Is cystoscopy a standard procedure prior to TURP?

Cystoscopy means look (scopy) into the bladder (cyst = bladder/pouch). This is done while awake with some numbing gel into the urethra and takes 3-5 minutes. We haven't had to soundproof the walls in the clinic yet; it is very tolerable with > 99% patients not demanding the next cysto (commonly abbreviated like this) is done in the operating room. The main reason it is done is for men with blood in the urine of unknown cause (hematuria) to rule out bladder cancer, the 4th most common cancer in men.

Our urology guidelines tell us some type of characterization of the prostate should be done prior to TURP. This can include a CT, MRI or other imaging - so not everyone needs a cysto prior to TURP. If the urologist is worried about something else in the list of things that could be causing urinary symptoms like urethral narrowing or stricture or bladder stone a cysto in clinic is helpful. Some Urologists will want to do a cysto prior to help determine the best treatment approach trying to answer the ? Is there a prominent median lobe of the prostate etc.

All the best,

Dr Kohler
Professor of Urology
Head of Mayo Men's Health

@johnfailla1018
It appears that you have a major issue if a cystoscopic procedure results in what you’re dealing with. I have had a cystoscopic done in Feb with little discomfort other than a bit of burning when I urinated just after the procedure. If your not seeing a urologist now, don,t wait have your issue investigated, you should not be suffering as you are.

@tkohler

Hi Dr. Kohler,

Just a quick question: I had a urodynamic test done and found it to be extremely painful and experienced a lot of discomfort...probably due to a low-pain threshold. I have a cystoscopy procedure coming up in a few weeks. Do I have anything to fear in this regard? Can a patient get light sedation coupled with gobs of lidocaine? Thanks in advance!

@pconnection I demanded to be put under for my cystoscopy! I have talked to friends who didn't go under and they said it was moderately painful, but not unbearable. I decided I wasn't trying to prove anything so why choose to experience any pain I don't have to. I got sedation by choice when I had a tooth pulled a few years back, so why not now, right. If you have medicare plus a plan G supplement, it will all be taken care of 100%. Good luck.

I had two cystoscopies done and both times I requested sedation. Both urologists gave me nitros oxide(gas to inhale that you control). Medicare does not pay anything, but I was happy to pay the $100. It worked great!

@fireman123 Not sure what your experience has been for a cystoscopic procedure but I have had three and except for a bit of “burning” with my first urination it was no big deal. I would rather be awake and see the procedure on the monitor. It helped me understand how the urethra was being squeezed by the prostate, fascinating for someone whose never seen the inside of the plumbing.

@grandmira Well, I have actually only had one done. My fear comes from a previous TURP I had years ago. I was sent home and told I could just remove the catheter the next day at home. My wife helped me, and just before it got completely out, it hung. All fluid expelled from the bulb, but it would not come out. I put a washrag in my mouth and told her to just pull for all she was worth. The most intense pain I have ever felt in my life, and I have had a lot. Bled a bit and had to go back to an ER the next day because I could not pee(that is a whole nother story). I now get the ebeegeebees just thinking of anything going in me that route! I may just be getting soft painwise in my old age, but it just ain't for me. BTW. My TURP worked pretty well 10 years ago, the PAE I had 1 year ago did nothing, and lastly this aquablation has worked the best.

@fireman123 sounds like you went to hell and back. That procedure should never have that outcome unless one has u turns the rest of don’t. I can see why you would be reluctant to have any procedure. Best of luck in ant future procedures and thank you for sharing that horrendous experience.

I have a cytoscopy with Dr Kohler in October. I'm inclined not to do anything further that's invasive based on how things are now.

Reading these articles on some men’s experience with cystoscopy begs the question as to what if anything is being told to patients prior to the procedure. I personally had had three, the first when I was 18, that one was unforgettable in of itself. The other two within the last ten years. I don’t believe men should forego this diagnostic procedure as there is a wealth of info a urologist gleans from it. I don’t say it’s not without some discomfort which should be mild unless there is an underlying issue not readily apparent until the scope is in.