may invade the bladder.

Cystoscopy is an extremely safe procedure. Theoretical risks include the possibility of bladder injury or perforation from the cystoscope.

Bibliography

Doherty, Gerard M., and Lawrence W. Way, eds. Current Surgical Diagnosis and Treatment. 13th ed. New York: Lange Medical Books/McGraw-Hill, 2010.

Miller, Brigitte E. An Atlas of Sigmoidoscopy and Cystoscopy. Boca Raton, Fla.: Parthenon, 2002.

Randall, Brian. "Cystoscopy." Health Library, April 17, 2013.

Rock, John A., and Howard W. Jones III, eds. Te Linde’s Operative Gynecology. 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2011

Stenchever, Morton A., et al. Comprehensive Gynecology. 5th ed. St. Louis, Mo.: Mosby/Elsevier, 2007.

Vorvick, Linda J. "Cystoscopy." MedlinePlus, June 18, 2012.