Cystoscopy and Urethrocystoscopy

What are Cystoscopy and Urethrocystoscopy?

Cystoscopy is a urological diagnostic procedure to examine the inside of the bladder for possible pathologies.

It can also be called urethrocystoscopy if, in addition to the bladder, the urethra and (in the case of men) the prostatic urethra is also examined.

This examination may be advised for patients with urinary symptoms related to:

Blood in the urine (haematuria);
Benign prostatic hyperplasia (enlarged prostate);
Urinary incontinence in men;
Urinary incontinence in women;
Lithiasis and renal colic (urinary “stones”);
Urinary infections.

In addition to this, the examination allows biopsies to be taken and the post-operative consequences and treatment results to be assessed.

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Importance of Cystoscopy

As this examination can diagnose a high number of pathologies, it is very important and used widely by urologists. No other examination can detect the same information.

Besides being a diagnostic examination, it can also be used for treatment, such as:

Fragmenting stones;
Dilating the urethra;
Removing catheters from the urinary tract;
Injecting botulinum toxin in the bladder.

How is a Cystoscopy Performed?

Cystoscopy is a procedure that on average takes 10–15 minutes and is performed with the aid of a cystoscope – a thin tube with a light and a camera on the end.

With their legs bent and placed in suitable supports, the patient’s genitals and urethral meatus (the external opening of the urethra) are cleaned and disinfected. An anaesthetic gel with a lubricant is applied to the urethra to make the examination more comfortable.

After preparation, the urologist inserts the cystoscope through the urethra up to the bladder to perform the examination.

Video cystoscopy may also be used to ensure the cystoscope is correctly inserted and images are taken if necessary.

Cystoscopic biopsy

If it is suspected that the bladder lining may have lesions or abnormalities, the doctor may perform a biopsy for laboratory analysis.

If only one biopsy (or a small number) is required, it can be performed during the cystoscopy under local anaesthetic. If multiple biopsies are needed, the procedure must be performed surgically at a later date to reduce discomfort/pain.

Limitation of cystoscopy

Cystoscopy is limited when a patient has urethral strictures, as the narrowing may make it impossible. It may be possible to pass the narrowed area, but the cystoscope may cause pain or haemorrhaging which, in addition to exacerbating the base condition, can hinder the desired endoscopic visualisation.

In these cases, treatment is first advised of the urethral stricture or other tests are suggested to obtain the information required before solving this problem.

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Flexible cystoscopy

This is the preferred option, as it is better tolerated than rigid cystoscopy. It is performed with what is called a flexible cystoscopy, which is a thin and flexible tube and therefore easier to tolerate.

As the urethra in women is very short, it is very easy to access the bladder for the test.

If performed with suitable care, i.e. with the appropriate anaesthetic, even for men it is easy to perform and well tolerated by patients.

Rigid cystoscopy

At times, certain aspects detected in the flexible cystoscopy need to be confirmed or a non-flexible technique is necessary to perform therapeutic procedures.

In that case, a rigid cystoscopy is performed which, as the name suggests, uses a firmer cystoscope. This can be done under local anaesthetic or sedation.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

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