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Flexible cystoscopy

Published by Bupa's health information team, November 2008.

This factsheet is for people who are planning to have a flexible cystoscopy, or who would like information about it.

Flexible cystoscopy is a procedure that allows doctors to look inside the bladder.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.

About flexible cystoscopy

Flexible cystoscopy uses a narrow, flexible, tube-like telescopic camera, called a cystoscope. This is carefully passed up your urethra and into your bladder (the urethra is the tube that carries urine from the bladder and out of the body).

Flexible cystoscopy can help find out what is causing recurrent urinary tract infection (UTI), incontinence or blood in your urine. It also allows your doctor to examine the bladder wall very closely for unusual growths, ulcers or stones. It may be used to check on the health of your bladder at regular intervals if you have already had treatment for a bladder tumour. This is called 'check flexible cystoscopy'.

During the procedure, your doctor may take a biopsy. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous.

Illustration showing a flexible cystoscopy
A flexible cystoscopy

What are the alternatives to flexible cystoscopy?

It may be essential to have a cystoscopy in order to diagnose some bladder conditions, as the cystoscope enables your doctor to see directly into your urethra and bladder.

Depending on your symptoms and circumstances, it may be possible to examine your bladder using ultrasound (an imaging technique using sound waves). However, this type of scan often needs to be combined with flexible cystoscopy.

Another form of cystoscopy, using a rigid rather than a flexible telescope, can be used to treat bladder conditions.

Preparing for your procedure

Your doctor will explain how to prepare for your procedure.

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

Flexible cystoscopy is routinely done as an out-patient or day case under local anaesthesia. This means that you will stay awake during the procedure. The anaesthetic gel reduces feeling and lubricates the inside your urethra allowing easy passage of the instrument. You may eat and drink as usual beforehand.

You may be offered a sedative to help you relax during the cystoscopy, although this is often not necessary.

Your doctor will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

The whole procedure may take up to 20 minutes but the bladder inspection itself usually only takes two to three minutes. It's not painful, but you may be aware of slight discomfort, pressure, or a pushing/pulling sensation in your bladder.

You may be asked to remove your lower clothing and put on a gown. You will need to empty your bladder.

Your doctor will place anaesthetic gel into your urethra using a syringe without a needle.

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 being inserted. This is simply to help relax the muscles - no urine will actually pass.

When the cystoscope is in place, sterile water is passed through it to fill your bladder up and make 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 and if necessary take a biopsy. This is done using special instruments passed inside the cystoscope.

Your doctor will gently remove the cystoscope when the check-up is finished.

What to expect afterwards

As your bladder will be full of water 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.

It's best to have someone drive you home, especially if you have a sedative to help you relax during the procedure.

If you have a biopsy taken, the results will be ready several days later and will usually be sent in a report to the doctor who recommended the cystoscopy. Your doctor or nurse may discuss any other findings from the test with you before you go home.

Recovering from your flexible cystoscopy

Once home, it's sensible to take it easy for the rest of the day. Most people feel able to resume normal activities later that day.

If you need them, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Sedation temporarily affects your coordination and reasoning skills. If you have had a sedative, you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving always follow your doctor's advice and please contact your motor insurer so that you're aware of their recommendations.

After the procedure, there is a risk you may develop a UTI. You should try to drink plenty of water in the first 24 hours, to help flush your bladder and urethra.

You should contact your GP if you develop any of the following symptoms:

  • persistent severe pain with an inability to pass urine
  • high temperature
  • burning sensation on passing urine or if your urine starts to smell
  • heavy blood-stained urine and/or blood clots

If you see blood in your urine, drink a little extra water and rest for an hour or two. If you continue to pass blood-tinged urine for more than 48 hours, you should call your GP for advice.

What are the risks of flexible cystoscopy?

Flexible cystoscopy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful investigation.

After your cystoscopy, you may:

  • feel some discomfort - this usually settles in a few hours
  • feel mild stinging when you pass urine for a day or two - drinking water regularly can help soothe this and stop infection from developing
  • have some blood in the urine for 24 hours - especially if a biopsy is taken

Complications

This is when problems occur during or after the operation. Most people aren't affected.

Complications of cystoscopy are uncommon but can include:

  • UTI - you may need antibiotics to treat a urinary infection
  • damage or injury to the urethra or bladder - this can lead to bleeding and infection, which may require treatment with medicines or surgery
  • urinary retention - an inability to pass urine because of swelling or inflammation of your bladder outflow

It's possible, although extremely rare, to develop septicaemia (toxic shock syndrome) after having a biopsy using a cystoscope. This is when bacteria enter your bloodstream through the tiny cut made by the biopsy taken from your bladder wall. If you develop a red rash or a high temperature in the first 24 hours of your cystoscopy, contact your GP immediately.

The exact risks are specific to you and will differ for every person, so we haven't included statistics here. Ask your doctor to explain how these risks apply to you.

Further information

Related topics

Sources

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: November 2008

 

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