What is a Cystoscopy?
A cystoscopy is a medical procedure used to examine the bladder and urethra, the tube that allows urine to exit the body. It is performed using a cystoscope, a thin tube with a light and a camera on the end. This tool allows a urologist to inspect the urinary tract for issues like inflammation, stones, tumors, or bleeding. Depending on the reason for the procedure, a urologist may use either a flexible or a rigid cystoscope, which influences the specific patient positioning and the type of anesthesia used.
Patient Positioning: Flexible vs. Rigid Cystoscopy
Positioning for Flexible Cystoscopy
During a flexible cystoscopy, which is typically an in-office procedure used for diagnosis, the patient's position is designed for comfort and ease of access.
- Position: The patient lies on their back on an exam table.
- Reasoning: The flexible nature of the scope means less-invasive positioning is required, and there is no need for stirrups.
- Experience: The patient is usually awake throughout the procedure, though a topical anesthetic gel is applied to the urethra to minimize discomfort. Patients can often watch the procedure on a screen if they wish, which can help ease anxiety.
Positioning for Rigid Cystoscopy
In contrast, a rigid cystoscopy is typically performed under general anesthesia or heavy sedation in an operating room, especially when additional instruments are needed to take biopsies or remove bladder stones.
- Position: The patient lies on their back with their knees bent and their feet placed in stirrups, similar to a gynecological pelvic exam.
- Reasoning: This position allows the doctor a clear, stable line of sight and an unobstructed path for the straight, rigid scope and any additional surgical instruments.
- Experience: The patient is typically asleep during this procedure, so they will not feel the positioning or the procedure itself.
Comparison of Cystoscopy Types and Positioning
| Feature | Flexible Cystoscopy | Rigid Cystoscopy |
|---|---|---|
| Purpose | Diagnostic, routine check-ups | Biopsy, stone removal, tumor treatment |
| Setting | Doctor's office or clinic | Operating room |
| Anesthesia | Local anesthetic gel | General or spinal anesthesia |
| Scope Type | Thin, flexible tube | Straight, rigid tube |
| Patient Position | Lying on back on exam table | Lying on back with feet in stirrups |
| Duration | 5–15 minutes | Up to 30 minutes, or longer |
| Recovery | Quick, same-day, minimal downtime | May require longer recovery, especially with sedation |
Preparing for Your Procedure
Proper preparation helps ensure a smooth and comfortable experience.
What to Do Before the Cystoscopy
- Empty Your Bladder: The doctor will ask you to urinate just before the procedure to empty your bladder.
- Medications: Discuss all medications, including supplements, with your doctor. They may advise you to stop taking blood thinners like aspirin for a specific period before the test.
- Anesthesia Instructions: If you are having a rigid cystoscopy with general anesthesia, you will be required to fast for a set number of hours before the procedure.
- Arrange a Ride: For procedures involving sedation or general anesthesia, you must arrange for someone to drive you home and stay with you for 24 hours.
On the Day of the Procedure
- Wear Loose Clothing: This will be more comfortable to wear to and from your appointment.
- Relax: Remember that this is a very common procedure. Communicating with your medical team if you have any anxiety or discomfort is always recommended.
The Step-by-Step Cystoscopy Process
- Preparation: You will be asked to empty your bladder and then positioned on the exam table according to the type of cystoscope being used.
- Anesthesia: A numbing gel is applied to your urethra. For rigid cystoscopies, additional anesthesia will be administered.
- Insertion: The doctor will carefully insert the lubricated cystoscope into the urethra and guide it into the bladder.
- Bladder Filling: Sterile water or saline is injected through the scope to fill the bladder. This stretches the bladder wall, allowing the doctor to get a better view. As the bladder fills, you may feel an urge to urinate.
- Examination: The doctor uses the camera on the cystoscope to inspect the lining of your bladder and urethra. Images may be projected onto a screen for a clearer view.
- Biopsy/Treatment (if needed): Small instruments can be passed through the rigid scope to take tissue samples (biopsies) or remove small stones or growths.
- Removal: The cystoscope is slowly withdrawn, and the injected fluid is drained from the bladder.
What to Expect After the Cystoscopy
Common Aftercare Tips
- Drink Water: Increase your fluid intake for a day or two to help flush your bladder and reduce the risk of a urinary tract infection (UTI).
- Manage Discomfort: It's normal to experience mild burning or discomfort when urinating for a day or two, and you may see a little pink or reddish blood in your urine.
- Use OTC Pain Relievers: Over-the-counter pain medication like ibuprofen can help manage any discomfort.
- Rest: Take it easy for the rest of the day and avoid strenuous activities.
When to Contact Your Doctor
While most side effects are mild, contact your doctor if you experience any of the following:
- Fever or chills
- Severe pain
- Inability to urinate
- Bright red or excessive bleeding
- Cloudy or foul-smelling urine
Conclusion
The positioning for a cystoscopy is a well-established part of the procedure designed to ensure patient safety and comfort. While you do lie down for a cystoscopy, the specific position varies based on the type of scope used. Flexible scopes allow for a more relaxed, flat-on-your-back position, while rigid scopes require the use of stirrups. With modern techniques and anesthetics, the procedure is quick and generally well-tolerated. Understanding the process and what to expect can significantly reduce any pre-procedure anxiety. For further detailed information on the procedure, you can consult reputable medical sources like the Cleveland Clinic.
