Cystoscopy

Overview

A cystoscopy is a procedure that lets a doctor look directly inside your bladder and the tube that carries urine out of your body (the urethra). A very thin, bendy tube with a tiny camera and light on the end, called a cystoscope, is passed gently through your urethra. The pictures show up on a screen, so your doctor can see clearly what is going on. It sounds daunting, but for most people it is quick, safe and less uncomfortable than they expect.

Yes. Cystoscopy is one of the most common tests used by urinary specialists. Thousands are done every week across the UK, and it is a routine day-case procedure for many hospitals.

Anyone can need a cystoscopy, at any age. It is done most often in adults over 50, and slightly more often in men. It is used in children too, but much less commonly and usually under a general anaesthetic.

Symptoms

Common symptoms

• Blood in your urine (doctors call this haematuria) — whether you can see it or it is only found on a urine test
• Urine infections that keep coming back, or an infection that does not clear up
• A burning or stinging feeling when you pass urine
• Needing to pass urine often, suddenly, or in a hurry
• Trouble starting to pass urine, or a weak or stop-start flow
• Pain in your lower belly, pelvis or back that your doctor wants to look into
• A feeling that your bladder is not emptying properly

Symptoms in children

• Repeated urine infections, especially with a high temperature
• Being born with a difference in the shape of the urinary system, such as a narrowed tube or a valve that blocks urine
• Blood in the urine
• Problems with wetting, or trouble passing urine, when other tests have not explained it
• A cystoscopy in a child is almost always done under a general anaesthetic, so your child will be asleep and feel nothing

Symptoms in older adults

• Blood in the urine, which is always worth checking in an older adult
• Needing to pass urine several times a night, or a weak flow
• Repeated infections, particularly if you have a catheter or a long-term bladder condition
• A cystoscopy may be combined with other tests to look at the whole urinary system at once

Causes

Main causes

• Looking for the cause of blood in the urine — this is the most common reason for a cystoscopy
• Checking why urine infections keep returning
• Investigating pain, a weak urine flow, or a feeling that the bladder is not emptying
• Checking the bladder for growths (polyps) or early changes that could become cancer
• Following up a bladder condition that has been treated before
• Removing a stent (a small tube) that was placed earlier, or taking out bladder stones
• Checking the urinary system before or after certain operations

Risk factors

• Smoking — it is the biggest known risk factor for bladder problems, including bladder cancer
• Being exposed at work to certain industrial chemicals, such as those used in dye, rubber, leather or aluminium work
• Being over 50, or being male
• Long-term use of a urinary catheter
• Previous radiotherapy to the pelvis
• Some long-term bladder conditions, or a family history of bladder problems
• Drinking very little fluid, or holding urine in for long periods, which can make infections more likely

When to see a doctor

See a doctor urgently if:

• You see blood in your urine, even once, even if it clears up on its own
• You have a urine infection with a high temperature, shivering or back pain
• You cannot pass urine at all
• You have severe pain in your lower belly or side
• You notice blood in your urine and you take a blood-thinning medicine

Book a routine appointment if:

• You keep getting urine infections — for example, more than two or three in a year
• Passing urine has become difficult, slow or dribbly
• You need to get up several times a night to pass urine
• You have a burning feeling when you pass urine that keeps coming back
• Your doctor has found blood in your urine on a routine test
• You have a lasting feeling of pressure or discomfort in your lower belly

Diagnosis

A cystoscopy is itself the test that lets your doctor see inside your bladder. Before it, you will usually have some simple checks first — a urine sample, sometimes a scan, and a talk about your symptoms. Your doctor will explain why the test is being suggested, what it can and cannot show, and whether a flexible or a rigid cystoscopy is right for you.

Tests that may be done

• Urine test (dipstick) to look for blood, infection or other clues
• Urine sample sent to the lab to check for infection and to look at the cells in your urine
• Ultrasound scan of your kidneys and bladder, which is painless and quick
• CT scan or a special X-ray of the urinary system, if more detail is needed
• A flow test — you pass urine into a machine that measures how fast it comes out
• A blood test to check kidney function, and for men sometimes a prostate blood test
• The cystoscopy itself, with a biopsy (tissue sample) if needed

What to expect at your appointment

For a flexible cystoscopy you will usually lie on your back, and the area around the opening of your urethra is cleaned and numbed with a gel. The tube is then passed gently in — most people describe a warm or stinging feeling and a strong urge to pass urine, rather than real pain. It takes only a few minutes. You can usually watch on the screen if you like, and you can ask questions as it happens. For a rigid cystoscopy you will be given medicine so you are asleep or feel nothing, and you will wake up in a recovery area. Afterwards you may feel a bit sore and need to pass urine more often for a day or two, and your urine may be slightly pink.

Treatment

A cystoscopy is mainly a test, so the treatment that follows depends entirely on what it finds. Sometimes the procedure is also the treatment — for example, a small growth can be removed, a stone taken out, or a narrowed area gently stretched, all during the same session. If everything looks normal, you may not need any treatment at all, just reassurance and perhaps a follow-up.

Self-care at home

• Follow the instructions your hospital gives you about eating, drinking and medicines beforehand — this matters most if you are having a general anaesthetic
• Arrange for someone to travel home with you if you are having sedation or a general anaesthetic
• Drink plenty of water for the rest of the day afterwards — this helps flush the bladder and eases stinging
• Take it easy for the rest of the day; most people can return to normal activities the next day
• A warm drink or a warm pack on your lower belly can help with mild cramping
• If your urine is pink, it should fade within a day or two — keep drinking fluids
• Avoid heavy lifting, cycling or strenuous exercise for a few days if you had a rigid cystoscopy
• Wait a few days before having sex if you feel sore or your doctor advises it

Medical treatments

If the cystoscopy shows an infection, your doctor may prescribe a short course of antibiotic tablets — a pharmacist or your GP can explain how to take them and what side effects to watch for. If a growth is found, your specialist team will explain what it is and what happens next, which may include a short operation to remove it and to check the deeper layers of the bladder wall. In some bladder conditions, medicine can be placed directly into the bladder through a thin tube (a catheter). If a narrowing is found, it may be stretched or a small tube called a stent may be put in to keep urine flowing. If a bladder stone is found, it is usually removed during the procedure. Your team will go through the options with you in plain words, including the benefits and the possible downsides, before anything is decided.

When is surgery considered?

A rigid cystoscopy is a small operation, usually done as a day case under a general or spinal anaesthetic. If a growth needs removing, this is usually done at the same time in a procedure called a TURBT — the surgeon passes a thin instrument through the urethra, so there are no cuts on the outside of your body. Most people go home the same day or the day after, and recover within a week or two.

Living with this condition

Most people get back to normal within a day or two after a flexible cystoscopy, and within a week or so after a rigid one. For a short while you may notice you need to pass urine more often, or feel a mild sting — this usually settles on its own. If you have a stent in place, you may feel a twinge in your back or see a little blood in your urine for a while, which is expected; your team will tell you what to watch for.

Lifestyle tips

• Drink fluids steadily through the day, aiming for pale yellow urine
• Go to the toilet when you need to rather than holding it in
• Cut down on smoking, and ask for help to stop — this is the single best thing you can do for your bladder health
• Keep alcohol and caffeine moderate, as both can irritate the bladder
• Avoid constipation by eating plenty of fruit, vegetables and wholegrains, and staying active
• Keep any follow-up appointments, even if you feel completely well

Diet and exercise

There is no special diet you must follow after a cystoscopy. Eating normally and drinking plenty of water is the main thing. Some people find that fizzy drinks, coffee, strong tea, citrus or spicy food make their bladder feel more sensitive — if you notice that, try cutting back and see if it helps. Gentle exercise such as walking is fine straight away. Give it a few days before lifting anything heavy, cycling, or doing strenuous workouts, especially after a rigid cystoscopy.

Mental health and emotional wellbeing

It is completely normal to feel anxious before a cystoscopy. Many people feel embarrassed, or worry about what the test might find, and some find the procedure itself uncomfortable. These feelings are real and worth mentioning. Telling your doctor or nurse that you are nervous helps — they can explain each step, go slower, or offer medicine to help you relax. Waiting for results is often the hardest part; try to keep to your normal routine, talk to someone you trust, and remember that most results turn out to be manageable or normal. If worry is affecting your sleep, your appetite or your mood, please speak to your GP. If you ever feel you cannot cope, contact your local emergency number or a crisis helpline in your country straight away.

Prevention

You cannot fully prevent needing a cystoscopy, but you can lower your chance of bladder problems. Not smoking is the most important step. Staying well hydrated, going to the toilet when you need to, and getting urine infections treated promptly all help keep your bladder healthy. Most importantly, never ignore blood in your urine — getting it checked early means any problem is found when it is easiest to treat.

Vaccines

There is no vaccine that prevents the conditions a cystoscopy looks for. Keeping up with routine vaccinations is still part of general good health, and your GP or pharmacist can tell you if you are due any.

Screening programmes

There is no routine national screening programme for bladder cancer in the UK. The test is offered when you have symptoms or risk factors, rather than to everyone. If you see blood in your urine — even once, even if it clears up — always have it checked. If you work with industrial chemicals that can affect the bladder, your workplace may run health checks, and it is worth asking about these.

Complications

If left untreated

• The reason for the test would stay unexplained, which can mean worry and ongoing symptoms
• Some bladder growths can grow larger if they are not found and removed early
• Repeated, untreated urine infections can, over time, put strain on the kidneys
• A blockage that stops urine flowing can be painful and needs treating quickly
• Rarely, a serious infection of the urinary system can develop

Long-term outlook

The outlook is generally very good. Cystoscopy is a safe, well-established procedure, and serious complications are uncommon. Most people feel back to normal within a day or two, and most tests either come back normal or find something that is straightforward to treat. Being checked is a positive step — it gives you and your doctor clear answers and a plan, rather than guesswork.

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