Cystoscopy: Procedure, Indications, and What to Expect

Cystoscopy is endoscopic visualization of the urethra and bladder using a rigid or flexible cystoscope.

Indications

• Hematuria (microscopic/gross) evaluation
• Recurrent UTI (≥3/yr or ≥2 in 6 mo)
• Voiding dysfunction (obstruction, retention)
• Bladder tumor surveillance (NMIBC)
• Urolithiasis (diagnosis/treatment)
• Foreign body, fistula, diverticulum
• Urethral stricture assessment
• Neurourologic evaluation

Procedure Types

Feature	Flexible	Rigid
Anesthesia	Topical lidocaine gel	Spinal/general
Setting	Office	OR
View	Angled, panoramic	Straight, larger working channel
Therapeutic	Limited (biopsy, injection)	TURBT, stone laser, stricture dilation, resection

Patient Experience

• Prep: Empty bladder, no fasting (flexible)
• Position: Lithotomy
• Duration: 5–15 min (diagnostic)
• Sensation: Pressure, urge to void, brief burning

Post-Procedure

• Mild dysuria, frequency, pink urine × 24–48 hrs
• Hydrate well
• Antibiotic prophylaxis only if high risk (prosthetic valve, immunosuppressed)
• Complications rare: UTI (<5%), bleeding, perforation (<0.1%)

Advanced Techniques

• Blue Light (Cysview) — fluorescence detection of carcinoma in situ
• Narrow Band Imaging (NBI) — vascular pattern enhancement
• Optical Coherence Tomography (OCT) — depth resolution