Test / Diagnostic Procedure: Flexible Cystoscopy

Flexible cystoscopy is a procedure which is routinely performed under local anaesthetic. It involves inserting a fibero-optic scope to the bladder via the urethra. Flexible cystoscopy is a very commonly performed urological procedure and typically is performed in a clinic or office setting.

The device used is usually cleaned, decontaminated and checked for leak or contamination prior to use. However, more commonly now disposal devices are being used to reduce the risk of cross contamination or the need for decontamination facilities on site.

Although flexible cystoscopy is mainly a diagnostic procedure, mainly other procedures now are undertaken using this technique. Bladder biopsies, laser ablation of small bladder tumours, ureteric stent removal and injection of botox to bladder are common procedures that are now largely performed in the outpatient clinic setting using flexible cystoscopy.

Other detection enhancing modalities are used in conjugation to flexible cystoscopy such as blue light or narrow band imaging to detect cases of bladder cancer

Flexible cystoscopy is the gold standard investigation procedure in patients with either visible and non visible haematuria (blood in urine). In the majority of cases, no abnormality is detected and performing the cystoscopy helps rule out potential health issues rather than confirming them. However, common findings are infection and inflammation, bladder cancer, bladder stones, and large bleeding prostate glands are among pathologies detected.

In addition, flexible cystoscopy is used to investigate patients presenting with lower urinary tract symptoms such as urgency, frequency and poor flow. Checking for possible urethral stenosis or stricture, understanding the anatomy of the prostate gland to discuss possible types of treatment if required accordingly.

Typically upon arrival for a flexible cystoscopy appointment, the patient is asked to fill in a questionnaire to check their medical health record, highlight any allergies if present and any recent change in medication history.

The patient will then be asked to provide a urine sample to check for any possible urinary tract infection prior to the procedure. It is better to ensure that the patient has emptied their bladder prior to the procedure. The patient will then be given the option of changing to a hospital gown and then be introduced to the clinician.

The clinician performing the procedure will check a few details prior to the procedure, explain the procedure and obtain consent. A chaperone will be present at all times and the patient will be asked to lie on the bed in preparation for the procedure.

The clinician will then clean the area with an antiseptic solution and use a local anaesthetic and antiseptic with lubricant gel to facilitate the scope passage into the bladder. During the procedure, the bladder will be filled with 100-200 mls of normal saline or water to stretch that bladder to make it easier to inspect.

The patient will then be asked to pass urine prior to being discharged home and post procedure care leaflet will be provided.

Flexible cystoscopy is a very well tolerated procedure and is not associated with any pain. Mild discomfort or burning sensation is common post procedure and mainly while passing urine for the first few times after the procedure. If these symptoms persist then it's useful to provide a urine sample to your doctor to detect any possible infection that could happen post procedure. Other possible side effects could include blood in urine or inability to pass urine.

It's always advised to hydrate well post procedure to minimise the chase of any of these side effects post procedure.

As the procedure is performed under local anaesthetic, patients are always invited to watch the findings or be provided with photos or video of the procedure if required. The clinician performing the procedure will explain the findings immediately after the procedure. The patient will also be provided with a procedure report which will contain all relevant findings and a copy will be sent to the caring general practitioner if applicable.

In cases where biopsies are taken, these results will take a few days while the histopathology laboratory analyses the results.