16553 Cystoscopy

Overview

A cystoscopy is a short procedure that lets a doctor look directly at the inside of your bladder and the tube that carries urine out of your body (the urethra, said you-REE-thra). A thin, flexible tube with a tiny camera and light on the end is gently passed through the opening you pass urine from and into your bladder. The camera sends pictures to a screen, so the doctor can see whether the bladder lining looks healthy or whether there is anything that needs checking, such as a small growth, a stone, a scar or an area of redness. A cystoscopy can also be used to take a tiny sample of tissue (a biopsy) or to treat small problems at the same time.

Yes. Cystoscopy is a very common and routine test. Hundreds of thousands are done every year, and clinics carry them out every day, so the staff looking after you will be very used to helping people through it.

It can be done at any age, from young children to older adults. It is most often offered to adults who have blood in their urine, repeated urine infections, or urinary symptoms that need a closer look. It is more common in men over 50, but women have it regularly too.

Symptoms

Common symptoms

• Blood in your urine (pee), which may be pink, red or brown, or only found on a urine test
• Urine infections that keep coming back, or that do not clear up with treatment
• Burning or stinging when you pass urine, or feeling you need to go more often than usual
• A weak or slow urine stream, dribbling, or trouble starting to pee
• Pain or discomfort in your lower belly or pelvic area
• These are the kinds of symptoms that might lead your doctor to suggest a cystoscopy. The procedure is done to find the cause, not because anything serious is certain.

Symptoms in children

• Children are sometimes offered a cystoscopy if they have repeated urine infections, problems passing urine, or a known difference in the shape of their urinary system.
• It is almost always done under a general anaesthetic, so your child sleeps through it and feels nothing.
• Children usually recover quickly, but may be clingy or tired for a day afterwards.

Symptoms in older adults

• Older adults are more likely to be offered a cystoscopy, often because of blood in the urine or repeated infections.
• Flexible cystoscopy is usually well tolerated, but tell the team about any medicines that thin the blood, and about heart, kidney or memory problems.
• Bring a family member or friend if you can, and ask about how you will get home afterwards, especially if you have sedation or a general anaesthetic.

Causes

Main causes

• The most common reason is blood in the urine, to check where it is coming from
• Repeated or stubborn urine infections that need a closer look at the bladder lining
• Urinary symptoms such as pain, frequent urination or a slow stream that tests have not explained
• Checking for bladder stones, small growths (polyps) or narrowing (strictures) of the urethra
• Following up a previous bladder problem, or monitoring a condition already known about
• Sometimes to treat as well as check, for example removing a small polyp, taking a biopsy or removing a stone

Risk factors

• Smoking, which raises the risk of bladder problems and is the main lifestyle factor linked to bladder cancer
• Working with certain chemicals, dyes or rubber over many years
• Being over 50, or being male, which makes urinary symptoms more common
• A history of repeated urine infections, kidney stones or bladder stones
• Long-term catheter use or previous surgery on the urinary system
• Some medicines and treatments, such as previous radiotherapy to the pelvic area

When to see a doctor

See a doctor urgently if:

• You notice blood in your urine, even once and even if it goes away
• You have a urine infection that keeps returning after treatment
• You cannot pass urine at all, or you have severe pain in your lower belly or back
• You have a fever with pain in your side or back

Book a routine appointment if:

• Burning or stinging when you pee that keeps happening
• Needing to pee much more often, or urgently, and it is affecting your day
• A slow or weak urine stream, dribbling, or a feeling that your bladder is not fully empty
• Any change in your urinary habits that lasts more than a couple of weeks

Diagnosis

A cystoscopy is itself a test rather than a treatment. Your doctor will first ask about your symptoms, your medical history and any medicines you take, and will usually test a sample of your urine. If a cystoscopy is recommended, you will be told which type is planned and how it will be done. During the procedure the doctor watches a screen and can see the whole lining of your bladder. Sometimes a small tissue sample (biopsy) is taken, or a tiny growth is removed, and the results of those are usually ready in one to two weeks.

Tests that may be done

• Urine test and urine culture, to look for infection or blood
• Flexible cystoscopy in the clinic, using a numbing gel so you stay awake and comfortable
• Rigid cystoscopy in an operating theatre under a general or spinal anaesthetic
• Biopsy, where a tiny piece of tissue is taken to be examined in the laboratory
• Ultrasound scan, CT scan or a flow test of your urine, often used alongside the cystoscopy
• Blood tests, to check your kidney function and general health

What to expect at your appointment

You may be asked to give a urine sample before the procedure to make sure there is no infection. For a flexible cystoscopy you lie down, the area is cleaned, and a numbing gel is used. The tube is gentle and thin, roughly the width of a pencil lead. It feels odd and you may feel a strong urge to pee, but it is usually more uncomfortable than painful and is over quickly. For a rigid cystoscopy you will be given an anaesthetic and will not feel anything. Afterwards you rest for a short while, are given a drink, and can usually go home the same day once you have passed urine.

Treatment

For most people the cystoscopy is a check that shows nothing serious, and no further treatment is needed. If something is found, the treatment depends on what it is: an infection is treated with medicines, a small growth can often be removed during the procedure, and a stone or narrowing can be dealt with by a specialist team. Your doctor will explain what was seen, what it means and what happens next before you go home.

Self-care at home

• Drink plenty of water for the rest of the day to help flush the bladder and dilute your urine
• Expect some stinging when you pee and possibly pink-tinged urine for a day or two, which usually settles on its own
• A warm compress or a warm bath can ease discomfort in the lower belly
• Ask your pharmacist about simple pain relief, and check it is safe with any other medicines you take
• Avoid heavy lifting, gym workouts or long car journeys for about 24 to 48 hours, or longer if you had an anaesthetic
• Follow any instructions the clinic gives you about medicines, dressings or when to restart your usual tablets

Medical treatments

Treatment depends on what the cystoscopy shows. If a urine infection is found, your doctor may prescribe a course of antibiotics and suggest you drink plenty of fluids. If there is inflammation of the bladder lining, treatment aims to calm it and ease symptoms. If a small growth or stone is found, your specialist team will explain whether it can be removed at the same time or needs a separate procedure. If nothing abnormal is found, treatment focuses on managing your symptoms and on follow-up if needed. Always ask your own doctor or pharmacist before taking any medicine.

When is surgery considered?

Sometimes the cystoscopy is done as a treatment rather than just a check. Examples include removing a small growth (polyp), taking a biopsy, removing or breaking up a bladder stone, stretching a narrowed area of the urethra, or placing a thin tube (stent) to help urine flow. These are usually done under a general or spinal anaesthetic, and your team will explain the risks, the recovery time and what to expect beforehand.

Living with this condition

Most people are back to normal within a day or two. You may notice a little stinging, a stronger urge to pee, or a small amount of blood for a short while. These effects usually fade quickly. If you had a general anaesthetic, plan a quiet day afterwards and arrange for someone to travel home with you.

Lifestyle tips

• Keep drinking water regularly through the day rather than large amounts all at once
• Cut down on very strong coffee, alcohol and fizzy drinks for a few days if they irritate your bladder
• Take it easy for 24 to 48 hours, then build back up to your usual activity
• If you smoke, stopping is one of the best things you can do for your bladder and overall health, and support is available
• Keep a note of any symptoms so you can describe them clearly at a follow-up appointment

Diet and exercise

There is no special diet after a cystoscopy. Eating normally and drinking plenty of water is all that is needed. Gentle walking is fine straight away and can help you feel better. Wait about 24 to 48 hours before swimming, heavy lifting or hard exercise, and longer if you had an anaesthetic. Some people find that very spicy food, alcohol or caffeine makes urinary symptoms worse; if that happens to you, ease off for a while.

Mental health and emotional wellbeing

It is completely normal to feel anxious before a cystoscopy, especially if you have been told it is to check for something serious. Waiting for results can be an uneasy time. Try to remember that most results are normal or show something easily treated. Talking to a friend, a family member or your GP about your worries can really help. If you feel very low or overwhelmed, please reach out for support, and remember that crisis support is available in your country through your local health service or emergency number.

Prevention

You cannot prevent needing a cystoscopy, because it is a test rather than an illness. What you can do is lower your chance of complications and look after your bladder health: drink enough water, treat urine infections promptly, stop smoking, and follow the clinic instructions about medicines before the procedure. If you take a blood-thinning medicine, tell the team well in advance so they can plan around it.

Screening programmes

There is no routine screening programme that uses cystoscopy for the general population. It is used when you have symptoms or risk factors that need checking. If you notice blood in your urine, do not wait for a screening test; see your doctor promptly.

Complications

If left untreated

• The symptoms that led to the cystoscopy would stay unexplained, which can mean a treatable problem goes unnoticed for longer
• A urine infection that is not treated can spread to the kidneys and make you more unwell
• Small growths in the bladder are much easier to treat when they are found early
• Rare complications of the procedure itself include infection, bleeding, or difficulty passing urine, which the clinic team will explain and monitor for

Long-term outlook

The outlook is good for the great majority of people. Cystoscopy is a safe, well-established test, and most people have a normal result or find something that is straightforward to treat. Even when a problem is found, picking it up early usually means simpler treatment and better outcomes. You will be told what was seen and what, if anything, comes next before you leave the clinic.

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