Cystoscopy Test: Why It Is Done and What to Expect
A cystoscopy test is a urology procedure used to look inside the urethra – the urine passage tube – and urinary bladder using a thin camera called a cystoscope. It is commonly advised for blood in urine, repeated urinary infection, burning urination, poor urine flow, suspected urethral stricture, bladder stone, prostate blockage, DJ stent removal or bladder cancer evaluation. Most flexible cystoscopies are done as an outpatient procedure with local anaesthetic jelly. You may feel pressure, mild burning or an urge to pass urine, but severe pain is not expected.
Cystoscopy test: what is it?
Cystoscopy allows a urologist to directly see the inside of your urethra and bladder. The cystoscope has a light and camera at the tip. Sterile fluid is gently filled into the bladder so that the bladder lining opens up and can be inspected clearly.
Cystoscopy is mainly a diagnostic test, but small treatments can also be done during the same procedure in selected cases. For example, a urologist may remove a DJ stent, take a small biopsy, inspect prostate-related blockage or treat certain bladder findings.
Why is cystoscopy done?
Cystoscopy is advised when symptoms, urine reports or scans suggest a problem inside the bladder or urine passage.
Common reasons include:
- Visible blood in urine.
- RBCs in urine report.
- Repeated urinary tract infection.
- Burning urination that keeps coming back.
- Frequent urination or urgency.
- Poor urine stream.
- Straining while passing urine.
- Feeling of incomplete bladder emptying.
- Suspected urethral stricture.
- Suspected bladder stone.
- Suspected bladder tumour.
- Follow-up after bladder tumour treatment.
- DJ stent removal after kidney stone surgery.
- Evaluation of prostate-related urinary blockage.
Cystoscopy is useful because ultrasound, CT scan and urine tests can suggest a problem, but cystoscopy lets the urologist see the bladder lining directly. In blood in urine evaluation, cystoscopy remains an important part of risk-based assessment when bladder inspection is needed.
When should you not delay cystoscopy evaluation?
You should not delay urology evaluation if you have:
- Visible blood in urine.
- Blood clots in urine.
- Repeated UTI in men.
- Recurrent UTI despite treatment.
- Bladder mass or suspicious finding on ultrasound/CT scan.
- Poor urine flow with incomplete emptying.
- Suspected urethral stricture.
- Long-standing catheter-related issues.
- Overdue DJ stent removal.
- Previous bladder cancer needing follow-up.
Having these symptoms does not mean you have cancer. Cystoscopy is done to find the cause clearly, so that serious causes can be ruled out or treated early.
Types of cystoscopy
Flexible cystoscopy
Flexible cystoscopy uses a soft, bendable camera. It is commonly used for diagnostic checking, follow-up cystoscopy and DJ stent removal.
It is usually done under local anaesthetic jelly. Most patients go home the same day. Mild burning while passing urine can happen after the procedure.
Rigid cystoscopy
Rigid cystoscopy uses a straight telescope. It is often used when a biopsy, bladder tumour removal, stone treatment or another procedure is planned.
Rigid cystoscopy is usually done under spinal anaesthesia or general anaesthesia, depending on the patient and the procedure needed.
Flexible vs rigid cystoscopy
| Point | Flexible cystoscopy | Rigid cystoscopy |
|---|---|---|
| Scope type | Soft, bendable camera | Straight telescope |
| Anaesthesia | Usually local anaesthetic jelly | Usually spinal/general anaesthesia |
| Common use | Diagnosis, follow-up, stent removal | Biopsy, tumour work, stone work, operative procedures |
| Hospital stay | Usually outpatient | Day-care or admission may be needed |
| Discomfort | Mild to moderate discomfort | Usually no pain during procedure due to anaesthesia |
| Recovery | Usually quick | Depends on what was done |
How to prepare for cystoscopy
Preparation depends on why cystoscopy is being done and whether it is planned under local anaesthesia or spinal/general anaesthesia.
Your urologist may ask for:
- Urine routine/microscopy.
- Urine culture, especially if infection is suspected.
- Serum creatinine.
- Ultrasound KUB or CT scan if already done.
- PSA report if prostate evaluation is relevant.
- Diabetes and blood pressure details.
- List of medicines.
- Blood thinner history.
- Allergy history.
- Previous operation records.
- DJ stent or catheter history.
Tell your doctor if you take aspirin, clopidogrel, warfarin, apixaban, rivaroxaban or any other blood thinner. Do not stop these medicines on your own. Your urologist will decide based on the reason for cystoscopy and bleeding risk.
If you have fever, active urinary infection or a positive urine culture, the procedure may be delayed or antibiotics may be advised.
What happens during cystoscopy?
Before the procedure, you may be asked to pass urine. You lie on the procedure table. The genital area is cleaned with antiseptic solution. The procedure is done with privacy, sterile precautions and proper draping.
For flexible cystoscopy, local anaesthetic jelly is placed inside the urine passage. The cystoscope is then gently passed through the urethra into the bladder. Sterile fluid is filled slowly so the bladder opens up and the lining can be seen clearly. During this part, you may feel pressure or an urge to pass urine.
The urologist checks:
- Opening of the urethra.
- Urethral passage.
- Prostate channel in men.
- Bladder neck.
- Bladder lining.
- Ureteric openings inside the bladder.
- Any stone, tumour, bleeding point, narrowing or inflammation.
A simple diagnostic cystoscopy usually takes only a few minutes. The total visit may take longer because of preparation, cleaning, observation and discussion after the procedure.
Is cystoscopy painful?
Most patients describe flexible cystoscopy as uncomfortable but tolerable, not severely painful.
You may feel:
- Mild burning.
- Pressure in the urine passage.
- Urge to pass urine.
- Lower abdominal fullness when the bladder is filled.
- Brief discomfort while the scope passes through the prostate area in men.
Men may feel more discomfort than women because the male urethra is longer and passes through the prostate area. Anxiety can also increase discomfort. Slow breathing and relaxing the pelvic muscles can make the test easier.
If you are very anxious, have a suspected tight stricture, need biopsy or need a longer procedure, your urologist may advise cystoscopy under anaesthesia.
What is normal after cystoscopy?
After cystoscopy, it is common to have:
- Mild burning while passing urine.
- Frequent urination for a few hours.
- Urgency to pass urine.
- Slight pink urine.
- A few drops of blood.
- Mild lower abdominal discomfort.
These symptoms usually settle within 24-48 hours. Drinking water may help reduce burning, unless your doctor has restricted fluids due to kidney, heart or other medical conditions. Burning, mild discomfort, bleeding, infection and difficulty passing urine are known post-procedure issues to watch for.
What are the risks of cystoscopy?
Cystoscopy is commonly performed and generally safe, but possible risks include:
- Urinary tract infection.
- Bleeding.
- Burning urination.
- Temporary difficulty passing urine.
- Injury to urethra or bladder, uncommon.
- Urethral narrowing due to scar tissue, uncommon.
- Anaesthesia-related risks if spinal/general anaesthesia is used.
The risk depends on your age, diabetes status, urine infection, prostate size, blood thinner use, previous urethral surgery and whether biopsy or tumour removal is done.
Emergency signs after cystoscopy
Contact your urologist or seek urgent care if you have:
- Fever or chills.
- Inability to pass urine.
- Bright red urine that does not reduce.
- Blood clots in urine.
- Severe lower abdominal pain.
- Worsening burning after 24-48 hours.
- Foul-smelling or cloudy urine with fever.
- Vomiting, weakness or feeling very unwell.
These warning signs may suggest infection, urinary retention or significant bleeding and should not be ignored.
What can cystoscopy show?
Cystoscopy may show:
- Normal bladder and urethra.
- Urethral stricture.
- Enlarged prostate causing blockage.
- High bladder neck.
- Bladder stone.
- Bladder inflammation.
- Bleeding point.
- Bladder tumour or suspicious patch.
- Diverticulum, which is an outpouching of the bladder wall.
- Trabeculation, which means thickened bladder muscle due to long-term obstruction.
- Changes after previous surgery.
- Retained or encrusted DJ stent.
If a suspicious bladder area is seen, a biopsy may be taken. For bladder cancer diagnosis, cystoscopy helps doctors look inside the bladder, and biopsy may be taken so tissue can be checked under a microscope.
What happens if biopsy is taken?
If biopsy is taken, the tissue is sent for histopathology examination. The report may take a few days, depending on the centre.
The biopsy can show whether the area is:
- Inflammation.
- Infection-related change.
- Non-cancerous growth.
- Pre-cancerous change.
- Bladder cancer.
- Recurrence after previous bladder tumour treatment.
Your urologist will explain the report and decide whether you need medicines, repeat cystoscopy, TURBT, imaging, follow-up surveillance or further treatment.
Can cystoscopy remove a DJ stent?
Yes. DJ stent removal is commonly done using cystoscopy. A flexible cystoscope is passed into the bladder, the lower end of the stent is held with a small instrument and the stent is removed gently.
This is usually a short procedure. Patients may feel brief discomfort, burning or urgency after stent removal.
Cost and hospital stay: what affects it?
The cost and stay depend on what type of cystoscopy is planned.
A simple flexible diagnostic cystoscopy is usually an outpatient procedure. Cystoscopy for DJ stent removal may also be done as a short procedure.
Cost and stay may increase if:
- Spinal/general anaesthesia is needed.
- Biopsy is planned.
- Bladder tumour removal is planned.
- Stone treatment is needed.
- Admission is required due to age, infection, bleeding risk or other medical problems.
Ask your urologist whether your cystoscopy is only diagnostic or whether any additional procedure is likely.
What to bring for consultation
Bring these reports if available:
- Urine routine/microscopy.
- Urine culture report.
- Ultrasound KUB.
- CT KUB or CT urography.
- Serum creatinine.
- PSA report if prostate-related symptoms are present.
- Uroflowmetry report if done.
- Previous cystoscopy notes.
- Previous surgery discharge summary.
- Histopathology report if biopsy/TURBT was done.
- DJ stent card or discharge paper.
- Current medicines.
- Blood thinner details.
- Diabetes and blood pressure records.
FAQs
Is cystoscopy test painful?
Flexible cystoscopy is usually uncomfortable but tolerable. You may feel burning, pressure or an urge to pass urine. Severe pain is not expected. If a longer procedure or biopsy is needed, anaesthesia may be used.
Is cystoscopy done for blood in urine?
Yes. Cystoscopy is commonly advised for visible blood in urine or significant RBCs in urine report, especially when the patient’s age, symptoms, smoking history, scans or risk factors suggest the need to inspect the bladder.
Can ultrasound replace cystoscopy?
Not always. Ultrasound can detect stones, swelling, urine retention and large masses. But small bladder lesions or subtle bladder lining changes may be missed. Cystoscopy directly checks the bladder lining.
Can cystoscopy detect bladder cancer?
Cystoscopy can show suspicious bladder growths or patches. If needed, biopsy is taken and sent for histopathology to confirm the diagnosis.
Can cystoscopy detect urethral stricture?
Yes. Cystoscopy can show narrowing in the urine passage. Sometimes a very tight stricture may not allow the scope to pass, and further imaging or treatment planning may be needed.
Can cystoscopy detect prostate blockage?
Yes. In men, cystoscopy can show narrowing at the prostate channel, bladder neck obstruction and bladder changes caused by long-standing blockage.
Can I go home after cystoscopy?
Most simple flexible cystoscopies are outpatient procedures. You can usually go home after passing urine. If spinal/general anaesthesia, biopsy or another procedure is done, observation or admission may be needed.
Can I drive after cystoscopy?
After flexible cystoscopy under local anaesthetic, many patients can resume routine activity. If sedation, spinal anaesthesia or general anaesthesia is used, you should not drive the same day.
Is bleeding after cystoscopy normal?
Mild pink urine or a few drops of blood can happen. Bright red bleeding, clots or inability to pass urine needs urgent medical attention.
Is cystoscopy safe in elderly patients?
Cystoscopy can be done safely in many elderly patients after proper evaluation. Diabetes, infection, blood thinners, prostate enlargement, heart disease and kidney function should be reviewed before the procedure.
Related reading
- Blood in Urine: Causes and When to See a Urologist
- RBCs in Urine Report: Should You Worry?
- Urethral Stricture: Symptoms, Tests and Treatment
- Bladder Cancer / Blood in Urine
- DJ Stent Removal After Kidney Stone Surgery
- Urologist in Latur
References
- National Institute of Diabetes and Digestive and Kidney Diseases. Cystoscopy & Ureteroscopy https://www.niddk.nih.gov/health-information/diagnostic-tests/cystoscopy-ureteroscopy
- British Association of Urological Surgeons. Flexible Cystoscopy Patient Information Leaflet https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Flexible%20cystoscopy.pdf
- American Urological Association/SUFU. Microhematuria Guideline, amended 2025 https://www.auanet.org/guidelines-and-quality/guidelines/microhematuria
- National Cancer Institute. Bladder Cancer Diagnosis https://www.cancer.gov/types/bladder/diagnosis