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Cystoscopy

This factsheet is for people who are having a cystoscopy, or who would like information about it.

Cystoscopy is a procedure that allows your doctor to look inside your bladder, take a tissue sample (biopsy) from your bladder wall or treat certain bladder conditions.

You will meet the doctor carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About cystoscopy

Cystoscopy is useful in helping to find out the cause of recurrent urinary tract infection (UTI), incontinence or blood in your urine. It’s also used to check your bladder and bladder wall for unusual growths, ulcers or stones.

A doctor who specialises in identifying and treating conditions of the urinary system (urologist), will carry out your cystoscopy.

There are two types of cystoscopy.

  • Flexible cystoscopy – this uses a thin, fibre-optic endoscope, called a flexible cystoscope. This medical telescope has a tiny light and lens in the tip, and a thin, flexible body. Your doctor passes it through your urethra (the tube that carries urine from your bladder and out of your body) and into your bladder. Flexible cystoscopes are used for check-ups and to make a diagnosis, and may also allow your surgeon to take a biopsy. The procedure is commonly performed under local anaesthesia.
  • Rigid cystoscopy – this uses a narrow, rigid cystoscope. Your surgeon passes it through your urethra and into your bladder. Instruments can be passed down it to take a tissue sample (biopsy), to remove polyps from your bladder wall or to perform laser treatment. Rigid cystoscopy is usually done under general or spinal anaesthesia because it’s more uncomfortable.

A flexible cystoscopy 

What are the alternatives to cystoscopy?

Depending on your symptoms and circumstances, other tests such as an ultrasound (an imaging technique using sound waves) may be suitable for examining your bladder.

Preparing for cystoscopy

Flexible cystoscopy is routinely done as an outpatient or day case under local anaesthesia. This means you will stay awake during the procedure. Your doctor will use anaesthetic gel to reduce feeling and lubricate the entrance to your urethra.

For a rigid cystoscopy, you may need to stay overnight in hospital. This depends on the type of treatment you’re having and the time of day you have it. Rigid cystoscopy is usually done under general anaesthesia. This means you will be asleep during the procedure and feel no discomfort.

Your doctor will explain how to prepare for your cystoscopy. If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

At the hospital, your nurse may check your heart rate and blood pressure, and test your urine.

Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during cystoscopy

A cystoscopy may take anything from a few minutes to 20 minutes, depending on what your doctor needs to do.

If you’re having a flexible cystoscopy, your nurse or doctor will ask you to put on a gown and lie on your back with your knees raised and apart. He or she will put anaesthetic gel into your urethra.

When the anaesthetic has taken effect, your doctor will carefully pass the cystoscope into your urethra. Men may be asked to try and pass urine or cough while the cystoscope is inserted. This is simply to help relax the muscles – no urine will actually pass. You may be aware of slight discomfort, urge to urinate or a pushing/pulling sensation in your bladder.

When the cystoscope is in place, sterile water is passed through it to fill your bladder. This makes your bladder wall easier to see.

A camera lens at the end of the cystoscope sends pictures from the inside of your bladder to a monitor. Your doctor will look at these images to check your bladder. If necessary, your doctor will take a biopsy, using special instruments passed through the cystoscope. It’s quick and painless, although you may feel a slight pinch. Your doctor will send the biopsy to a laboratory for testing to determine the type of cells and whether these are benign (non-cancerous) or cancerous.

If you’re having a rigid cystoscopy, you will be asleep throughout the procedure. Your doctor will check your bladder and, if necessary, take a biopsy and/or perform surgery to treat your medical condition.

After a rigid cystoscopy, a thin, flexible tube (catheter) may be passed into your urethra and left in place for a few hours or overnight. The catheter will drain urine from your bladder into a bag. This is done to prevent any blood clots forming that may affect how your bladder works.

What to expect afterwards

If you have general anaesthesia, you may need to rest until the effects of the anaesthetic have passed.

If you have a catheter fitted, it may be connected to a system which washes any blood and blood clots out of your bladder. This is called bladder irrigation. The catheter is usually removed before you go home.

If you have a flexible cystoscopy, your bladder will be full of water and you will probably need to pass urine. You may feel slight discomfort when you do this. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home.

After general anaesthesia, try to have a friend or relative stay with you for the first 24 hours.

If you have a biopsy, your results may be ready a few days later, but it can take up to three weeks. Results are usually sent to the doctor who carried out the cystoscopy or the doctor who referred you for the procedure. At the hospital, your doctor may discuss other findings from the test with you before you go home, or may give you a date for a follow-up appointment.

Recovering from cystoscopy

Once home, it's sensible to take it easy for the rest of the day. You should try to drink enough water in the first 24 hours, to help flush your bladder and urethra.

Your urethra may feel sore for the first few hours. If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and ask your pharmacist if you have any questions.

General anaesthesia (and sedation) temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your doctor’s advice.

Most people have no problems after a cystoscopy, but you should contact your GP if you develop any of the following symptoms.

  • Persistent, severe pain with an inability to pass urine.
  • A high temperature.
  • Burning sensation on passing urine that gets worse or starts again after any initial stinging has worn off.
  • An unpleasant smell to your urine.
  • Blood or blood clots in your urine.

What are the risks?

As with every procedure, there are some risks associated with cystoscopy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure, for example, feeling sick as a result of the general anaesthetic. After your cystoscopy, you may have:

  • mild stinging when you first pass urine – drinking water regularly can help soothe this and stop an infection from developing
  • blood in your urine for 24 hours

Complications

This is when problems occur during or after the procedure. Most people are not affected.

Your doctor will be experienced at performing a cystoscopy, however, some procedures aren’t successfully completed and may need to be repeated.

Complications of cystoscopy are uncommon but can include:

  • reaction to the sedative or general anaesthesia – for example, a skin rash or heart problems
  • urinary tract or bladder infection (cystitis) – you may need antibiotics to treat this
  • damage to your bladder wall – particularly if a biopsy is taken, which may cause bleeding
  • damage to your urethra – particularly as the cystoscope is passed through your urethra into your bladder
  • urinary retention – an inability to pass urine because of swelling in your urethra

 

Produced by Kerry McKeagney, Bupa’s Health Information Team, March 2012.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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