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 is 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 performed as outpatient procedures, so you'll be able to go home on the same day.
Why it is 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
Is a cystoscopy painful?
You shouldn't feel any serious pain as a flexible cystoscopy is usually carried out using a local anaesthetic gel or spray to numb the urethra. A rigid cystoscopy is usually done under general anaesthetic (where you are asleep), or a spinal anaesthetic (epidural) that numbs all feeling below your spine.
However, for some people the procedure may feel uncomfortable and you may have 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 pass blood in your urine. This is normal and not something to worry about unless it is severe and lasts longer than a few days.
It's rare to experience serious complications after a cystoscopy, but some people experience persistent bleeding or problems passing urine.
There's also a small risk of developing a urinary tract infection (UTI) that affects your urethra, bladder or kidneys. You should see your GP if you experience symptoms of infection such as a high temperature (fever) of 38ºC (100.4ºF) or above.
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
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’)
having a feeling your bladder isn't completely empty after passing urine
A cystoscopy may also be needed if you have a condition that affects your urinary system, or previous test results suggest you may do (such as abnormal urine test results).
Conditions that a cystoscopy may be used to detect or monitor include:
a narrowed or blocked urethra (urethral stricture); the urethra is the tube that carried urine out of the body
serious or repeated urinary tract infections
polyps (non-cancerous growths)
problems with the ureters (the tubes that connect the kidneys to the bladder)
bladder cancer, as well as other cancers of the urinary tract
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 (a 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 which will be highlighted on an X-ray and will help identify problems, such as a blockage or a kidney stone
injecting medication into the bladder or ureters, for example to treat a problem where urine flows up the ureters
How a cystoscopy is performed
Before your appointment to have a cystoscopy, you will 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 a camera at one end). The anaesthetic needed 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 will be asked to sign a consent form to show you have understood and give permission for the procedure to be carried out.
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 performed on an outpatient basis, which means you will be able to go home on the same day.
If you are having a local anaesthetic, an anaesthetic gel is 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 will be given an injection of anaesthetic either in your spine (epidural) or 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 is 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 (specialist in treating bladder conditions) to get a clearer view.
If local anaesthetic is used, you may be able to see the pictures being displayed by the cystoscope. A nurse will stay with you during the procedure and they can explain what is happening.
The cystoscope is usually kept in your bladder for between two and 10 minutes.
After a cystoscopy, you may need to go to the toilet so the sterile water can pass out of your system. You may also be prescribed antibiotics to reduce your risk of developing a bladder infection.
Is a cystoscopy painful?
People are often concerned that having a tube inserted into their urethra and up into their bladder will be painful. A cystoscopy isn't usually painful but 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 experience mild muscle pain and nausea after a general anaesthetic.
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 (tissue sample) 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.
Cystoscopy in men
If you notice any of the above, contact the hospital staff for advice (you'll be given a contact telephone number before you're discharged for this purpose).
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.
Recovering from a cystoscopy
The type of anaesthetic that's used will affect how long it takes to recover from a cystoscopy. It is also normal to experience some side effects for a few days afterwards.
If you have a local anaesthetic before a cystoscopy, you will be able to go home when the procedure has finished.
If you have a epidural or general anaesthetic, it usually takes a few hours to recover from its effects, so you'll need to arrange for someone to accompany you home. You should rest for 24 hours and avoid driving, operating complex or heavy machinery and drinking alcohol for 48 hours.
Urinary tract infections
Urinary tract infections (UTIs) are an infection of your urethra, bladder or kidneys. Symptoms of a UTI can include:
Contact your GP or hospital staff as soon as possible if you have any of the above symptoms. Most UTIs can be successfully treated with antibiotics.
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 an increased risk.
Urinary retention may be a sign your urethra (the tube the 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 sample was removed during the procedure. However, in rare cases bleeding may be a sign your bladder has been damaged.
Seek medical advice if you have persistent or severe bleeding because you may need a temporary catheter fitted or surgery to repair any damage to your bladder.
a burning sensation when urinating that lasts longer than two days
a high temperature (fever) of 38ºC (100.4ºF) or above
unpleasant smelling urine
pain in your lower back or side
Most people will experience a burning pain when passing urine during the first few days after a cystoscopy. This is normal and 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 in cases where a biopsy is also carried out. Drinking plenty of water can help ease both 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 are unable to pass urine more than eight hours after the procedure
you develop a high temperature (fever) of 38ºC (100.4ºF) or above
your urine smells unpleasant
you have nausea or vomiting
you have pain in your lower back or side