Flexible cystoscopy
A cystoscopy is an examination of the inside of the bladder using a thin, flexible, tube-like telescope called a cystoscope. This instrument is carefully passed up the urethra (the tube that passes urine out of the body) and into the bladder.

Why have a cystoscopy?
Cystoscopy is useful for finding out what is causing symptoms such as blood in the urine or difficulties with urination, and as a check-up for certain bladder conditions. It enables the doctor to inspect the bladder lining very closely for abnormal growths, bulges, ulcers or stones. During the procedure, the doctor may also take a biopsy – a small sample of the lining of the bladder – for examination in the laboratory.
The operation
Cystoscopy is routinely performed as an outpatient or day case, with no overnight stay in hospital. It is usually done under local anaesthetic, which is given in the form of a gel placed into the opening of the urethra. This means that if you have this procedure, you will be awake but feel no pain, although there may be some moments of discomfort.

A cystoscopy usually only takes about five minutes to perform, although 45 minutes should be allowed for the appointment. It is necessary to empty the bladder just before having the procedure, which is performed in a private room or cubicle, with a nurse present throughout to provide care and reassurance.

If anaesthetic jelly is used, it will be squeezed into the urethra using a syringe without a needle, and will take effect in five to ten minutes. The cystoscope will then be carefully passed into the urethra. Men may be asked to try and pass urine while the cystoscope is being inserted. This is simply to help relax the muscles – no urine will actually be passed.

Once the end of the cystoscope is in the bladder, sterile water will be passed through it to fill the bladder up and make the whole of the lining visible. A tiny light and lens on the cystoscope enable the doctor to see any abnormal growths or disease.

If necessary, the doctor will take a biopsy of the bladder lining for analysis, using tiny instruments that can be passed inside the cystoscope. This procedure is quick and painless. After the examination, the cystoscope is removed quickly and easily.

What to expect afterwards
As the bladder will be full of water, it will probably be necessary to pass urine again once the procedure is finished. Most people feel ready to go home after a short rest in a full-length chair or on a bed.

Once home, it's sensible to take it easy for the rest of the day. Most people feel able to resume normal activities on the following day.

It is normal to experience mild stinging on passing urine for a day or two after this procedure. Drinking plenty of water can help this, and can also prevent the development of infection or inflammation. The recommended amount is about three litres of water over the course of 24 hours, with the intake evenly spaced out.

If blood is present in the urine, drinking a little extra water and resting for an hour or two will usually settle things down. However, it is important to contact the hospital or a GP immediately if any of the following occur:

the bleeding does not seem to have slowed down after 24 hours,
it becomes difficult to pass urine,
there are any signs of infection such as a high temperature, pain or persistent burning on passing urine.
Results
If a biopsy has been done, the results will be ready several days later and will usually be sent in a report to the doctor who recommended the test.

Side-effects
Side-effects are the unwanted but usually mild and temporary effects of a successful procedure. For cystoscopy, they may include:

a small amount of discomfort after the procedure – this will settle in a few hours,
temporary swelling of the urethra after the procedure – this should not last long, but a narrow tube (catheter) may need to be temporarily left in the bladder to drain urine until the swelling goes down,
a stinging sensation when passing urine for a couple of days after the procedure,
a small amount of blood in the urine – this is quite normal, especially if a biopsy is taken, and should clear up gradually within 48 hours.

Complications
Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. However, the possible complications of a cystoscopy include:

Development of a urinary tract infection or inflammation, requiring treatment with medicines.
Very rarely, the urethra or bladder may be damaged or perforated. This can lead to bleeding and infection, which may require treatment with medicines or surgery.
In a few cases, the cystoscopy is not successful and has to be repeated.
The chance of complications depends on the exact type of procedure that is being performed and other factors such as the person's general health.





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