Having a flexible cystoscopy: examining your bladder

This leaflet is for patients who have been referred for a flexible cystoscopy. This leaflet explains the following.

• What a flexible cystoscopy is.

• The benefits, risks, and alternatives.

• What you can expect when you come to hospital.

• How you will feel afterwards.

We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to a member of your healthcare team.

What is a cystoscopy?

A cystoscopy is a procedure that looks at the bladder and other parts of the urinary system. It involves:

• inserting a special tube, called a cystoscope, into the urethra; and

• then passing it through to the bladder.

There are two types of cystoscope: rigid and flexible.

• A rigid cystoscope is a solid, straight tube with a light at one end. It is often used to take samples, or carry out surgery under a general anaesthetic (you are asleep).

Why do I need a cystoscopy?

Your doctor has recommended you have a flexible cystoscopy as it is a quick and easy way to diagnose problems. Also, using a local anaesthetic rather than general anaesthetic, carries less risks.

Some urinary symptoms (see below) are due to problems in the bladder or urethra. Sometimes the cause of your symptoms will be clear from x-rays or tests of your blood or urine. But often the only way your doctor can be sure what is going on, is to look inside your bladder.

A cystoscopy can help to diagnose the causes of symptoms. Below are some examples of symptoms.

• Blood in your urine (haematuria).

• Frequent urinary tract infections.

• Difficulty or pain when urinating (passing urine (pee)).

• Incontinence (inability to control when you urinate (pee)).

What are the risks to the procedure?

There are risks to having most procedures. Your doctor will explain the potential complications of a cystoscopy. Please ask questions if you are uncertain. Once you have decided to proceed, they will ask for your written consent to go ahead with the procedure.

Why do I need to sign a consent form?

All patients must give permission before they receive any type of medical treatment, test, or examination. Consent is usually given when you sign the consent form before your treatment, but we may ask you to give it verbally.

• You must give your consent voluntarily.

• The hospital must give you all the information you need to make a decision about your treatment. This is so you can give us informed consent.  If you have not been given this information, or you have but you still have questions, please speak to a member of staff. 

• You must be capable of giving consent. This means that you understand the information given to you and can make an informed decision.

When we ask you to give consent, please use this time to ask any questions you may still have. For more information, please go to the NHS Consent for Treatment web page. Remember, you can withdraw your consent for treatment at any time.

Possible side effects

A cystoscopy is usually performed with no problems. However, possible side effects can include the following.

• You may feel a stinging sensation when you urinate (pee), but this should only last a day or two. Taking your usual pain-relieving medicine (such as paracetamol) may help. If your pain is severe and lasts for more than 2 days, please contact your GP or go to the Urgent Treatment Centre at Kent and Canterbury Hospital.

• You may have a small amount of bleeding from the cystoscope being passed up your urethra. Some patients do not have any bleeding at all. However, some find their urine is slightly pink for a few days after their procedure. Drinking 2 to 3 litres of water (spaced out over 24 hours) can help clear your urine. If your urine remains pink after a few days, please contact your GP or go to the Urgent Treatment Centre at Kent and Canterbury Hospital.

• A urine infection can cause a fever and pain when you pass urine. You can reduce the risk of this happening by drinking plenty of water after your procedure.

Rare risks (affects between 1 in 10,000 and 1 in 1,000 people)

• You may need a temporary catheter insertion if you are unable to pass urine normally following your procedure.

• Delayed bleeding which may need further surgery.

• Injury to your urethra causing delayed scar formation. This may need surgery in the future to widen your urethra.

If you have any concerns or questions about these risks, please speak to your doctor.

Are there any alternatives?

A cystoscopy is the only way to have a close enough look at your urinary system and diagnose certain bladder conditions. If there are alternatives, your doctor will discuss these with you.

What happens before my examination?

The procedure is carried out in either:

• the Urology Suite at Kent and Canterbury Hospital; or

• the Derry Unit at the Royal Victoria Hospital, Folkestone.

Check your appointment letter for details.

You will have a short consultation with your doctor or specialist nurse before your procedure. Use this time to ask any last minute questions.

Can I eat and drink before my procedure?

Yes, you can eat and drink as normal before your examination. But empty your bladder before your procedure.

What should I bring to my appointment?

• A list of all your medications.

• A urine sample. Please make sure that the container you use is clean. If there are signs of bacteria in the sample, we may need to reschedule your procedure. You will discuss this with your doctor at your appointment.

  Collect your urine sample as close to your appointment time as possible. Leave no longer than 4 hours between collecting your sample and bringing it to your hospital appointment.

What happens during my examination?

• We will ask you to lie down on your back. We will ask women to lie down as if they were having a smear test.

• We will clean the opening of your urethra and the surrounding area.

• We will squeeze some local anaesthetic ‘jelly’ into your urethra using a syringe (no needle). This can cause a ‘stinging or mild burning sensation’. However, it reduces the discomfort when we insert the cystoscope into your urethra.

• Once the cystoscope is in place, your doctor will fill your bladder with sterile water using the cystoscope. This helps your doctor see the lining of your bladder.

  You may feel water around your genitals. It can make your bladder feel full, and you may feel like you need to urinate. This can be mildly uncomfortable.

• We may ask you to do a flow test during your procedure. This involves passing urine into a special funnel, which measures how fast you pass urine.

How long does the examination take?

We carry out this examination as a clinic procedure. It will take about 5 minutes.

When will I get my results?

Your doctor will be able to tell you the results of your cystoscopy straight after your procedure. They will also arrange any appropriate follow-up. You should get a letter confirming your results, which may take slightly longer. If anything is unclear, please speak with the Urology team or your GP.

The hospital will send your GP a copy of your results.

Will I need a follow-up appointment?

Not all patients need a follow-up appointment. If you do need follow-up investigations, we will discuss this with you before you leave hospital.

Will I need any dressings?

You may want to wear an incontinence pad the day after your cystoscopy. This will protect your clothing from the small amount of bleeding you may have. If you have any bleeding that will not stop, please contact your GP or the Urgent Treatment Centre at Kent and Canterbury Hospital for advice.

Why have I been given antibiotics?

We may prescribe you antibiotics to reduce the chance of an infection. If we do, it is important that you complete the whole course of tablets. Do not drink any alcohol until you have finished the antibiotics, and your symptoms have completely cleared.

What do I need to do when I get home?

• You can return to your normal activities on the same day as your procedure.

• You can have a bath or shower, and eat and drink normally.

• You can drive after your procedure.

• Drink at least 2 litres of water each day, to flush out your bladder and clear any bleeding.

When can I have sex again?

Do not have sex until any swelling or bleeding has cleared. This reduces your risk of developing an infection.

How will I feel after my procedure?

For the first 24 hours, you may feel a mild burning when you pass urine. You may also feel the need to pass urine more often.

Your urine may look pink due to mild bleeding, particularly if you had a biopsy. The bleeding should settle within 24 hours of your examination.

What if I have problems at home following my procedure?

Please contact your GP if you:

• are in extreme pain;

• have a raised temperature (38ºC (100.4ºF) or above);

• have difficulty passing urine; or

• feel your symptoms are persisting and you need further care.

Please go the Urgent Treatment Centre at Kent and Canterbury Hospital, if you:

• have continuous or excessive bleeding; or

• pass blood clots.

If you think it is an emergency, please go straight to your nearest Emergency Department.

What if my original symptoms continue, even though I have been given the ‘all-clear’?

Your symptoms may continue, even though the flexible cystoscopy gave you the ‘all-clear’. If this happens, please contact your GP.

Ask 3 Questions

There may be choices to make about your healthcare. Before making any decisions, make sure you get the answers to these three questions:

• What are my choices?

• What is good and bad about each choice?

• How do I get support to help me make a decision that is right for me?

Your healthcare team needs you to tell them what is important to you. It’s all about shared decision making.

What do you think of this leaflet?

We welcome feedback, whether positive or negative, as it helps us to improve our care and services.

If you would like to give us feedback about this leaflet, please fill in our short online survey. Either scan the QR code below, or use the web link. We do not record your personal information, unless you provide contact details and would like to talk to us some more.

If you would rather talk to someone instead of filling in a survey, please call the Patient Voice Team.

• Patient Voice Team
  Telephone: 01227 868605
  Email

We have used the term ‘women’ in this leaflet. When we use this term we also mean people with female reproductive organs who do not identify as a woman. East Kent Hospitals is committed to supporting people of all gender identities. Please tell your nurse or doctor how you would like them to address you, so we can be sure to get this right.