A cystoscopy is a test that looks at the urethra and the inside of the bladder. To do this your doctor or nurse uses a cystoscope. A cystoscope is a thin tube with a camera and light on the end.
You may have a cystoscopy:
- if you have possible symptoms of bladder cancer, such as passing blood in your pee (urine) or having problems when peeing (passing urine)
- to check if a cancer has spread into the bladder or urethra from other nearby areas such as the kidney, upper urinary tract, vulva, vagina or cervix.
This test is also used after some treatments for bladder cancer to:
- monitor how well treatment has worked
- check that no new cancers are growing in the bladder.
Some people may feel uncomfortable about having a cystoscopy. You can talk to your nurse or doctor about any concerns you have. They will try to make you as comfortable as possible.
There are different types of cystoscopy. Your doctor or nurse will talk to you about the type of cystoscopy you are having and why you are having it.
Having a flexible cystoscopy
Before the cystoscopy, you are asked to give a sample of pee (urine). The sample is checked for infection. If there is an infection you may be given antibiotics and the test will be delayed.
You undress from the waist down and may be given a hospital gown to put on. You then lie on your back on a couch or bed. You may be given an antibiotic to help prevent infection.
The doctor or nurse squeezes a numbing gel into the opening of your urethra. This is a local anaesthetic and makes the procedure less uncomfortable. The gel starts to work after a few minutes. The doctor or nurse then gently passes the cystoscope through the urethra into the bladder.
The light from the cystoscope helps them look closely at the lining of the bladder and urethra. They may also put sterile water into the bladder to help them see more clearly.
The test takes a few minutes. You may feel some discomfort during the procedure, but it should not be painful. Before you go home you have to pee (pass urine).
A rigid cystoscope cannot bend. During this test, the doctor passes surgical instruments through the cystoscope to:
- treat bladder problems
- remove a tumour in the bladder – this is called a transurethral resection of bladder tumour or TURBT
- take a small piece of tissue for tests – this is called a biopsy.
You may have this done in one of the following ways:
- Under a general anaesthetic, which means you are asleep.
- Using a spinal anaesthetic, which means the lower part of your body is numb. You are awake during the test, but you cannot feel anything.
Before your appointment you may be seen in a pre-assessment clinic. You may have some tests, for example blood pressure and blood tests.
You will also be given information about the rigid cystoscopy and when to stop eating and drinking before it. This is because you will have a general or spinal anaesthetic for this test.
Having a rigid cystoscopy
On the day of the test you will be asked for a sample of pee (urine). The sample is checked for infection. If there is an infection you may be given antibiotics and the test may be delayed.
You will be asked to change into a hospital gown. You then lie on your back on a bed. Some people may be given an antibiotic to help prevent infection.
You will have either a general anaesthetic or spinal anaesthetic. Once you have your anaesthetic the doctor gently passes the cystoscope through the urethra and into the bladder. They may also put sterile water into the bladder to help them see more clearly. They look closely at the bladder and may take biopsies or treat bladder problems.
After the cystoscopy you go to a recovery area where a nurse monitors you. You may be able to go home on the same day or you may have to stay in hospital. This will depend on:
- how you are feeling
- how many biopsies were taken
- what treatment you may need
- what time you had the anaesthetic
- if there is anyone at home to help you.
Sometimes extra imaging techniques are used to help to see if there is any cancer in the bladder. There are different techniques used and these may include narrow band imaging (NBI) and photodynamic diagnosis (PDD).
Narrow band imaging (NBI)
Some people may have a type of cystoscopy called narrow band imaging (NBI). It may be used to look for bladder cancer. The doctor or nurse doing the test shines light at specific blue and green wavelengths on the inside of the bladder. Blood absorbs more blue and green light than white light. This makes it easier for them to see any small tumours or carcinoma in situ (CIS).
NBI is not available at every hospital as it is a new procedure. Your doctor or nurse can give you more information.
Blue light cystoscopy or photodynamic diagnosis (PDD)
During a cystoscopy, the doctor sometimes uses a technique called blue-light cystoscopy. It is also called photodynamic diagnosis (PDD). This is a way of helping the doctor see small bladder tumours and CIS more easily.
Before the cystoscopy, a doctor or nurse passes a tube called a catheter through the urethra and into the bladder. The doctor or nurse puts a light-sensitive dye into the bladder through the catheter. This dye stays in the bladder for an hour before the cystoscopy and is absorbed by any cancer cells.
During the cystoscopy, the doctor uses a special camera and a blue light to look at the bladder. Because the cancer cells have absorbed the dye, they look pink under the blue light. This means the doctor can see them more clearly.
This is not available at every hospital. Your doctor or nurse can give you more information.
You may have some burning or mild pain when you pee (pass urine) for a few days after the test. You may also notice some blood or blood clots in your pee. This should get better after 1 or 2 days.
Your doctor will ask you to drink about 2 litres (3½ pints) of fluid. This will help flush out your bladder.
Tell your doctor straight away if these symptoms do not go away or you have a high temperature, smelly or cloudy pee. They can check to make sure you do not have an infection.
Below is a sample of the sources used in our bladder cancer information. If you would like more information about the sources we use, please contact us at email@example.com
Mottet N, Bellmunt J, Briers E, et al. Non-muscle-invasive bladder cancer (TaT1 and CIS). European Association of Urology (Internet), 2021. Available from uroweb.org/guideline/non-muscle-invasive-bladder-cancer (accessed September 2021).
Witjes JA, Bruins HM, Cathomas R, et al. Muscle-invasive and metastatic bladder cancer. European Association of Urology (Internet), 2021, Available from uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic (accessed September 2021).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Ursula McGovern, Consultant Medical Oncologist.
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