What are common indications for performing a cystoscopy in the evaluation of incontinence?

• A. Persistent symptoms after treatment, microscopic hematuria, suspicion of urethral obstruction or bladder lesions, or to evaluate bladder neck.
• B. Routine screening in all cases of incontinence.
• C. To measure bladder capacity only.
• D. To assess kidney function.

Answer: (A)

Cystoscopy is used in incontinence workups when there is a need to directly inspect the bladder and urethra to identify problems that noninvasive tests can miss. It’s particularly indicated if symptoms persist after initial treatment, because ongoing symptoms may point to an underlying lesion, obstruction, or other pathology that requires visualization—such as tumors, stones, bladder wall lesions, or diverticula—that could be contributing to incontinence or altering management.

Microscopic hematuria raises concern for bladder pathology, making cystoscopy a useful tool to look for tumors, inflammatory changes, stones, or other mucosal abnormalities. If there’s a suspicion of urethral obstruction or bladder lesions, cystoscopy helps confirm and localize the issue, guiding therapy. Evaluating the bladder neck with a scope also aids in understanding outlet function, which can influence decisions about treatment for incontinence, especially when outlet-related factors are suspected.

Cystoscopy isn’t a routine screening test for all incontinence cases, since many patients do not have visible bladder or urethral pathology and the procedure is invasive. It isn’t performed merely to measure bladder capacity—capacity assessment is done with filling cystometry or other urodynamic testing. And it does not assess kidney function, which is evaluated through blood tests and renal imaging or function studies.