What is a Cystoscopy?

Reviewed by: HU Medical Review Board | Last review date: September 2017.

A cystoscopy, often referred to as a "scope", is a procedure that is commonly used as part of the process of diagnosing a patient with bladder cancer.1,2 Healthcare providers may recommend a cystoscopy if the results of a patient’s physical examination and urine lab tests suggest that bladder cancer may be the cause of the patient’s symptoms, such as blood in the urine.

How is a cystoscopy used to diagnose bladder cancer?

A cystoscopy allows a healthcare provider to check for signs of cancer by examining the inside of the bladder and the urethra, which is the hollow, tube-like organ that connects to the bladder and allows urine to flow out of the body. A cystoscopy can also be used to take tiny tissue samples from the bladder or urethra that can be analyzed in the laboratory for possible signs of cancer cells.

What happens during a cystoscopy procedure?

A cystoscopy is often performed by a urologist, which is a doctor who specializes in urinary tract health, including bladder cancer.1,3 Depending upon your circumstances, the cystoscopy procedure can be performed in a healthcare providers office or in an operating room at a hospital, for example. Sometimes a cystoscopy is done when the patient is unconscious under general anesthesia; in other cases, the patient is sedated or the lower part of the patient’s body is numbed. It can also be done using only local anesthesia to numb the bladder and the urethra to reduce the patient’s discomfort during the procedure. A cystoscopy is generally a relatively short procedure that takes less than an hour.

In the first part of the procedure, a long, thin medical instrument called a cystoscope is inserted into the patient’s bladder through the urethra. The cystoscope has a tiny light and viewing lens on the end of it, which allows the healthcare provider to look at the inside lining of the bladder, and the images may be projected on a nearby computer monitor as the procedure is performed.

In the second part of the procedure, the healthcare provider uses the cystoscope to fill the bladder up with a sterile liquid. By expanding the bladder fully with this liquid, the healthcare provider can look at the lining of the bladder more precisely than when the bladder is not full. At the end of the procedure, a sample of the sterile liquid that was used to fill the bladder may be sent to the lab for further analysis—called cytology testing—that can potentially detect the presence of cancer cells in the liquid.

What is an enhanced cystoscopy?

An enhanced cystoscopy is an additional procedure that may be carried out during a cystoscopy.1 Enhanced cystoscopy is also called fluorescence or blue light cystoscopy. During this procedure, a type of drug that is only absorbed by cancer cells is put into the bladder. When a special blue light is used on the cystoscope inside the bladder, bladder cancer cells containing the drug start glowing. This makes it easier for the healthcare provider to detect signs of cancer that are not visible during a regular cystoscopy.

What are the next steps when diagnosing bladder cancer?

The cystoscopy is one of several tests that can be used to diagnose bladder cancer and learn more about the bladder cancer in patients who have already been diagnosed.1,2 Other tests include:

  • Urine lab tests
  • Examination under anesthesia
  • Transurethral resection of bladder tumor (TURBT)
  • Imaging tests, including pyelogram, CT/CAT scan, MRI, x-rays, and ultrasound
  • Biopsy of tissue samples from the bladder

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