Cystoscopy Technique

Updated: Jan 05, 2016
  • Author: Gamal Mostafa Ghoniem, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Technique

Endoscopy of Urinary Bladder

The patient is positioned on the cystoscopy table, prepared, and draped in the usual sterile manner. Before the scope is inserted, 2% lidocaine gel is inserted into the urethra and left for 5 minutes. The patient is warned about some increased discomfort at the level of the external urethral sphincter. When a rigid cystoscope is used in a female patient, it should be introduced with its obturator to minimize urethral trauma and pain.

The flexible cystoscope is then inserted under direct vision and navigated to the bladder. It is critical to remain aware of the major landmarks at all times. Urethral orifices and air bubbles are the most important landmarks.

The bladder is examined in a systematic manner (see the videos and images below). The trigone, the bladder neck, and both ureteral orifices are identified. The bladder base and the posterior bladder wall are examined, and the air bubble is identified. The lateral walls are examined, and the test is concluded by visualizing the urethra.

Cystoscopy, part 1. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Cystoscopy, part 2. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Bladder distention in patient with interstitial cy Bladder distention in patient with interstitial cystitis.
Large supratrigonal vesicovaginal fistula, showing Large supratrigonal vesicovaginal fistula, showing tip of vaginal clamp.

Cystoscopy may also be performed for therapeutic purposes, as in cystolithotripsy (see the videos below).

Cystolithotripsy, part 1. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
Cystolithotripsy, part 2. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
Cystolithotripsy, part 3. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
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Complications

In general, the complications of cystoscopy are usually minor and may include the following:

  • Urinary tract infection [11]
  • Hematuria
  • Dysuria
  • Bladder or urethral injury
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Approach Considerations

A study by Seklehner et al found that flexible diagnostic cystoscopy caused less pain than rigid cystoscopy in men. [12]

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