Can Females Undergo Cystoscopy?
Yes, females can absolutely undergo cystoscopy—it is a routine, safe, and commonly performed procedure in women for both diagnostic and therapeutic purposes. 1
Clinical Indications for Cystoscopy in Females
Cystoscopy is performed in women for multiple clinical scenarios:
Diagnostic Indications
- Hematuria evaluation to identify bladder pathology including malignancies, stones, or inflammatory conditions 1, 2, 3
- Recurrent complicated urinary tract infections when diagnostic uncertainty exists or underlying anatomic abnormalities are suspected 1
- Obstructive voiding symptoms to evaluate for urethral strictures, bladder neck obstruction, or foreign bodies 1, 4
- History of bladder cancer requiring surveillance cystoscopy 1
- Suspected urethral diverticula or other structural abnormalities 1
Intraoperative Indications
- Mandatory during certain surgical procedures including mid-urethral slings and fascial pubovaginal slings to confirm lower urinary tract integrity and absence of foreign bodies 1
- Selective use during gynecologic surgery such as laparoscopic hysterectomy or complex pelvic surgery to recognize lower urinary tract injuries 5, 3
When Cystoscopy Should NOT Be Performed
Cystoscopy should not be routinely performed in specific clinical contexts:
- Index patients with stress urinary incontinence who are otherwise healthy with normal urinalysis and no concern for urinary tract abnormalities 1
- Uncomplicated recurrent UTIs in women without underlying risk factors, as these patients typically have normal urinary tracts 1
- Initial evaluation of overactive bladder unless there is hematuria, history of recurrent UTI, obstructive voiding, or prior sling surgery 1
Technical Considerations
Procedure Options
Both flexible and rigid cystoscopy can be performed safely in female patients 6, 7. The female urethra is shorter (approximately 4 cm) compared to males, making the procedure technically straightforward 6, 3.
Pain Management
Meatal analgesia with lidocaine gel does not significantly reduce pain during cystoscopy in women compared to water-soluble lubricant alone 7. Pain levels are similar regardless of whether flexible or rigid cystoscopes are used in female patients 7.
Positioning
Female patients are typically positioned frog-leg supine for office-based flexible cystoscopy 6.
Common Incidental Findings
When performing cystoscopy in women, clinicians may encounter various pathological conditions requiring recognition 2, 3:
Benign findings: squamous metaplasia, duplicated ureteral orifice, ureterocele, bladder diverticulum, trabeculation, interstitial cystitis, endometriosis, and cystitis glandularis 2
Malignant findings: papillary urothelial neoplasm, carcinoma in situ, high-grade urothelial carcinoma 2
Intraoperative complications: bladder or urethral penetration, nonpatent ureters, foreign body erosion, or fistulas 3
Special Populations
Bladder Cancer Patients
Women with bladder cancer can safely undergo cystoscopy and even orthotopic urinary diversion with urethral preservation when appropriately selected 1. The incidence of urethral tumor involvement in women with bladder cancer ranges from 6-46% (weighted average 12.4%), with bladder neck involvement being the most important risk factor 1.
Patients with Prior Pelvic Surgery
Women with history of prior anti-incontinence surgery or pelvic organ prolapse surgery may benefit from cystoscopy when evaluating new urinary symptoms, as they have higher risk of anatomic complications 1.