Cystoscopy

Defi nition
Cystoscopy examines the inside of the urethra and bladder using
a cystoscope and is one of the most widely used invasive urological
investigations. It gives direct visualization of the urethra and
bladder for both males and females but it is especially important
in males as the urethra is much more complex (Fillingham and
Douglas 2004 , Rodgers et al. 2006 ).

Indications

Bladder dysfunction.
Unexplained haematuria.
Diagnosis of bladder cancer.
Staging of bladder cancer.
Obstruction or strictures.
Dysuria.

Contraindications

Confi rmed urinary tract infection.

Pre-procedural considerations
Equipment
A cystoscope may be fl exible or rigid. A rigid cystoscope is
utilized in the operating theatre where the patient is anaesthetized.
The fl exible cystoscope can be used in the outpatient setting
with local anaesthesia. The fl exible cystoscope is useful
for patients who require more regular examinations for followup
after bladder cancer treatment (Fillingham and Douglas
2004 ).

Specifi c patient preparation

It is essential that the patient does not have a UTI as the organism
responsible for the infection may be spread into the bloodstream
during the procedure. If the patient is having a general anaesthetic,
they will have to fast prior to the procedure, dependent on
anaesthetic instruction. Prior to the procedure, patients undergoing
a local anaesthetic can usually eat and drink as normal and
should empty their bladder prior to the procedure (Fillingham
and Douglas 2004 ). It may be necessary for some patients to be
treated with antibiotics before the procedure to reduce the risk of
infection (AUA 2012).

Post-procedural considerations
Immediate care

Dependent on the type of procedure, recovery will vary. After a

general anaesthetic, the patient will be recovered by recovery
nursing staff . In the outpatient setting, physiological observations
may be required. Nursing staff should monitor for signs of
haematuria, infection, urinary retention and excessive pain in the
abdomen or urethral area. It is also possible that the patient may
experience bladder spasms which can be minimized with prescribed
analgesics. Oral fl uids should be encouraged (Chernecky
and Berger 2013 ).

Ongoing care

It is common for the patient to experience some burning sensations

whilst passing urine for a few days. It is advised that the
patient drink plenty of water post procedure to fl ush the bladder
and reduce the risk of infection. Any signs of excessive bleeding
should be reported to the medical team (Chernecky and Berger
2013 , Fillingham and Douglas 2004 ).

Complications
Infection

There is a risk of urinary infection in approximately 5% of cystoscopies

performed. If an infection were to occur, relevant prescribed
antimicrobial therapy may be required (Rodgers et al.
2006 ).