Cystoscopy is a common diagnostic procedure that allows doctors to examine the inside of the bladder and urethra using a thin, flexible tube called a cystoscope. It’s frequently used to evaluate symptoms such as blood in urine, frequent urinary tract infections, or painful urination. While generally safe, cystoscopy is not without potential complications. Understanding these risks is essential for patients preparing for the procedure.

While cystoscopy is generally considered safe and is performed routinely in outpatient and hospital settings, it is not entirely free of risk. Like any medical procedure, cystoscopy can lead to side effects and complications some of which may require further treatment or medical attention. These complications can range from mild issues such as temporary discomfort or minor bleeding to more serious problems like urinary tract infections, urethral injury, or rarely, bladder perforation.

What Is Cystoscopy?

A cystoscopy is a urological test performed by inserting a cystoscope a thin, lighted instrument through the urethra and into the bladder. There are two types: flexible cystoscopy and rigid cystoscopy. The flexible type is often used for diagnostic purposes and can be performed in an outpatient setting under local anesthesia. Rigid cystoscopy, on the other hand, is usually performed under general or regional anesthesia and is often used for therapeutic procedures.

While cystoscopy is minimally invasive and typically well tolerated, some patients may experience side effects or complications depending on their health condition, type of cystoscopy, and the skill of the practitioner.

Common Complications of Cystoscopy

Most patients experience only mild discomfort following a cystoscopy. However, certain side effects are relatively common and usually resolve within a few days.

Pain or Discomfort During and After the Procedure :- It is normal to feel a burning sensation during urination or to experience some abdominal cramping after the test. This discomfort usually lasts a day or two. Drinking plenty of water post-procedure can help flush the bladder and ease symptoms.
Blood in the Urine (Hematuria) :- Seeing pink tinged urine or small clots after cystoscopy is not unusual, especially if the bladder lining was irritated or if a biopsy was taken. This symptom typically resolves within 24–48 hours. However, persistent or heavy bleeding should be evaluated by a doctor.
Increased Urge to Urinate :- Many patients report feeling an urgent or frequent need to urinate after the procedure. This occurs due to irritation of the bladder lining. The symptom usually resolves on its own in a few days.

Urinary Tract Infections (UTIs)

UTIs are one of the more frequent complications of cystoscopy. Bacteria may enter the urinary tract during the procedure, especially if sterile techniques are not strictly followed.

Signs of a UTI after cystoscopy include

Cloudy or foul smelling urine
Burning sensation while urinating
Fever or chills
Lower abdominal pain

To prevent infections, doctors may prescribe antibiotics before or after the procedure, particularly for high-risk patients.

Rare but Serious Complications

While most cystoscopies go smoothly, there are rare cases where complications can be more serious. These need immediate medical attention.

Bladder Perforation :- This is a very rare but serious complication in which the cystoscope accidentally punctures the bladder wall. Symptoms of bladder perforation may include severe abdominal pain, nausea, fever, or difficulty urinating.

If bladder perforation is suspected, the patient may need imaging tests or even surgical intervention to repair the damage.
Urethral Injury or Stricture :- In some cases, the insertion of the cystoscope may damage the urethra, leading to pain, bleeding, or scar tissue formation. Urethral strictures can later cause difficulty in urination or urinary retention and may require further treatment, such as dilation or surgery.
Bleeding Disorders Complications :- Patients with bleeding disorders or those on blood-thinning medications like warfarin or aspirin may face increased risk of significant bleeding. It’s important to inform the doctor of any such conditions before undergoing the procedure.

Risk Factors That May Increase Complications

While cystoscopy is considered safe for most people, certain factors may increase the likelihood of complications

Weakened immune system :- Increases susceptibility to infection
Existing urinary tract infection :- Can worsen post-procedure
Urethral abnormalities or strictures :- Make insertion difficult or riskier
History of frequent bladder surgeries :- May lead to increased tissue sensitivity
Use of anticoagulant medication :- Increases risk of bleeding

Doctors usually evaluate these risk factors before proceeding with the test to minimize complications.

How to Reduce the Risk of Complications?

There are several steps both doctors and patients can take to reduce the risk of cystoscopy complications.

Pre procedure Evaluation :- Before undergoing a cystoscopy, your urologist will take a detailed medical history, including any ongoing infections, allergies, or medications. In some cases, urine tests may be conducted in advance to rule out active infections.
Following Pre and Post Procedure Instructions :- Patients should follow all instructions provided before the test, including fasting if required. After the procedure, drinking plenty of fluids helps flush the urinary system and reduce irritation. Avoiding strenuous activity and refraining from sexual intercourse for a couple of days may also be advised to promote healing.
Promptly Reporting Any Symptoms :- If you notice any unusual symptoms especially fever, heavy bleeding, or difficulty urinating after your cystoscopy, contact your healthcare provider immediately. Early detection of complications can prevent more serious issues.

When to Call the Doctor?

While minor symptoms like light bleeding or mild burning are normal, the following signs should prompt immediate medical attention :-

Fever above 100.4°F (38°C)
Severe pain or burning during urination
Persistent blood clots in urine
Inability to urinate
Severe abdominal or pelvic pain

Timely intervention can help manage complications effectively and prevent lasting damage.

Conclusion

Cystoscopy is a valuable tool for diagnosing and treating urinary tract conditions, and most procedures are completed without any major problems. However, like any medical intervention, it carries a small risk of complications. Being informed about potential issues, knowing the warning signs, and maintaining close communication with your healthcare provider can ensure a safe experience and successful outcome.