What are the indications for a rigid cystoscopy?
A cystoscopy is one of the most common procedures in urology. It may be recommended to look for the cause of your symptoms or to monitor a known condition. Typical reasons include:
- Visible or microscopic blood in the urine (haematuria).
- Recurrent or persistent urine infections.
- Bladder symptoms such as frequency, urgency or pain.
- Follow-up surveillance after treatment for a bladder tumour.
- To take a biopsy of an abnormal area, or to treat a small lesion.
Because rigid cystoscopy is performed under general or regional anaesthesia it allows for biopsies and other minor procedures such as urethral dilatation and hydrodistension that cannot be performed at flexible cystoscopy.
What are the alternatives?
- Flexible cystoscopy — A similar diagnostic inspection of the urethra and bladder performed using local anaesthetic gel. Flexible cystoscopy does not normally allow for simultaneous diagnosis and treatment.
- Imaging — An ultrasound or CT scan can image the bladder and prostate, but may miss small abnormalities and cannot sample tissue or treat lesions.
- Observation — If investigation is not felt to be urgent, symptoms may be monitored over time.
What happens before surgery?
You will be asked to attend for a pre-operative assessment approximately 2-3 weeks before surgery, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain drugs should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.
On the day of surgery you should avoid eating for six hours before, and drink only clear fluids within two hours of the procedure. You will be given a gown and compression stockings to wear, your consent will be confirmed, and an anaesthetist will discuss your anaesthetic and pain relief.
What does the procedure involve?
- The procedure is carried out under general or spinal anaesthetic.
- You may be given an injection of antibiotics beforehand.
- A rigid telescope is passed gently along the urethra into the bladder.
- The urethra, bladder neck and bladder are carefully inspected.
- Small biopsies may be taken from any abnormal areas and the sites sealed to stop bleeding.
- Additional minor procedures such as urethral dilatation may be performed.
- Most patients go home the same day once they have passed urine comfortably.
What are the side-effects?
- Mild burning when passing urine for a short time (almost all patients).
- Some bleeding in the urine for a few days (30-40%).
- A urine infection needing antibiotics (5-10%).
- Temporary insertion of a bladder catheter (0-5%).
What happens after surgery?
For the first 24–48 hours, drink about twice as much fluid as usual to flush the bladder through and lower the risk of infection. Any burning usually settles quickly.
You will be sent a letter outlining the details of the procedure, a copy of which is sent to your GP, and can return to work once you feel comfortable. Contact your GP promptly if you develop a fever, severe pain, heavy bleeding, or find you cannot pass urine.
Patient information leaflet
Read the British Association of Urological Surgeons (BAUS) leaflet: Inspection of the bladder with a rigid instrument.
View the BAUS leaflet