Cystoscopy at Cardiff and Vale Hospitals

What is a cystoscopy?

A cystoscopy is a test that lets a doctor or nurse look inside your bladder and urethra (the tube that carries urine out of your body). They do this using a cystoscope, a thin tube with a light and camera on the end.

Why might I need a cystoscopy?

Your doctor might suggest a cystoscopy to find the cause of a bladder problem, such as blood in your urine, a urine infection that keeps coming back, or unusual growths, ulcers or stones in your bladder. It can also check whether a cancer has spread into the bladder or urethra from a nearby area.

This test is sometimes used after treatment for bladder cancer too, to see how well the treatment has worked and to check that no new growths have appeared.

What are the benefits of having one?

A cystoscopy can pick up on problems that might not show up clearly on a scan or in blood and urine tests alone because the doctor can see directly inside your bladder. If anything unusual is found, a small tissue sample (a biopsy) can sometimes be taken during the same procedure, rather than needing a separate appointment.

Are there different types of cystoscopy?

There are two main types:

• flexible cystoscopy, which uses a cystoscope that can bend. This is usually done with a local anaesthetic gel, so you stay awake, and it takes only a few minutes
• rigid cystoscopy, which uses a cystoscope that cannot bend. This is usually done under a general or spinal anaesthetic, and lets your doctor pass instruments through the cystoscope to take a biopsy or treat some bladder problems.

Your doctor or nurse will tell you which type you're having and why. Sometimes special lighting techniques are also used during a cystoscopy to help spot small tumours more easily, though these are not available at every hospital.

How do I prepare for a cystoscopy?

For a flexible cystoscopy, you do not usually need to do anything special beforehand, and you can eat and drink normally. You will be asked for a urine sample when you arrive, which is checked for infection, as the test may need to be delayed and antibiotics given if an infection is found.

If you are having a rigid cystoscopy under general or spinal anaesthetic, you may be seen at a pre-assessment appointment beforehand, and you'll be given instructions on when to stop eating and drinking before the test.

What happens during the test?

A flexible cystoscopy is usually carried out like this:

• you undress from the waist down, change into a hospital gown, and lie down on a couch or bed
• a chaperone will usually be present during the examination with you and may assist the doctor or nurse
• a local anaesthetic gel is used to numb and lubricate your urethra, which takes a few minutes to start working
• the doctor or nurse gently passes the cystoscope through your urethra and into your bladder
• sterile water is passed through the cystoscope to fill your bladder, giving a clearer view of the bladder lining
• the doctor or nurse looks closely at the lining of your bladder and urethra on a nearby monitor, and may take a small tissue sample (a biopsy) if needed
• once the examination is finished, you'll be asked to pass urine before you go home.

The whole test usually takes only a few minutes, though you may feel some discomfort or an urge to pass urine. A rigid cystoscopy follows a similar process, but you'll be asleep or numb from the waist down throughout.

What happens after the test?

Most people can go home shortly after a flexible cystoscopy, once they've passed urine. If you had a rigid cystoscopy under general or spinal anaesthetic, you'll be taken to a recovery area where a nurse will monitor you, and you may need to stay in hospital rather than go home the same day, depending on things like how you're feeling and whether any biopsies were taken.

The doctor can usually tell you straight after the test if they've seen anything that might explain your symptoms, and will talk to you about what happens next. You may be given a copy of the report, but your GP will usually receive a copy too.

What are the risks or side effects?

Most people have no problems at all after a cystoscopy, but as with any procedure, there are some possible side effects:

• mild burning or discomfort when you pass urine for a day or two
• a small amount of blood or blood clots in your urine, which usually settles within 1 to 2 days
• a urine infection, which is why you may be asked to drink plenty of fluids, around 2 litres (3½ pints), over the following day or so
• rarely, difficulty passing urine afterwards, or injury to the bladder wall or urethra during the procedure.

Contact your GP or NHS 111 if you develop a high temperature, or if bleeding, burning or pain does not settle.