A cystourethroscopy is a procedure where a doctor inserts a thin, camera-tipped tube through the urethra to visually examine the inside of the bladder and the urinary tract. It’s one of the most common procedures in urology, used both to diagnose problems and, in some cases, to treat them on the spot. If your doctor has recommended one, it’s typically a quick outpatient procedure that takes 5 to 15 minutes for a standard diagnostic exam.
What It’s Used For
The most common reason urologists order a cystourethroscopy is blood in the urine, whether it’s visible to the naked eye or only detected under a microscope (three or more red blood cells per high-powered field on a urine test). The procedure gives a direct, real-time view of the bladder lining and urethra that imaging like CT scans or ultrasounds can’t always match.
Beyond blood in the urine, your doctor may recommend a cystourethroscopy for:
- Bladder cancer surveillance: If you’ve been treated for bladder or urethral cancer, regular cystoscopies at scheduled intervals are standard follow-up care.
- Urinary symptoms: Difficulty emptying your bladder, frequent or urgent urination, incontinence, chronic pelvic pain, or recurrent urinary tract infections.
- Enlarged prostate evaluation: The scope can reveal narrowing of the urethra caused by prostate growth.
- Abnormal imaging results: If a CT scan or ultrasound showed something unusual in or near the bladder.
- Foreign body removal: Such as a ureteral stent that needs to come out.
- Trauma: When there’s concern about injury to the bladder or urethra after an accident or surgery.
During the same procedure, a urologist can sometimes treat what they find. Small bladder tumors can be removed, tissue samples (biopsies) can be taken, and bladder stones can be addressed, all through the scope.
Flexible vs. Rigid Scopes
There are two types of cystoscopes. A flexible scope bends and moves with the body’s natural curves, while a rigid scope is a straight, solid instrument. For men, flexible cystoscopy is generally preferred because the longer male urethra and its angle make a rigid scope more uncomfortable. For women, the difference in comfort is minimal: studies show pain scores of about 1.4 out of 10 for flexible scopes versus 1.8 out of 10 for rigid scopes, a gap that isn’t statistically significant.
Rigid scopes do have advantages. They provide a slightly wider field of view, and they’re the standard choice when the urologist needs to pass larger instruments through the scope to take biopsies or remove tissue. In practice, your urologist will choose the scope type based on why you’re having the procedure and what they expect to find.
How to Prepare
Preparation depends on the type of scope and whether you’ll need sedation or general anesthesia. For a flexible cystoscopy done in the office with local numbing gel, you can eat and drink normally beforehand. For a rigid cystoscopy performed under general anesthesia (more common when a treatment is planned), you’ll typically need to fast for several hours before your appointment.
You may be asked to provide a urine sample on the day of the procedure to check for infection. An active urinary tract infection usually needs to be treated before the cystoscopy can go ahead, since introducing a scope during an infection raises the risk of spreading bacteria. Let your doctor know about all medications you’re taking, particularly blood thinners, and whether there’s any chance you could be pregnant.
What Happens During the Procedure
For a standard office-based cystourethroscopy, you’ll change into a gown and lie on an exam table. Women are typically positioned with knees bent and feet apart. If a flexible scope is being used, women can sometimes lie in a more relaxed position rather than stirrups.
The urologist applies a numbing gel to the urethra and waits a few minutes for it to take effect. The scope is then gently inserted through the urethral opening. Sterile fluid flows through the scope to fill the bladder, which stretches the bladder wall and gives the camera a clear view. You’ll feel a sensation of fullness and a strong urge to urinate during this part. The doctor systematically examines the urethra, the bladder lining, and the openings where the ureters (the tubes from your kidneys) connect to the bladder. The whole process for a diagnostic exam typically takes under 15 minutes.
If general or regional anesthesia is used, the procedure takes place in a surgical suite, and you won’t be awake for it. This is more common when the urologist plans to remove tissue, take biopsies, or perform other interventions through the scope.
Recovery and Side Effects
After an office-based flexible cystoscopy, most people can drive themselves home and return to normal activities the same day. If you had general anesthesia, you’ll need someone to drive you and should plan to rest for the remainder of the day.
It’s normal to experience some burning or stinging when you urinate for the first day or two afterward. You may also notice a small amount of blood in your urine, which typically clears within 24 to 48 hours. Drinking extra water helps flush the bladder, dilutes the urine (making it less irritating), and can ease these symptoms. A warm, damp cloth held against the urethral area can also help with discomfort.
These mild effects are expected and not a cause for concern. What would warrant a call to your doctor is heavy bleeding that doesn’t improve, inability to urinate, fever, or worsening pain after the first couple of days. Urinary tract infection is the most notable complication, occurring in roughly 5 to 8 percent of cases based on prior studies. Signs include persistent burning, cloudy or foul-smelling urine, and fever.
When Guidelines Say It’s Necessary
For microscopic blood in the urine, the American Urological Association’s 2025 guidelines use a risk-based system to determine who needs a cystoscopy and how urgently. If you fall into the low-risk category (younger age, small amount of blood, no other risk factors), your doctor may simply repeat a urine test in six months rather than sending you straight for a scope. For intermediate-risk patients, cystoscopy along with a kidney ultrasound is strongly recommended, though in some cases a urine marker test can help decide whether the scope is truly needed. If blood persists on a follow-up test, cystoscopy then becomes necessary.
For high-risk patients, such as older adults, smokers, or anyone with significant blood in the urine, cystoscopy and upper tract imaging are both strongly recommended without delay. In these groups, the procedure is considered essential rather than optional because the chance of finding a treatable condition like bladder cancer is meaningfully higher.