Overview

Cystoscopy is a procedure that allows direct visualization of the inside of the bladder and urethra using a small telescope (cystoscope) inserted through the urethra. It is a key diagnostic tool in urogynecology, both in the office setting and during surgical procedures.

Cystoscopy procedure showing cystoscope insertion into the bladder

When Is It Considered?

Cystoscopy may be recommended for:

Recurrent urinary tract infections
Blood in the urine (hematuria)
Urinary incontinence or overactive bladder symptoms not responding to initial treatment
Painful bladder symptoms or suspected interstitial cystitis
Abnormal cells found in a urine sample
Evaluation of bladder or urethral pain
During or after pelvic reconstructive surgery to confirm bladder and ureteral integrity

The Procedure

A flexible or rigid cystoscope (approximately pencil-thickness) is gently inserted through the urethra into the bladder
The bladder is filled with sterile fluid to allow clear visualization of the bladder wall
Local anesthetic gel is applied to the urethra for office procedures; regional or general anesthesia is used during operative cases
The procedure typically takes 10-20 minutes in the office setting
Biopsies or small therapeutic interventions can be performed if needed

Normal bladder interior as seen during cystoscopy

Intraoperative Cystoscopy

Cystoscopy is frequently performed during pelvic reconstructive and gynecologic surgery to:

Confirm no injury to the bladder during the procedure
Verify that both ureters are functioning normally (bilateral ureteral patency)
Check for suture or mesh placement within the bladder or urethra
This is considered standard of care during many prolapse and incontinence procedures

What to Expect After

Mild burning or stinging during urination is common and usually resolves within 24 hours
Small amounts of blood in the urine may occur briefly
You may feel a more frequent urge to urinate temporarily
Increased fluid intake is recommended to help flush the bladder
Most patients can return to normal activities the same day or the following day

Risks and Success Rates

Cystoscopy is a very safe and well-tolerated procedure. It remains the gold standard for direct evaluation of the lower urinary tract. Potential risks include:

Urinary tract infection — uncommon
Bleeding — minor and self-limiting
Urethral or bladder injury — rare, including perforation
Discomfort — most women tolerate the procedure very well with local anesthesia

Illustrations courtesy of the International Urogynecological Association (IUGA) Patient Information Leaflets.