Cystoscopy for bladder cancer

A cystoscopy is the main test used to diagnose bladder cancer. A cystoscope is a thin tube with a camera on the end to look at the inside of your bladder.

What is a cystoscopy?

A cystoscope is a thin tube with a camera and light on the end. A doctor or specialist nurse uses it to look at the inside of your bladder.

You may have a cystoscopy to help diagnose bladder cancer.

This test is also used after treatment for non-muscle-invasive bladder cancer to:

  • monitor how well treatment has worked
  • check that no new cancers are growing in the bladder.

Your doctor or specialist nurse will tell you how often you will have a cystoscopy. Most people have cystoscopy follow-up for several months or years after treatment finishes.

Flexible cystoscopy

A flexible cystoscopy looks for changes inside the bladder. This is usually done under local anaesthetic. You are awake for the procedure. Before the cystoscopy, you are asked to give a sample of urine, which is checked for infection.

The doctor or nurse squeezes a numbing gel into the opening of your urethra. This is the local anaesthetic and makes the procedure less uncomfortable. The gel starts to work after a few minutes.

The doctor gently passes the cystoscope through the urethra and into the bladder. The light from the cystoscope helps them look closely at the lining of the bladder and urethra. The test takes a few minutes and you can go home after it. You may feel some discomfort during the procedure, but it should not be painful.

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 lots of fluids to help flush out your bladder.

Tell your doctor straight away if these symptoms do not go away or you have a high temperature. They can check to make sure you do not have an infection.

After the cystoscopy, the doctor can usually tell you if they have seen a bladder tumour. If they have, they will arrange for you to go back to the hospital to have a rigid cystoscopy.

Narrow band imaging (NBI)

Some people may have a type of flexible cystoscopy called narrow-band imaging (NBI). It filters the light from the cystoscopy into wavelengths of blue and green. Blood absorbs more blue and green light than white light. This makes it easier for your doctor to see any cancer cells or tumours.

This is not available at every hospital as it is a new procedure. Your doctor or specialist nurse can give you more information.

Rigid cystoscopy

During this test, the doctor passes surgical instruments through the cystoscope to either:

  • remove the tumour
  • take a small piece of tissue (biopsy).

You may have this done under a general anaesthetic or using a spinal anaesthetic. A spinal anaesthetic numbs the lower part of your body. You are awake during the test, but you do not feel anything. We have more information about surgery to remove a bladder tumour.

Blue light cystoscopy or photodynamic diagnosis

During a rigid 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 tumours that are flat more easily. Tumours that are flat are called carcinoma in situ (CIS).

Before the cystoscopy, a nurse passes a tube through the urethra and into the bladder. This tube is called a catheter. The doctor puts a light-sensitive drug into the bladder through the catheter. This drug 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 drug, they look pink under the blue light. This means the doctor can see them more clearly.