A cystoscopy is a procedure where a urologist uses a thin, tube-shaped camera called a cystoscope to look inside your urethra and bladder. A simple diagnostic cystoscopy typically takes 15 to 30 minutes, including preparation, and most people go home the same day.
Why a Cystoscopy Is Done
Cystoscopy gives your urologist a direct, real-time view of the bladder lining and the urethra, the tube that carries urine out of your body. It’s used both to diagnose problems and, in some cases, to treat them during the same session. Your doctor might recommend one if you’re experiencing blood in your urine, urinary incontinence, frequent or urgent urination, painful urination, or urinary tract infections that keep coming back.
Beyond symptom investigation, cystoscopy is a key tool for detecting bladder cancer and bladder stones. Small bladder tumors can sometimes be removed right through the cystoscope, eliminating the need for a separate surgery. In men, the procedure can also reveal whether an enlarged prostate is narrowing the urethra, a common condition known as benign prostatic hyperplasia.
Flexible vs. Rigid Cystoscopes
There are two types of cystoscopes, and which one your urologist uses depends on the reason for the procedure. A flexible cystoscope is a thin, bendable tube that’s used for most routine diagnostic exams. It’s performed with a local numbing gel applied to the urethra, and you stay awake throughout. Most patients tolerate it well. A study comparing the two approaches found that patients significantly preferred flexible cystoscopy over rigid cystoscopy, and post-procedure discomfort was notably lower.
A rigid cystoscope is a straight, slightly wider tube that allows the urologist to pass instruments through it for biopsies, tumor removal, or stone extraction. Because it’s less comfortable and requires more precise maneuvering, rigid cystoscopy is typically done under general or regional anesthesia. If your procedure is purely diagnostic, you’ll almost certainly get the flexible version.
What Happens During the Procedure
You’ll change into a gown and lie on an exam table, usually on your back with your knees bent. The urologist or nurse cleans the area around the urethral opening with an antiseptic solution. Then a numbing gel is applied inside the urethra. This gel needs a minute or two to take effect, and it also acts as a lubricant.
Once the area is numb, the urologist slowly inserts the cystoscope through the urethra. You may feel pressure or a brief sensation of needing to urinate, but the gel keeps actual pain minimal. Sterile water is gently pumped through the scope to fill and expand the bladder, which gives the urologist a clearer view of the entire bladder wall. This filling can create a strong urge to urinate, which is normal and temporary.
The urologist examines the bladder lining on a video screen, looking for abnormalities like inflammation, growths, or stones. If a biopsy or minor treatment is needed, tiny instruments are passed through a channel in the cystoscope. Once the exam is complete, the scope is withdrawn and the fluid is drained from your bladder, or you’re asked to empty it in the bathroom. The whole process, for a straightforward diagnostic exam, takes about 15 to 30 minutes. Procedures involving biopsies or stone removal run longer.
How to Prepare
Preparation for a flexible cystoscopy with local anesthesia is minimal. You can usually eat and drink normally beforehand. If your procedure requires sedation or general anesthesia (typically for rigid cystoscopy), you’ll be asked to fast for several hours ahead of time. Your urologist’s office will give you specific instructions.
Let your doctor know about any medications you take, especially blood thinners, which may need to be paused before the procedure. In some cases, particularly if you have a history of urinary tract infections or certain heart conditions, you may be prescribed a short course of antibiotics to take beforehand. You’ll also want to arrange a ride home if you’re receiving any sedation.
Recovery and Common Side Effects
After a flexible cystoscopy with local numbing, most people can return to normal activities the same day. If you had general anesthesia, expect to spend an hour or so in a recovery area before going home, and plan to rest for the remainder of the day.
Some temporary side effects are common and not cause for alarm. You may notice a burning sensation when you urinate for the first day or two. A small amount of blood in your urine, giving it a pink tinge, is typical and usually clears within 24 to 48 hours. You might also feel the urge to urinate more frequently than usual. Drinking plenty of water in the hours after the procedure helps flush the bladder and reduces irritation.
Complication Risks
Serious complications from cystoscopy are uncommon. Overall 30-day complication rates in a large study were between roughly 2% and 4%, depending on the type of equipment used. The most frequently tracked complications include urinary retention (temporary difficulty emptying the bladder), blood in the urine that persists beyond the first couple of days, and urinary tract infection. Sepsis and significant urethral injury are rare.
Patients 65 and older have a somewhat higher complication rate, around 3% to 6% within 30 days, largely because age-related changes to the urinary tract make the tissue more sensitive. Regardless of age, contact your urologist if you develop a fever, are unable to urinate, see bright red blood or clots in your urine after the first day, or experience worsening pain rather than gradual improvement. These can signal an infection or injury that needs prompt attention.
Getting Your Results
If the cystoscopy is purely visual, your urologist can often discuss what they saw immediately after the procedure. You’ll know right away whether the bladder lining looked normal, whether stones were found, or whether any areas appeared suspicious. If a biopsy was taken, tissue samples go to a lab for analysis, and results typically come back within a week or two. Your urologist will schedule a follow-up visit or phone call to review those findings and discuss next steps if treatment is needed.