When caring for a patient after cystoscopy What should the nurse include in the plan of care?

Last updated on 10 February 2022

What is a cystoscopy?

A cystoscopy, or bladder scope, is a medical procedure that examines the lining of your urinary bladder and the urethra. The urinary bladder is an organ that stores the urine before it is emptied when you relieve yourself, a process doctors refer to as ‘voiding’. The urethra is the tube where the urine passes from the bladder and out of the body.

Cystoscopy is performed using a thin tube with a light source and camera at the end. This tube is inserted up to the bladder so that the doctor can visualise the inside of the bladder.

What is a cystoscopy for?

Patients who experience recurrent urinary tract infections (UTIs), blood in urine, and difficulty in urinating are advised to undergo a cystoscopy.

Cystoscopy is used to:

• Check for the causes of problems involving the urinary tract and pelvic pain
• Remove tissue samples for laboratory testing
• Remove bladder stones, insert or remove a stent and administer medicine into the bladder

During a cystoscopy, the urologist looks out for any of the following:

• Abnormal masses or tissues
• Abnormal outpouching of the bladder or urethra
• Bladder stones
• Inflammation of the bladder or urethra

Types of cystoscopy procedures

There are 2 main types of cystoscopy procedures: flexible cystoscopy and rigid cystoscopy. Both involve passing a thin viewing tube called a cystoscope along the urethra and into the bladder, but they are done in slightly different ways.

Flexible cystoscopy

This involves a thin and flexible cystoscope, that is inserted while you are awake.

Rigid cystoscopy

A wider and rigid cystoscope is used for this procedure. It is performed either while the patient is sedated or with the lower half of the body numbed.

Preparing for a cystoscopy

There is no limitation to eating or drinking before the procedure. Just that you’ll have to empty your bladder before the procedure starts. You will then be asked to change into a hospital gown, and the procedure takes place while you’re lying down.

The doctor will first apply a local anaesthetic at the urethra. A thin tube will be inserted gently through the bladder. Saline will then be infused through the tube to stretch the bladder. This is done so that the doctor can visualise the bladder more clearly. After a few minutes, the tube will be removed.

You can choose to do the procedure under sedation, if so, you would need to fast 2 – 4 hours before the procedure.

You can go home after the procedure. Hospital admission is not necessary for a cystoscopy.

Depending on the type of cystoscopy you are going for, flexible or rigid cystoscopy, the procedure and necessary preparations may vary.

Flexible cystoscopy

• You can usually eat and drink as normal before the procedure
• You’ll be asked to change into a hospital gown before the procedure begins
• The procedure is done with you laying down flat on a special couch
• Your genitals are cleaned with antiseptic and a sheet is placed over the surrounding area
• An anaesthetic gel is applied to your urinary tract to numb it. Then the cystoscope is inserted and gently moved towards your bladder
• Water may be pumped into your bladder to see the insides more clearly

Rigid cystoscopy

• You may be asked to stop eating and drinking a few hours before the procedure
• You’ll be asked to change into a hospital gown before the procedure begins
• General anaesthetic may be injected into your hand, which will make you fall asleep. Otherwise, a spinal anaesthetic may be administered, which only numbs the lower half of your body
• The procedure is done with you laying down flat on a special couch and your legs supported
• Your genitals are cleaned with antiseptic and a sheet is placed over the surrounding area
• The cystoscope is inserted and gently moved towards your bladder
• Water may be pumped into your bladder to see the insides more clearly

It will take about 24 hours for the anaesthetic to wear off, therefore limiting the activities you can do including driving.

Is a cystoscopy painful?

You may be given anaesthetic if you are undergoing a rigid cystoscopy procedure. While both flexible and rigid cystoscopy procedures are not painful, you may feel some discomfort or the urge to urinate while the procedure is ongoing.

Cystoscopy recovery

After the procedure, you may feel sore or have a burning sensation at the urethra for up to 48 hours. You may also find some blood mixed with your urine for up to 24 hours. These symptoms should improve within the next 1 – 2 days and you should be able to resume work or most of your usual activities.

Cystoscopy side effects, risks and complications

Cystoscopy is generally considered safe. There is a small risk of developing infection of the urinary bladder, bleeding while urinating or a reaction to the anaesthetic used. To reduce your risk for complications, your doctor will advise you to drink plenty of fluids after the procedure.

Visit the A&E department immediately if any of the following symptoms show up after the procedure:

• Fever
• Bloody urine lasting more than 48 hours
• Pain persisting for more than 48 hours

Complications from a cystoscopy are rare. They include:

• Urinary tract infections. These are infections of the bladder, kidneys or small tubes connected to them that may be due to germs that are introduced into the body during the procedure
• Inability to empty bladder. Sometimes it might be difficult to pee after a cystoscopy. This could indicate a swelling of your urinary tract or prostate.
• Bleeding and bladder damage. In rare cases, blood in the urine could mean injury or damage to the bladder.
• Pain. Abdominal pain and a burning sensation when urinating may be felt after the procedure.

Article reviewed by Dr Shirley Bang, urologist at Parkway East Hospital

References

Gee JR, Waterman BJ, Jarrard DF, et al. Flexible and Rigid Cystoscopy in Women, retrieved on 2 July 2020 from https://pubmed.ncbi.nlm.nih.gov/19660204/. (n.d.)

Cystoscopy, retrieved on 2 July 2020 from https://www.cancer.org/treatment/understanding-your-diagnosis/tests/endoscopy/cystoscopy.html. (14 January 2020)

What happens: Cystoscopy, retrieved on 2 July 2020 from https://www.nhs.uk/conditions/cystoscopy/what-happens/. (20 April 2020)

What is Cystoscopy?, retrieved on 2 July 2020 from https://www.urologyhealth.org/urologic-conditions/cystoscopy. (n.d.)

Cystoscopy, retrieved on 2 July 2020 from https://www.mayoclinic.org/tests-procedures/cystoscopy/about/pac-20393694. (22 August 2018)

Cystoscopy: Results and Follow-up, retrieved on 2 July 2020 from https://my.clevelandclinic.org/health/diagnostics/16553-cystoscopy/results-and-follow-up. (5 July 2017)

Cystoscopy. (2020, April 20) Retrieved December 28, 2021, from https://www.nhs.uk/conditions/cystoscopy/

Cystoscopy. (2021, January 05) Retrieved December 28, 2021, from https://www.mayoclinic.org/tests-procedures/cystoscopy/about/pac-20393694

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