Office cystoscopy for female patients is usually performed in the dorsal lithotomy position with the patient undressed from the waist down and covered in a sterile drape. Prior to this, the patient is instructed to void and a dip-stick urinalysis is performed to rule out an active urinary tract infection. Per the American Urological Association guidelines, routine antibiotic prophylaxis is not indicated for diagnostic cystoscopy unless the following risk factors are present and a negative urine culture is not documented prior to the procedure: immunocompromised state, known anatomic abnormalities of the urinary tract, active infection, chronic steroid use, or external catheter use [1]. Consent for cystoscopy is obtained and the urethra is cleansed with either a povidine–iodine solution or equivalent antimicrobial solution if an allergy exists. A disposable urinary catheter is inserted to obtain a post void residual if indicated and a topical analgesic may or may not be applied directly into the urethra from a tube or needleless syringe.

Under sterile technique, the equipment is assembled with the proper cystoscope, a light source, distending media, and imaging source if desired. If rigid cystoscopy is selected, a 30° or 70° cystoscope is routinely used along with a 17 French sheath. For rigid cystoscopy, ensure closure of all the appropriate ports to prevent leakage, turn on the light source and open the distending media flow to allow passage of a minimal amount of liquid media. For both flexible and rigid cystoscopy, gently guide the tip of the cystoscope into the distal urethra under direct visualization and follow the central opening past the urethrovesicular junction (UVJ) into the bladder cavity. Some physicians prefer the use of a blunt obturator for the cystoscopy sheath rather than direct visualization. One may then increase the flow of the distending media to adequately distend the bladder, typically around 300 cc, or the maximum capacity tolerated by the patient.