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Cystoscopy Content Supplied by NHS Choices
Introduction

A cystoscopy is a medical procedure used to examine the inside of the bladder using an instrument called a cystoscope.

A cystoscope is a thin, fibre optic tube that has a light and a camera at one end. It's inserted into the urethra (the tube that carries urine out of the body) and moved up into the bladder.

The camera relays images to a screen, where they can be seen by the urologist (specialist in treating bladder conditions).

There are two types of cystoscope:

  • flexible cystoscope - a thin, flexible tube used when the only purpose of a cystoscopy is to look inside your bladder
  • rigid cystoscope - a thin, straight metal tube used for passing small surgical instruments down through the cystoscope to remove a tissue sample or carry out treatment

Most cystoscopies are carried out as outpatient procedures, so you'll be able to go home on the same day.

Read more about what happens during a cystoscopy

Why cystoscopies are used

A cystoscopy can be used to investigate and treat symptoms and conditions that affect the bladder and urinary system. For example, it can be used to:

  • check for abnormalities in the bladder
  • remove a sample of bladder tissue for further testing (a biopsy) in cases of suspected cancer
  • treat certain bladder conditions, such as removing small bladder stones

Read more about why a cystoscopy might be used.

Is a cystoscopy painful

A flexible cystoscopy is usually carried out using a local anaesthetic gel or spray to numb the urethra. This will reduce any discomfort when the cystoscope is inserted into the urethra.

A rigid cystoscopy is usually carried out under general anaesthetic (where you're asleep), or a spinal anaesthetic (epidural) that numbs all feeling below your spine.

However, for some people, the procedure may feel uncomfortable and can lead to mild side effects afterwards, such as muscle pain and nausea.

For a few days after the procedure, you may feel a burning sensation when passing urine and you may also pass blood in your urine. This is normal and isn't something to worry about, unless it's severe and lasts longer than a few days.

Read more about recovering from a cystoscopy.

Risks

It's rare to experience serious complications after having a cystoscopy, but some people experience persistent bleeding or problems passing urine.

There's also a small risk of developing a urinary tract infection that affects your urethra, bladder or kidneys. See your GP if you experience the symptoms of infection, such as a high temperature (fever) of 38C (100.4F) or above.

Read more about the possible complications of a cystoscopy.

Why a cystoscopy is used

A cystoscopy can be used to investigate problems with your bladder or urinary system, or it may be used as part of a medical procedure.

Investigating symptoms

You may need to have a cystoscopy if you experience symptoms that suggest there's something wrong with your bladder. For example:

  • urinary incontinence - the involuntary passing of urine
  • blood in your urine (haematuria)
  • persistent pelvic pain
  • pain or a burning sensation when you pass urine (dysuria)
  • frequently needing to urinate
  • not being able to pass urine or only being able to pass urine intermittently ("stop-start")
  • a feeling that your bladder isn't completely empty after passing urine

Investigating conditions

A cystoscopy may also be needed if you have a condition that affects your urinary system, or previous test results suggest that you may do (such as abnormal urine test results).

Conditions that a cystoscopy may be used to detect or monitor include:

Carrying out procedures

A urologist (specialist in treating bladder conditions) can carry out a number of medical procedures using surgical instruments passed down a cystoscope. These include:

  • removal of a stone from the bladder or ureter
  • obtaining a urine sample from each of the ureters to check for an infection or tumour
  • removing a sample of tissue for testing in cases of suspected bladder cancer (biopsy)
  • inserting a stent (small tube) into a narrowed ureter to help the flow of urine, or removing an existing stent
  • injecting dye into the ureters up towards the kidneys - this will be highlighted on an X-ray and will help to identify problems such as a blockage or kidney stone
  • injecting medication into the bladder or ureters - for example, to treat a problem where urine flows up the ureters
Recovering from a cystoscopy

The type of anaesthetic used will affect how long it takes to recover from a cystoscopy.

It's normal to experience some side effects for a few days afterwards.

Anaesthetic

If you have a local anaesthetic, you'll be able to go home shortly after the cystoscopy.

It usually takes a few hours to recover from the effects of an epidural or general anaesthetic, so you'll need to arrange for someone to take you home. You should rest for 24 hours and avoid driving, operating complex or heavy machinery, and drinking alcohol for 48 hours.

Side effects

Most people experience a burning pain when passing urine for the first few days after a cystoscopy. This is normal and it should stop within a few days.

Having blood in your urine or bleeding from your urethra (the tube that carries urine out of the body) is also common in the first few days after a cystoscopy, particularly when a biopsy is also carried out. Drinking plenty of water can ease both of these symptoms.

You should only be concerned if:

  • your urine becomes so bloody that you can't see through it
  • you notice clots or tissue in your urine
  • you experience severe pain while urinating
  • pain and bleeding lasts more than a few days
  • you're unable to pass urine more than eight hours after the procedure
  • you develop a high temperature (fever) of 38C (100.4F) or above
  • your urine smells unpleasant
  • you have nausea or vomiting
  • you have pain in your lower back or side

Contact the hospital staff if you notice or experience any of the above. Before being discharged, you'll be given a contact telephone number for this purpose.

Read more about the possible complications of a cystoscopy.

Risks of a cystoscopy

A cystoscopy is usually a safe procedure and serious complications are rare.

Occasionally, there may be problems passing urine or an infection may develop.

Urinary tract infections

Urinary tract infections (UTIs) are infections of the urethra, bladder or kidneys. Symptoms of a UTI can include:

  • a burning sensation when urinating that lasts longer than two days
  • a high temperature (fever) of 38C (100.4F) or above
  • unpleasant smelling urine
  • nausea and vomiting
  • pain in your lower back or side

Contact your GP or hospital staff as soon as possible if you have any of the above symptoms. Antibiotics can be used to successfully treat most UTIs.

Problems passing urine

Some people find it difficult to pass urine after having a cystoscopy. This is known as urinary retention. Urinary retention after a cystoscopy is uncommon in women, but men with pre-existing urination problems are at increased risk.

Urinary retention may be a sign that your urethra (the tube that carries urine out of the body) or your prostate (in men) is swollen, so you should contact staff at the hospital where you had the cystoscopy if you experience this problem.

In some cases, a thin tube called a catheter may need to be temporarily inserted through your urethra to allow urine to drain.

Bleeding and bladder damage

Mild bleeding that lasts for a few days is common after having a cystoscopy, particularly if a biopsy (tissue sample) was taken during the procedure. However, in rare cases, bleeding may be a sign that your bladder has been damaged.

Seek immediate medical advice if you have persistent or severe bleeding after a cystoscopy, because you may need to have a temporary catheter fitted or surgery to repair any damage to your bladder.

How a cystoscopy is carried out

Before your appointment to have a cystoscopy, you'll be sent information and instructions to follow.

If you're having a local anaesthetic you can eat and drink normally on the day of the appointment.

If you're having a spinal anaesthetic (epidural) or general anaesthetic, you won't be able to eat or drink for several hours before the procedure.

A cystoscopy is carried out using an instrument called a cystoscope (a thin, fibre-optic tube that has a light and camera at one end). The type of anaesthetic you'll need will depend on whether a rigid (straight) or flexible cystoscope is used. Flexible cystoscopes are usually used under local anaesthetic, whereas general or epidural anaesthetic is used with a rigid cystoscope.

Most prescription medication can be taken as usual on the day of your appointment. However, you may not be able to take aspirin, warfarin or ibuprofen, because they could cause excessive bleeding during the procedure.

If you're taking one of these medications, contact the hospital for advice before your appointment. You may have to temporarily stop taking the medication.

Before the procedure, your doctor will explain what will happen and the risks involved. You'll be asked to sign a consent form to show you have understood and to give permission for the procedure to be carried out.

Read more about giving consent to treatment.

You'll be asked to go to the toilet, before changing into a surgery gown. You may also be asked to provide a urine sample, so it can be checked for signs of infection. The procedure may not go ahead if you have an infection.

The cystoscopy procedure

In most cases, a cystoscopy can be carried out on an outpatient basis, which means you'll be able to go home on the same day.

If you're having a local anaesthetic, an anaesthetic gel will be applied to your urethra (the tube that carries urine out of the body) to numb it. If you're having an epidural or general anaesthetic, you'll be given an injection of anaesthetic either in your spine (epidural) or in the back of your hand (general anaesthetic).

Your genitals will be cleaned with an antiseptic and a sterile paper sheet will be placed over the surrounding area.

The cystoscope will be lubricated with a special gel before being gently inserted into your urethra and passed into your bladder. Sterile water may be pumped through the cystoscope to expand your bladder. This enables the urologist (a specialist in treating bladder conditions) to get a clearer view.

If local anaesthetic is used, you may be able to see images transmitted to a television monitor by the cystoscope. A nurse will stay with you during the procedure to explain what's happening.

The cystoscope will usually be kept inside your bladder for anywhere between 2 and 10 minutes.

After a cystoscopy, you may need to go to the toilet, so the sterile water can be passed out of your system. You may also be prescribed antibiotics to reduce your risk of developing a bladder infection.

Is a cystoscopy painful

People often fear that having a tube inserted into their urethra and up into their bladder will be painful. A cystoscopy isn't usually painful, although it can sometimes be uncomfortable.

If you're having a cystoscopy under a local anaesthetic, you may feel a burning sensation and an urge to urinate when the cystoscope is inserted and removed from your urethra. You may also feel an uncomfortable sensation of fullness and a need to urinate when water is pumped into your bladder to expand it.

If you're having an epidural, you may feel a brief stinging sensation when the needle is inserted into your back, and you may experience some mild back pain after the procedure.

You may also have mild muscle pain and nausea after having a general anaesthetic.

Results

In some cases, the urologist will be able to discuss the results of your cystoscopy and any associated implications with you as soon as you recover from the anaesthetic.

However, it can sometimes take a few days for the results to become available. If a biopsy was taken, it may take several weeks for the results to come back.

A follow-up appointment may be arranged to discuss the results of the procedure.

Read more about recovering from a cystoscopy.

 
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