Cystoscopy is generally a safe procedure. Serious complications are rare. As with any surgery, there is the risk of infection, bleeding, and complications from the anesthesia. In all but the simplest procedures, antibiotics are used before the surgery to reduce the incidence of urinary tract infection. Bleeding is generally controlled during the procedure with the use of cautery.
- A complication unique to cystoscopy is the risk of perforation or a tear. A perforation can occur anywhere along the urinary tract-the urethra, bladder, or ureter. The risk of perforation increases with the complexity of the procedure being performed. Most perforations can be managed conservatively, without open surgery. A small flexible tube called a stent can be placed in the ureter to bridge a perforation of the ureter and to allow urine to drain into the bladder. Similarly, a Foley catheter (a flexible rubberized tube) can be placed into the bladder to divert urine from the bladder and urethra while a perforation heals.
- Cystoscopic procedures can also create scar tissue. This tissue can cause a stricture, or narrowing, in the urethra, which may cause difficulties during urination. Sometimes an additional cystoscopic procedure is necessary to remove the scar tissue. This complication is almost exclusive to males and most commonly results from urethral manipulation such as resection of the prostate.
- Men can sometimes experience pain and swelling in the testicles after an extensive procedure. This is called epididymitis, or epididymo-orchitis, depending on the portion of the testicle involved. This complication is rare.
- For a variety of reasons, urinary retention (inability to urinate) can occur after cystoscopy. This will generally require the placement of a catheter to drain the bladder.
- Swelling caused by the procedure can obstruct the flow of urine.
- The bladder can also become distended during the procedure, which temporarily weakens the voiding muscles.
- Anesthesia plays a significant role in the development of urinary retention as well. Even people who have surgery in areas of the body away from the urinary tract can have difficulty urinating after surgery.
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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