Flexible Cystoscopy

What is flexible cystoscopy?

Flexible cystoscopy is an outpatient procedure to examine the urethra and the inside of the bladder using a thin, flexible fibre-optic telescope (cystoscope). The scope has a diameter of approximately 4–5 millimetres and contains a channel through which the surgeon can visualise the bladder lining in detail.

The procedure is performed in the clinic under local anaesthetic lubricating gel, without the need for a general anaesthetic or admission to hospital. It takes approximately 5–10 minutes in most cases.

When is flexible cystoscopy used?

Flexible cystoscopy is used in a variety of clinical situations:

• Haematuria investigation: Blood in the urine — whether visible to the naked eye or detected on urine testing — requires inspection of the bladder to exclude tumour, stone, or other pathology. Flexible cystoscopy is combined with upper tract imaging (CT urogram or ultrasound) as part of a haematuria investigation.
• Bladder cancer surveillance: After a bladder tumour has been treated, regular cystoscopic surveillance is essential because bladder tumours have a tendency to recur. Surveillance cystoscopy allows early detection of any recurrent disease.
• Ureteric stent inspection and removal: Following placement of a ureteric stent (DJ stent), flexible cystoscopy allows the stent to be inspected and removed in the clinic under local anaesthetic — without requiring a general anaesthetic.
• Recurrent urinary tract infections: In selected patients, cystoscopy helps to identify any structural abnormality within the bladder or urethra that may predispose to repeated infections.
• Lower urinary tract symptoms: In some patients with symptoms such as frequency, urgency, or pelvic discomfort, cystoscopy helps to exclude bladder pathology.

What to expect: before, during, and after

Before the procedure

A urine sample is taken and tested. If infection is detected, the procedure is deferred until treatment is complete. No fasting is required — you can eat and drink normally.

During the procedure

You will lie on a couch with your lower half covered. Local anaesthetic gel is instilled into the urethra and allowed to take effect for a few minutes. The flexible cystoscope is then gently introduced through the urethral opening and passed into the bladder. The surgeon inspects the urethra, both ureteric openings, and the entire bladder wall systematically. The procedure takes 5–10 minutes. If a stent is being removed at the same time, a small grasping instrument is passed through the cystoscope to retrieve it.

After the procedure

You can go home immediately. Drink plenty of fluid — at least two litres over the day — to help flush the bladder and reduce the risk of post-procedure urinary tract infection. Some mild discomfort when passing urine and a small amount of blood in the urine for a day or so is expected and does not require treatment.

Results and follow-up

Your urologist will discuss the findings with you immediately after the procedure. If the cystoscopy is normal, you will be informed and any further management planned. If any abnormality is identified — such as a suspicious area of the bladder lining — a biopsy or formal operating theatre procedure under anaesthesia will be arranged.

Follow-up arrangements depend on the reason for the cystoscopy. Surveillance cystoscopy for bladder cancer is performed at intervals determined by tumour risk stratification; your urologist will explain the schedule recommended for your situation.