Overview

What is a cystoscopy

• A cystoscopy is a procedure that allows a healthcare professional to look inside your bladder.
• It can be used to check what’s causing certain symptoms and treat some bladder conditions.
• A long, thin tube with a small camera inside (cystoscope) is gently put into your urethra and moved through it into your bladder. The urethra is the tube that carries pee from your bladder out of your body.

You may have a local anaesthetic during a cystoscopy, where the area around your urethra or the lower half of your body is numbed.

Alternatively, a general anaesthetic can be used, where you're asleep during the cystoscopy.

Why is it necessary?

A cystoscopy can be done to check what's causing your bladder symptoms, treat some bladder conditions, or to help diagnose and treat bladder cancer.

Checking bladder symptoms

A cystoscopy can be used to check what’s causing your bladder symptoms, such as:

• blood in your pee
• urinary tract infections (UTIs)
• urinary incontinence
• pain in the lower part of your tummy (pelvic pain) that does not go away
• symptoms affecting your peeing, such as it hurting when you pee, peeing more than normal, or it not feeling like you’ve fully emptied your bladder after peeing

Treating bladder conditions

You might also have a cystoscopy to treat certain bladder conditions.

A cystoscope can be used to:

• remove bladder stones
• help shrink the prostate if you have prostate enlargement
• inject medicines directly into the bladder, such as Botox for an overactive bladder
• repair damage to the bladder
• remove a sample of cells for testing (a biopsy)

Checking for and treating bladder cancer

A biopsy can be used to check for any changes in the bladder, which could be bladder cancer.

Bladder cancer can be hard to diagnose, so you may also have other tests.

If you’ve been diagnosed with bladder cancer, a cystoscopy may be used to:

• remove a tumour in the bladder
• check how well treatment, such as chemotherapy, is working,

Find out more about how bladder cancer is treated

Preparations

How to prepare for a cystoscopy is different depending on the type of cystoscopy you’re having.

Types of cystoscopy

There are 2 types of cystoscopy:

• a flexible cystoscopy – which uses a thin, flexible tube with a camera in, it’s bendy and is often used for checking bladder symptoms
• a rigid cystoscopy – which uses a straight tube with a camera inside, it does not bend and is often used to treat bladder conditions

You should be told what type of cystoscopy you're having and if there's anything you need to do to prepare.

If you do not know, contact the GP or doctor who referred you for the cystoscopy for advice.

Preparing for a flexible cystoscopy

A flexible cystoscopy is usually carried out using a local anaesthetic to numb the area around your urethra (the tube your pee comes out of).

You should be able to eat and drink as normal on the day of a flexible cystoscopy.

Preparing for a rigid cystoscopy

A rigid cystoscopy can be done using:

• a general anaesthetic, where you're asleep during the procedure
• anaesthetic given in your spine (spinal anaesthetic), which numbs the lower half of your body during the procedure

If you’re having a general anaesthetic, you may be asked to attend an assessment appointment around a week before your cystoscopy. This usually involves a nurse taking some measurements, such as your blood pressure. This helps plan the safe use of the anaesthetic.

You'll usually be told to avoid eating or drinking (fast) for several hours before a rigid cystoscopy. You'll be given more detailed information about this.

You will also need somebody to take you home after a rigid cystoscopy and stay with you for 24 hours afterwards.

How it's done

What happens during a cystoscopy

You’ll probably be asked to go to a local hospital or clinic to have your cystoscopy.

Before the procedure you’ll be asked to empty your bladder by having a pee. You may be asked to give a urine sample at the same time to check for any infections. If you have an infection, the cystoscopy may need to be rescheduled.

Having a flexible cystoscopy

1. You’ll be asked to undress, behind a screen, from the waist down. You’ll be given a gown to wear.
2. You’ll be asked to lie down on a couch or bed.
3. A local anaesthetic gel will be used to numb the area around your urethra (the tube that carries pee from your bladder out of your body).
4. A thin, flexible tube with a camera inside (cystoscope) is gently put into your urethra and moved through it into your bladder.
5. A saline solution is pumped into your bladder to inflate it. This makes it easier to see inside.
6. The cystoscope is moved around inside your bladder to check it. The images are sent to a screen that you can watch if you want to.
7. Tools can be used through the cystoscope to remove a small sample of cells for testing (biopsy).
8. Once the test is complete the cystoscope is gently removed from your bladder.

A flexible cystoscopy usually takes around 10 to 15 minutes.

Having a rigid cystoscopy

1. You'll either be given a general anaesthetic (so you're asleep during the procedure), or have the lower half of your body numbed with anaesthetic given in your spine (spinal anaesthetic).
2. A tube with a camera inside (cystoscope) is gently put into your urethra and moved through it into your bladder.
3. A saline solution is pumped into your bladder to inflate it. This makes it easier to see inside and do any treatment.
4. Tools can be used through the cystoscope to remove a small sample of cells for testing (biopsy) or to treat certain conditions.
5. Any cuts made during testing or treatment are sealed and the cystoscope is gently removed from your bladder.

A rigid cystoscopy usually takes around 30 minutes.

After a cystoscopy

If you’ve had a flexible cystoscopy, you can go home as soon as the procedure is complete. You can return to work and normal activities as soon as you feel able to.

If you’ve had a rigid cystoscopy you can usually go home once you recover from the effects of the anaesthetic, and you’re able to pee.

For most people, this takes a few hours.

If you've had a spinal or general anaesthetic, somebody needs to take you home and stay with you for 24 hours.

During this 24-hour period do not:

• drink alcohol
• drive
• operate heavy or complex machinery

You may have a small amount of blood in your pee for a few days after having a cystoscopy. It may also be painful when you pee.

These symptoms should pass in a few days and are usually nothing to worry about. Paracetamol or ibuprofen can help treat any pain. Speak to a GP if the symptoms do not go away after a few days.

Results

Complications

Possible complications of a cystoscopy

A cystoscopy is a common procedure and serious complications are rare. A doctor or nurse will explain all the possible risks to you.

Urinary tract infection

There's a small chance of getting a urinary tract infection after a cystoscopy.

A UTI is an infection of your urinary tract, which can include your bladder, kidneys, and the various tubes that connect them.

You’ll usually need to take antibiotics to treat a UTI.

Problems emptying your bladder

You’ll be checked to see if you can pee before you're sent home. But sometimes, swelling of the bladder and urethra can lead to you not being able to pee once you get home. This can cause swelling or pain in your tummy.

You may need to have a tube put into your urethra to drain pee from your bladder (urinary catheter) until you can pee again.

Bladder damage

Very rarely, your bladder may be damaged during a cystoscopy. This can cause blood in your pee, which may be heavy or continue for several days.

Surgery may be needed to repair this, if the bleeding does not settle down.

See a GP if:

• you have pain or a burning sensation when peeing that does not go away after a few days
• you're needing to pee more often or urgently than usual
• your pee looks cloudy

Let the GP surgery know you’ve had a cystoscopy.

Ask for an urgent GP appointment or get help from NHS 111 Wales if:

• you think you have a UTI and have a high temperature, or are feeling hot and shivery, or a very low temperature below 36C
• you have lower tummy pain or pain in your back, just under the ribs
• you have blood in your pee that's heavy or does not go away after a few days

If you cannot speak to or see a GP, or your symptoms are getting worse, contact 111 Wales.

Let the GP surgery or 111 service know you’ve had a cystoscopy.

Call 999 or go to A&E if:

• you cannot pee and your tummy is swollen and painful