Overview-Cystoscopy
A cystoscopy is a procedure to look inside the bladder using a thin camera called a cystoscope.
A cystoscope is inserted into the urethra (the tube that carries pee out of the body) and passed into the bladder to allow a doctor or nurse to see inside.
Small surgical instruments can also be passed down the cystoscope to treat some bladder problems at the same time.
Types of cystoscopy and how they're carried out
There are 2 types of cystoscopy:
- flexible cystoscopy – a thin (about the width of a pencil), bendy cystoscope is used, and you stay awake while it's carried out
- rigid cystoscopy – a slightly wider cystoscope that does not bend is used, and you're either put to sleep or the lower half of your body is numbed while it's carried out
Flexible cystoscopies tend to be done if the reason for the procedure is just to look inside your bladder. A rigid cystoscopy may be done if you need treatment for a problem in your bladder.
Anyone can have either type of cystoscopy. Ask your doctor or nurse which type you're going to have if you're not sure.
Why cystoscopies are used
A cystoscopy can be used to look for and treat problems in the bladder or urethra.
For example, it can be used to:
- check for the cause of problems such as blood in pee, frequent urinary tract infections (UTIs), problems peeing, and long-lasting pelvic pain
- remove a sample of tissue for testing in a laboratory (a biopsy) to check for problems such as bladder cancer
- carry out treatments, such as removing bladder stones, inserting or removing a stent (a small tube used to treat blockages), and injecting medicine into the bladder
Does a cystoscopy hurt?
A cystoscopy can be a bit uncomfortable, but it's not usually painful.
For a flexible cystoscopy, local anaesthetic gel is used to numb the urethra. This will reduce any discomfort when the cystoscope is inserted.
A rigid cystoscopy is carried out under general anaesthetic (where you're asleep) or a spinal anaesthetic (which numbs the lower half of your body), so you will not have any pain while it's carried out.
It's normal to have some discomfort when peeing after a cystoscopy, but this should pass in a few days.
Recovering from a cystoscopy
You should be able to get back to normal quite quickly after a cystoscopy.
You can usually leave hospital the same day and can return to your normal activities – including work, exercise, and having sex – as soon as you feel able to.
This may be later the same day if you had a flexible cystoscopy, or a couple of days after a rigid cystoscopy.
It's normal to have discomfort when peeing and a bit of blood in your pee for a day or two.
See a GP if the discomfort is severe or does not improve in a few days, or you develop a high temperature.
Risks of a cystoscopy
A cystoscopy is usually a very safe procedure and serious complications are rare.
The main risks are:
- a urinary tract infection (UTI) – which may need to be treated with antibiotics
- being unable to pee after going home – which may mean a thin tube called a catheter needs to be temporarily inserted into your bladder so you can empty your bladder
There's also a risk your bladder could be damaged by the cystoscope, but this is rare.
Speak to your doctor or nurse about the possible risks of the procedure before having it.
What happens-Cystoscopy
There are 2 types of cystoscopy: a flexible cystoscopy and a rigid cystoscopy.
Both involve passing a thin viewing tube called a cystoscope along the urethra (the tube that carries pee out of the body) and into the bladder, but they're done in slightly different ways.
Anyone can have either type of cystoscopy. Ask your doctor or nurse which type you're going to have if you're not sure.
Flexible cystoscopy
A flexible cystoscopy is where a thin (about the width of a pencil) and bendy cystoscope is used. You stay awake while it's carried out.
Preparation
You'll be sent instructions to follow before your appointment. This will include advice about eating, drinking, and what to do about any medicines you're taking.
You can usually eat and drink as normal before a flexible cystoscopy.
Before the procedure starts, you'll be asked to undress from the waist down and put on a hospital gown.
You may be asked to pee into a container so it can be checked for an infection. The procedure may be delayed if a urine infection is found.
The procedure
For a flexible cystoscopy:
- you lie down flat on a special couch
- your genitals are cleaned with an antiseptic and a sheet is placed over the surrounding area
- local anaesthetic gel is applied to your urethra to numb it and help the cystoscope move along it more easily
- the cystoscope is inserted into your urethra and gently moved down towards your bladder
- water may be pumped into your bladder so your doctor or nurse can see inside it more clearly – you may be able to see images sent to a monitor by a camera in the cystoscope
The cystoscope is usually removed after a few minutes. A nurse will stay with you throughout to explain what's happening.
Does it hurt?
People often worry that a cystoscopy will be painful, but it does not usually hurt. Tell your doctor or nurse if you feel any pain during it.
It can be a bit uncomfortable and you may feel like you need to pee during the procedure, but this will only last a few minutes.
Afterwards
After the cystoscope is removed, you may need to go straight to the toilet to empty your bladder before changing back into your clothes.
Your doctor or nurse may be able discuss the results of the cystoscopy shortly afterwards. But if a small tissue sample was removed for testing (biopsy), you may not get the results for 2 or 3 weeks.
You can usually go home shortly after a flexible cystoscopy.
Rigid cystoscopy
A rigid cystoscopy is where a cystoscope that does not bend is used. You're either put to sleep for the procedure or the lower half of your body is numbed while it's carried out.
Preparation
You'll be sent instructions to follow before your appointment. This will include advice about eating, drinking, and what to do about any medicines you're taking.
You'll usually need to stop eating and drinking for a few hours before a rigid cystoscopy. You'll also need to arrange for someone to give you a lift home, as you will not be able to drive for 24 hours.
You'll be asked to change into a hospital gown for the procedure.
You may be asked to pee into a container so it can be checked for an infection. The procedure may be delayed if a urine infection is found.
The procedure
For a rigid cystoscopy:
- you're given an injection of general anaesthetic (which makes you fall asleep) into your hand, or a spinal anaesthetic (which numbs the lower half of your body) into your lower back
- you will be lying on a special couch with your legs in supports
- your genitals are cleaned with an antiseptic and a sheet is placed over the surrounding area
- the cystoscope is inserted into your urethra and gently moved along towards your bladder
- water may be pumped into your bladder so your doctor or nurse can see inside it more clearly
The procedure can last up to 30 minutes.
Does it hurt?
You may have a short, sharp pain as the injection of anaesthetic is given, but you will not have any pain or discomfort during the procedure because you'll be asleep or your lower half will be numbed.
Afterwards
When the procedure is finished, you'll be taken to a room or ward to recover from the anaesthetic.
Sometimes you may have a thin tube called a catheter placed into your bladder to help you pee. This will be taken out before you go home.
Your doctor or nurse may be able to discuss the results of the cystoscopy shortly afterwards. But if a small tissue sample was removed for testing (biopsy), you may not get the results for 2 or 3 weeks.
You can usually go home once the anaesthetic has worn off, the catheter has been removed (if you have one) and you're able to empty your bladder.
Recovery-Cystoscopy
You should be able to get back to normal quite quickly after a cystoscopy.
How long it takes to recover depends if you had a flexible cystoscopy (using local anaesthetic gel) or a rigid cystoscopy (under general anaesthetic or spinal anaesthetic).
Going home
After a flexible cystoscopy
You'll be able to go home shortly after a flexible cystoscopy, once you've emptied your bladder.
There's usually no need to wait in the hospital until the anaesthetic has completely worn off.
After a rigid cystoscopy
If you have a rigid cystoscopy, you'll probably need to stay in hospital for a few hours until the anaesthetic starts to wear off.
You can go home once you're feeling better and you've emptied your bladder. Most people leave hospital the same day, but sometimes an overnight stay might be needed.
You'll need to arrange for someone to take you home as you will not be able to drive for at least 24 hours.
Getting back to normal
After a flexible cystoscopy
You can return to your normal activities – including work, exercise and having sex – as soon as you feel able to after a flexible cystoscopy.
This will often be later the same day or possibly the day after.
After a rigid cystoscopy
After a rigid cystoscopy:
- rest at home for a day or two – you may need to take a couple of days off work
- make sure someone stays with you for the first 24 hours
- do not drive or drink alcohol for at least 24 hours
You can usually return to your normal activities – including work, exercise and having sex – when you feel able to.
After effects of a cystoscopy
After a cystoscopy, it's normal to have:
- a burning or stinging sensation when peeing
- some blood in your pee, which may turn it slightly pink
- a need to pee more often than usual
These side effects should pass after a day or two.
Drinking plenty of water during the first few days can help. You can also take painkillers such as paracetamol to reduce any discomfort.
When to get medical advice
Contact a GP for advice if:
- the pain or bleeding lasts more than a few days
- peeing is very painful
- your pee becomes so bloody that you cannot see through it
- you see red lumps (blood clots) in your pee
- you cannot empty your bladder
- your pee smells bad
- you get a high temperature
- you feel sick or vomit
- you have pain in your lower back or side
Go to your nearest accident and emergency (A&E) department if you feel really unwell.
These problems could be caused by complications of a cystoscopy, such as an infection.
Cystoscopy
A cystoscopy is usually a very safe procedure and serious complications are rare.
Speak to your doctor or nurse about the possible risks of the procedure before having it.
Urinary tract infections
Urinary tract infections (UTIs) are one of the most common complications of a cystoscopy. These are infections of the bladder, kidneys, or small tubes connected to them.
Symptoms of a UTI can include:
- a burning sensation when peeing that lasts longer than 2 days
- a high temperature (fever)
- pee that smells bad
- feeling and being sick
- pain in your lower back or side
Contact a GP if you have symptoms of a UTI. You may need to take antibiotics.
Being unable to empty your bladder
Some people find it difficult to pee after having a cystoscopy.
You'll normally be asked to empty your bladder before leaving hospital to make sure you're able to, but sometimes it can become difficult to pee after going home.
This can be a sign that your urethra (the tube that carries pee out of the body) or your prostate (a small gland found in men) is swollen.
Contact a GP for advice if you're unable to empty your bladder after a cystoscopy. A thin tube called a catheter may need to be temporarily placed in your bladder to help you pee.
Bleeding and bladder damage
It's normal to have some blood in your pee for a few days after a cystoscopy. But in rare cases it can be a sign that your bladder has been damaged.
Contact a GP if you have lots of blood in your pee – for example, you cannot see through your pee – or the bleeding does not stop within a few days.
You may need to have a temporary catheter or surgery to repair any damage to your bladder.