This information will help you prepare for your cystoscopy and other related procedures at Memorial Sloan Kettering(MSK).
A cystoscopy is a procedure that allows your doctor to examine your urethra, bladder, and openings to your ureters. Your ureters are the tubes that carry urine from your kidneys to your bladder (see Figure 1). A cystoscopy is done to look for problems in the urinary tract, such as a blockage in your urethra caused by kidney stones or tumors.
A cystoscopy is done using a thin, hollow, lighted instrument called a cystoscope. Your doctor will insert the cystoscope into your urethra and slowly move it into your bladder. Small surgical instruments can be inserted through the cystoscope to remove samples of tissue for a biopsy, stones, or small growths.Back to top
During your cystoscopy, you may also have 1 or more of the following procedures:
- Transurethral resection of the bladder tumor (TURBT)
- During a TURBT, your doctor will remove a bladder tumor by using an instrument that goes through the cystoscope.
- Ureteroscopy (YER-eh-ter-OS-koh-pee)
- During a ureteroscopy, your doctor will insert a thin instrument called a ureteroscope through your urethra, bladder, and ureter. This procedure is done to see if there is anything blocking or interfering with the flow of urine.
- Retrograde pyelogram
- A retrograde pyelogram is done to see if there is anything blocking or interfering with the flow of your urine. Your doctor does this by looking at your ureters and renal pelvis in your kidney (see Figure 2).
- During this procedure, small, thin, catheters (flexible tubes)are guided up to your kidney through your ureters. Contrast media is then injected through the catheters. The contrast media makes these areas stand out so your doctor can see them better. X-rays are taken of your renal pelvis and ureters.
- Removal of stones or blood clots from your bladder
- Placement of ureteral stents
- The stents will keep your ureters open. That helps urine flow from your kidneys to your bladder.
Before Your Procedure
You may need to stop taking some of your medication before your procedure. We have included some common examples below.
- If you take medication to thin your blood, such as to treat blood clots or to prevent a heart attack or stroke, ask the doctor who prescribes it for you when to stop taking it. Some examples are aspirin, warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), cilostazol (Pletal®), dabigatran (Pradaxa®), and apixaban (Eliquis®).
Tell your doctor or nurse what medications you are taking, including prescription medications, patches, creams, herbal supplements, and over-the-counter medications.
Tell your doctor or nurse if you have had an allergic reaction to contrast media in the past.
You must have someone 18 years or older take you home after your procedure. If you don’t have anyone, call one of the agencies below. They will provide someone to accompany you home, however there is usually a charge for this service and you will also need to provide transportation.
In New York:
Partners in Care: 888-735-8913
Prime Care 212-944-0244
In New York or New Jersey:
Caring People: 877-227-4649
If you take vitamin E, stop taking it 10 days before your procedure, because it can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
If you take aspirin, ask your doctor if you should continue. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (e.g., Advil®, Motrin®) and naproxen (e.g., Aleve®). These medications can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).Back to top
The Day Before Your Procedure
A clerk from the Admitting Office will call you after 2:00 pm the day before your procedure. He or she will tell you what time you should arrive at the hospital for your procedure. If you are scheduled for your procedure on a Monday, you will be called on the Friday before. If you do not receive a call by 7:00 pm, please call 212-639-5014.
On the day of your procedure, you will go to the Presurgical Center (PSC) on either the 2nd or the 6th floor. Both locations are at 1275 York Avenue between East 67th and East 68th streets.
The Day of Your Procedure
Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of clear liquids (see Figure 3).
Examples of clear liquids include:
- Clear broth, bouillon, or consommé (no particles of dried food or seasonings)
- Gelatin, such as Jell-O®
- Clear fruit juices (no pulp), such as white cranberry, white grape, or apple
- Soda, such as 7-Up®, Sprite®, ginger ale, seltzer, or Gatorade®
- Coffee or tea, without milk or cream
- Take a shower with soap and water. You can brush your teeth and rinse your mouth.
- Do not put on any lotion, cream, deodorant, makeup, powder, or perfume.
- Do not wear any metal objects. Remove all jewelry, including body piercings.
- Leave valuables, such as credit cards, jewelry, or your checkbook, at home.
- Bring only the money you may need for a newspaper, bus, taxi, or parking.
Parking at MSK is available in the garage on East 66th Street between York and First Avenues. To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There is a pedestrian tunnel that you can walk through that connects the garage to the hospital. If you have questions about prices, call 212-639-2338.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Your nurse will start an intravenous (IV) line in your vein to give you anesthesia (medication to make you sleep).
Once you are asleep, your doctor will perform the cystoscopy and any other procedures that you are having. He or she may insert a urinary catheter at the end of your cystoscopy to help drain your urine into a bag.
Your procedure will take up to 1 hour.Back to top
After Your Procedure
When you wake up, you will be in the Post Anesthesia Care Unit (PACU). While you are in the PACU, your nurse will check your heart beat, breathing rate, temperature, and blood pressure. Your nurse will also check your urine output to make sure your flow of urine is not blocked. You may still have the urinary catheter in place. It may be removed before you are discharged or a few days after your procedure.
If you catheter is removed before you go home, you must urinate before you are discharged. If you go home with a catheter in place, your nurse will show you how to care for it before you go home. You may need to take medication(s) at home, such as antibiotics to prevent infection or medications to relieve discomfort. Ask your doctor or nurse when you can go back to work.
Your nurse will explain your discharge instructions to you and your caregiver before you go home.
Do not drive for 24 hours after your procedure.
Biopsy or tumor removal
If you had a biopsy or a tumor removal, you will have a scab inside your bladder. It will loosen within a month. If the scab loosens before your healing is complete, it may cause bleeding. If this happens, rest and drink more liquids. Most bleeding will stop within 3 to 4 hours, but it is best to rest that day to help stop the bleeding. Call your doctor if you continue to bleed, or if you are not able to urinate.
Changes when you urinate
You will most likely experience hematuria (blood in your urine) after your procedure. This should go away within 1 week.
You may also have frequent urination and pain or burning when you urinate. Although these symptoms can last for 3 to 4 weeks, they should be improving as you heal. If they do not improve or if they worsen, call your doctor, because you may have a urinary tract infection (UTI).
To help relieve both of these symptoms, drink 8 (8-ounce) glasses of liquids a day for the first 2 weeks after your procedure. Avoid drinking liquids after 8:00 pm so that you don’t have to go to the bathroom during the night. Be sure to get plenty of rest.
While the urinary catheter is in place, you may feel a strong urge to urinate. This happens because the small inflated balloon that keeps it in place may cause your bladder to feel full. Relaxing and allowing the urine to flow will decrease this urge.
- You may feel the stents. They usually feel like pain in the kidney. The pain may be worse when you urinate or exercise. Your doctor may give you medication to help with the pain.
- Drink plenty of liquids while you have the stents.
- If you need to go on car trips that are longer than 1 hour for 1 week after your procedure, talk with your doctor or nurse.
- Don’t lift objects heavier than 10 pounds (4.5 kilograms) for 2 weeks after your procedure.
- Don’t do strenuous exercise, such as tennis, jogging, or exercise programs, for 2 weeks after your procedure.
- You can walk and climb stairs right away after your procedure.
If you had ureteral stents placed during your procedure, call your doctor’s office to schedule a follow-up appointment. The stents will need to be changed every 3 to 6 months, or as instructed by your doctor.
- Continuous bright red blood or blood clots in your urine
- Bleeding (pink urine) for more than 1 week that is not getting better
- Pain or burning when you urinate for more than 3 days that is not getting better
- Frequent urination for more than 3 days that is not getting better
- A temperature of 101° F (38.3° C) or higher
- Shaking chills
- Pain in your lower back
- An inability to urinate