Adverse effects of cystoscopy and its impact on patients' quality of life and sexual performance

Cystoscopy, the principal means of diagnosis and surveillance of bladder tumors, is invasive and associated with unpleasant side effects. To determine the early complications of rigid cystoscopy and the impact on patients' quality of life and sexual performance. One hundred consecutive patients undergoing diagnostic rigid cystoscopy filled in questionnaires that included anxiety and pain levels (0-5 visual analogue scale), adverse events, Short-Form Health Survey, International Prostate Symptom Score, and functional sexual performance. Questionnaires were administered before, immediately after, and 1, 2 days, 2 and 4 weeks following cystoscopy. The pre-cystoscopy anxiety level was 2.01. The average pain during the examination was 1.41. SF-36 score was not affected by cystoscopy. The subjective impact on patients' quality of life was 0.51. The mean IPSS increased following cystoscopy (6.75 vs. 5.43, P = 0.001) and returned to baseline 2 weeks later. A decline in libido was reported by 55.6% (25/45) and 50% (3/6) of the sexually active men and women, respectively. Cystoscopy was associated with a decreased Erectile Dysfunction Intensity Score, from 15.6 to 9.26 during the first 2 weeks (P = 0.04). The overall complication rate was 15% and included urethrorrhagia and dysuria, None of the patients had fever or urinary retention and none was hospitalized. The complication rate was higher in patients with benign prostatic hyperplasia (24% vs. 9.7%, P = 0.001). Rigid cystoscopy is well tolerated by most patients and has only a minor impact on quality of life. However, cystoscopy transiently impairs sexual performance and libido. The early complications are mild and correlate with a diagnosis of BPH.