Cystoscopy

Cystoscopy is a procedure in which a urologist (a doctor who specialises in the urinary system) uses a thin, lighted tube called a cystoscope to look directly inside the bladder and the urethra (the tube that carries urine out of the body).

The cystoscope is gently passed through the urethra and into the bladder. A small camera at the tip sends live images to a screen. This lets the doctor see the lining of the bladder up close, spot anything unusual, and — if needed — take a tiny tissue sample or carry out a minor treatment at the same time. The procedure does not involve any cuts to the skin.

Cystoscopy is used whenever a doctor needs a direct view of the bladder or urethra to investigate symptoms, confirm a diagnosis, or monitor a known condition. It is one of the most common procedures in urology.

• Blood in the urine (haematuria) — visible or found on a urine test
• Frequent or painful urination that has no clear cause after standard tests
• Recurrent urinary tract infections (UTIs) — infections of the bladder or urethra that keep coming back
• Suspected bladder stones (hard mineral deposits that form inside the bladder)
• Suspected bladder tumours or polyps (abnormal growths on the bladder wall)
• Urinary incontinence (leaking urine) that needs further investigation
• Narrowing of the urethra (urethral stricture) causing difficulty passing urine
• Monitoring of previously treated bladder cancer to check whether it has returned
• Investigating problems with a ureteral stent (a small tube placed between the kidney and bladder)

Cystoscopy is usually avoided or postponed in certain situations. Your doctor will assess these carefully before scheduling the procedure.

• Active, untreated urinary tract infection — the infection is normally cleared first to reduce the risk of spreading bacteria
• Severe bleeding disorders that cannot be managed safely
• Inability to cooperate with the procedure, which may require general anaesthesia (medicine that puts you in a deep sleep) instead of the usual local approach

Cystoscopy is a low-risk procedure, and serious complications are uncommon, but patients should be aware of the following possibilities.

• Mild burning or stinging when passing urine for one to two days after the procedure — this is the most common experience
• Small amounts of blood in the urine (pink-tinged urine) for a short time after the procedure
• Urinary tract infection — bacteria can occasionally be introduced during the procedure; antibiotics are usually given to reduce this risk
• Temporary difficulty urinating or a feeling that the bladder has not fully emptied
• Bladder spasms (sudden, painful squeezing of the bladder muscle)
• Rarely, a small tear or injury to the urethra or bladder wall
• Reaction to the local anaesthetic gel (numbing gel) used to ease insertion of the scope — allergic reactions are rare
• If general or spinal anaesthesia is used, there are additional but uncommon risks related to the anaesthetic itself, which the anaesthesiologist will explain separately

Preparation for cystoscopy is usually straightforward. Most patients do not need to fast beforehand unless general or spinal anaesthesia is planned, in which case the hospital will give specific fasting instructions. If only a local anaesthetic gel is used, eating and drinking normally is usually fine.

Your doctor will review all medications before the procedure. Blood thinners are often paused for a number of days beforehand, but your doctor will decide whether this is necessary and for how long. Do not stop any medication without being told to do so by your doctor. Inform the team of any allergies, especially to latex or anaesthetic agents. Smoking and heavy alcohol use are generally discouraged in the days before the procedure, as both can affect healing.

Tests that are commonly arranged before cystoscopy include:

• Urine culture (a test to check for active infection — cystoscopy is usually postponed if infection is present)
• Urine analysis (a general check of the urine for blood, protein, and signs of infection)
• Blood tests to assess kidney function and clotting ability, if a more complex procedure is planned
• Imaging such as USG (ultrasound) or CT scan of the urinary tract, depending on the reason for the cystoscopy

On the day of the procedure, the steps typically follow this order:

• 1. The patient changes into a hospital gown and is asked to empty their bladder.
• 2. The patient lies on an examination table, usually on their back with knees bent or legs supported.
• 3. The genital area is cleaned with an antiseptic solution.
• 4. A local anaesthetic gel is applied inside the urethra to reduce discomfort. If general or spinal anaesthesia has been planned, it is given at this stage instead.
• 5. The urologist gently inserts the cystoscope through the urethra.
• 6. Sterile water or saline (salt water) is slowly passed through the scope to fill the bladder, which creates a clearer view of the bladder wall.
• 7. The doctor examines all areas of the bladder and urethra on the monitor.
• 8. If a tissue biopsy (a small sample taken for testing) or a minor treatment is needed, it is carried out through a channel in the cystoscope.
• 9. The cystoscope is removed. The whole examination usually takes between ten and thirty minutes, though this can vary.

Most patients who have cystoscopy under local anaesthetic can go home the same day, usually within an hour or two of the procedure ending. If general or spinal anaesthesia was used, a longer stay for monitoring is typical. The team will observe for any immediate reactions before discharge.

• Drink plenty of water in the hours and days after the procedure — this helps flush the bladder and reduces burning when urinating
• Mild burning or pink-tinged urine is expected for up to two days; this usually settles on its own
• Contact the medical team if you develop a high fever, severe pain, heavy bleeding, or are unable to urinate — these may be signs of a complication that needs prompt attention
• Avoid strenuous physical activity and heavy lifting for a day or two, or as advised by your doctor
• Sexual activity is usually paused for a short period; your doctor will advise on the appropriate timeframe
• If a biopsy was taken or a treatment was performed, the doctor may prescribe a short course of antibiotics; take the full course as directed
• A follow-up appointment will be arranged to discuss biopsy results if tissue was taken, or to review symptoms; the timing will depend on the reason for the procedure
• Patients who required general or spinal anaesthesia should not drive or operate machinery until the day after the procedure, or as advised by the anaesthesiologist