A cystoscopy lets a specialist look directly inside your bladder and urethra. Most flexible cystoscopies take only a few minutes and are done while you are awake with numbing gel.
Imagine noticing blood in your urine one morning. There is no pain, and it stops by the next day. Your healthcare provider still refers you for a cystoscopy, because painless blood in the urine always needs checking.
What a cystoscopy is
A cystoscopy uses a thin tube with a camera and light, called a cystoscope, passed through the urethra (the tube you urinate through) into the bladder. It allows the specialist to see the lining of the urethra and bladder.,There are two main types. A flexible cystoscopy uses a thin, bendy scope and is usually done under local anaesthetic gel. A rigid cystoscopy uses a straight scope, is usually done under general or spinal anaesthetic, and allows more treatments, such as removing bladder tumours or stones.
Why it might be needed
- Blood in the urine, visible or found on a test
- Repeated urinary tract infections
- Difficulty passing urine or a weak stream
- Frequent urination or urgency that has not improved
- Bladder pain
- Checking for bladder cancer recurrence
- Removing a ureteric stent
Before the test
- You can usually eat and drink normally before a flexible cystoscopy
- You may be asked to give a urine sample to check for infection; the test may be postponed if you have one
- Tell the team if you take blood thinners
- For a rigid cystoscopy under anaesthetic, follow fasting instructions and arrange someone to take you home
What happens during a flexible cystoscopy
You lie on your back, and the genital area is cleaned. Local anaesthetic gel is put into the urethra to numb it and help the scope slide in. The scope is then gently passed into the bladder, and sterile water is used to fill the bladder so the lining can be seen.,You may feel a sensation of needing to urinate as the bladder fills. The examination usually takes about five minutes. Many people can watch on the screen if they want.
Does it hurt?
Most people describe a flexible cystoscopy as uncomfortable rather than painful. Men may feel more discomfort as the scope passes through the prostate. Breathing slowly and relaxing the pelvic muscles can help. Tell the team if you feel pain.
After the test
- You can usually go home soon after a flexible cystoscopy
- It is common to have a mild burning feeling when you urinate for a day or two
- Your urine may be slightly pink
- Drink plenty of fluids for a couple of days to flush the bladder
- Simple painkillers can help
When to seek help
- Fever or shivering
- Severe pain
- Bright red blood or clots in your urine
- Being unable to pass urine
- Burning that gets worse after two days, which may be an infection
Results
The specialist can often tell you what they saw straight away. If a biopsy was taken, results usually take one to three weeks. Many cystoscopies are normal, which is reassuring. If an abnormality such as a growth is found, you will be told what further treatment or tests are needed.
Blood in the urine: why it is always checked
Blood in the urine, called haematuria, can come from anywhere in the urinary tract: the kidneys, ureters, bladder, prostate or urethra. Common causes include infections, kidney stones and an enlarged prostate, but it can also be the first sign of bladder or kidney cancer, especially in people over 40 or those who smoke.
Visible blood, even once, should always be checked, even if it stops on its own and there is no pain. That is why a cystoscopy is often combined with a scan of the kidneys, such as an ultrasound or CT scan, and urine tests.
Rigid cystoscopy and bladder treatments
A rigid cystoscopy is usually done in an operating theatre under general or spinal anaesthetic. It allows the surgeon to remove bladder growths, take larger biopsies, break up stones or treat narrowing of the urethra.
After a rigid cystoscopy, you may need a catheter for a short time and may stay in hospital overnight. Recovery is usually a few days, though you should avoid heavy lifting and strenuous exercise for longer if tissue was removed.
Bladder cancer: the main risk factor
Smoking is the biggest single risk factor for bladder cancer, because chemicals from tobacco pass through the urine and damage the bladder lining. Some occupational exposures, such as certain dyes and chemicals used in older industries, also increase risk. If you smoke, stopping lowers your risk over time, as well as benefiting your heart, lungs and overall health.
Questions to ask before your cystoscopy
- Will it be a flexible or rigid cystoscopy?
- Will any biopsies or treatments be done at the same time?
- Do I need to stop any medicines beforehand?
- How and when will I get my results?
- Who should I contact if I have problems afterwards?
Frequently asked questions
Can I drive after a flexible cystoscopy?
Usually yes, as only local anaesthetic gel is used.
How long until I can have sex?
Many people wait a few days until any discomfort settles. Ask your team.
Will I need antibiotics?
Not routinely. Some people are given one dose to reduce infection risk.
Is a cystoscopy different for women and men?
The procedure is the same, but the urethra is shorter in women, so many women find it a little more comfortable.
But I am embarrassed about the test
The team performs these tests every day and will protect your privacy and dignity. You can ask for a chaperone.
Your next step: If you notice blood in your urine, even once and without pain, see a healthcare provider promptly.
Related: Blood in urine: causes
Sources: British Association of Urological Surgeons, NHS, American Urological Association, European Association of Urology.
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