Cystoscopy Sterility: Procedure Classification and Infection Prevention

Cystoscopy is a sterile procedure. The urethra and bladder are normally sterile; instrumentation requires strict aseptic technique to prevent iatrogenic infection.

Sterile Protocol Elements

• Sterile cystoscope, sheath, instruments, irrigation fluid
• Sterile prep of urethral meatus (chlorhexidine/povidone-iodine)
• Sterile drapes, gloves, gown
• Sterile lubricant (lidocaine jelly)
• Aseptic no-touch technique throughout

Infection Risk Despite Sterility

• Bacteriuria prevalence increases with age, catheterization, instrumentation
• Post-cystoscopy UTI rate: 1–5% (higher with risk factors)
• Prophylactic antibiotics indicated for: immunosuppression, valvular heart disease, prosthetic joints, active UTI, traumatic catheterization

Flexible vs. Rigid Cystoscopy

Both require sterile technique. Flexible (office) uses disposable sheaths; rigid (OR) uses sterilized metal instruments.

Key point: "Clean" is insufficient—sterile technique is standard of care.