Flexible cystoscopy - what does the examination look like and what to expect?

Content author: MD. Arthur Abbazov, urologist, andrologist · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Arthur Abbazov · Date of creation: 07/08/2026 · Date of review: 07/08/2026 · Updated: 07/08/2026

The article is of an educational nature and does not replace a urological consultation or qualification for the examination. Fever with chills, urinary retention, severe bleeding with clots, severe pain in the lower abdomen or lumbar region after cystoscopy require urgent contact with a doctor.

The most important information in short

• Flexible cystoscopy involves inserting a thin, flexible speculum with a camera through the urethra and viewing the inside of the urethra and the urinary bladder.
• This is an outpatient examination. They are usually performed under local anesthesia, in the form of a gel administered into the urethra.
• Just looking at the bladder usually takes a few minutes. The entire visit, including preparation and conversation, takes more time.
• The examination can be unpleasant and involves a feeling of pressure and pinching, but in most patients it is described as discomfort rather than severe pain.
• A flexible cystoscope is thinner and more flexible than a rigid one, so it is usually better tolerated during diagnostic examinations, especially in men.
• The most common reasons for cystoscopy are hematuria, suspected bladder lesions, surveillance after bladder cancer treatment, recurrent infections and persistent lower urinary tract symptoms.
• Cystoscopy shows the inside of the bladder in real time. No imaging test can fully replace it in the assessment of the bladder mucosa.
• For the first 24 hours after the examination, burning sensation when urinating, more frequent urgency and pink color of urine are normal.
• Fever with chills, urinary retention and severe bleeding with clots are symptoms that require contact with a doctor rather than waiting.
• After the diagnostic test, the patient usually goes home the same day and may return on his own if sedation is not used.

Find out more about the specialist

Doctor. Arthur Abbazov is a urologist and andrologist at Wyspa Medycyny Przyjaznej in Gdańsk. He deals with the diagnosis and treatment of diseases of the urogenital system, including hematuria, lower urinary tract symptoms, recurrent infections, and the qualification of patients for further urological diagnostics. He also conducts consultations in Russian.

Meet the doctor. Arthur Abbazova

What is flexible cystoscopy?

Cystoscopy is an endoscopic examination of the lower urinary tract. The urologist inserts a thin speculum with a camera and a light source through the urethral opening, and the image is displayed on the monitor. This allows you to view the urethra, bladder neck and the entire bladder mucosa from the inside.

The term "flexible" refers to the construction of the equipment. The flexible cystoscope has a movable, flexible tip that the doctor can control to fit the natural course of the urethra. This is an important difference, especially in men whose urethra is longer and has bends.

During the examination, the bladder is filled with sterile fluid. This is necessary for the bladder walls to expand and for the mucosa to be assessed. It is the filling of the bladder that is responsible for the characteristic feeling of urge to urinate that patients report most often.

When does a urologist order cystoscopy?

Cystoscopy is not a screening test and is not performed "just in case". It is ordered when a direct assessment of the inside of the bladder is needed, which cannot be replaced by ultrasound or tomography. The most common indications are:

• hematuria visible to the naked eye, even once,
• hematuria, i.e. blood in urine detected in a laboratory test, requiring explanation,
• suspicion of a lesion in the bladder in an imaging test,
• supervision after treatment of bladder cancer, carried out according to a set schedule,
• recurrent urinary tract infections without an identifiable cause,
• persistent lower urinary tract symptoms that do not respond to treatment,
• suspected urethral stricture,
• suspected bladder stones or foreign body,
• chronic bladder pain and suspected interstitial cystitis,
• assessment before or after planned urological surgery.

It is worth remembering one rule: hematuria always requires explanation, even if it occurred once and disappeared on its own. When the bleeding stops, it does not mean that the cause has disappeared.

Flexible and rigid cystoscopy – what is the difference?

Patients often hear both terms and do not know which applies to them. The choice depends primarily on the purpose of the study.

In practice, this means that if the goal is to view the bladder and possibly take a small sample, a flexible cystoscope is usually chosen. If removal of the lesion, crushing of the stone or other procedure is planned, rigid equipment and other anesthesia are needed.

How to prepare for flexible cystoscopy?

Preparation is simple, but there are a few things you shouldn't skip. Detailed recommendations are always provided by the center performing the test, as they may vary.

• Urine test. They are usually performed before cystoscopy to rule out active infection. Active infection is usually the reason for postponing the test.
• Anticoagulant and antiplatelet drugs. Tell your doctor if you are taking them. The decision about possible modification is made by the doctor, never by the patient himself.
• Allergies. Report allergies, including local anesthetics and latex.
• Chronic diseases and implanted devices. Tell us about diabetes, reduced immunity, artificial valves, prostheses and previous urological surgeries.
• Meal. When examining under local anesthesia, you usually do not need to fast, unless the center advises otherwise.
• Bladder. Most often, you are asked to urinate just before the test.
• Documentation. Take the results of previous tests: ultrasound, tomography, previous cystoscopies and histopathological results.
• Back home. After the examination under local anesthesia, you can usually return on your own. If sedation is planned, an accompanying person is needed.

Step-by-step examination procedure

Most anxiety comes from not knowing what exactly will happen. Below is a typical course of flexible cystoscopy performed for diagnostic purposes.

The examination of the bladder usually takes a few minutes. It takes much more time to prepare, wait for the gel to work and talk after the test.

Does cystoscopy hurt?

This question is asked most often and deserves an honest answer. Flexible cystoscopy is not a patient-friendly test, but most people describe it as discomfort rather than severe pain. The anesthetic gel significantly reduces the symptoms, although it does not eliminate them completely.

There are usually two moments that are most noticeable: the insertion of the speculum through the urethra and the increasing pressure as the bladder fills. Both are short-lived. Patients most often describe it as pinching, pressure and a strong urge to urinate.

In men, the urethra is longer and has natural bends, so the examination may be more noticeable than in women. Previous treatments, urethral narrowing, inflammation and muscle tension also play a role. The more tense the patient is, the technically more difficult it is to insert the speculum, so calm breathing really helps.

If pain occurs during the examination, it must be reported immediately. The doctor may slow down, adjust the technique, or stop the examination. In selected situations, such as high anxiety, significant urethral narrowing or difficult anatomy, sedation or examination under general anesthesia is considered.

What does the doctor see during cystoscopy?

Cystoscopy provides an image in real time, so it allows you to assess things that cannot be seen in imaging tests. The urologist assesses, among others:

• the patency and appearance of the urethra, including possible strictures,
• in men the appearance of the prostatic section of the urethra and the degree to which the enlarged prostate narrows the outflow of urine,
• the condition of the bladder mucosa: redness, swelling, ulcers, inflammatory changes,
• the presence of papillary or flat lesions suspected of cancer,
• trabeculation of the bladder wall, typical of chronic obstruction of urine outflow,
• bladder diverticula,
• deposits, clots and foreign bodies,
• ureteral openings and the way urine flows out of them.

If necessary, a small sample can be taken through the working channel of the cystoscope for histopathological examination. Then the final result is known only after the material is assessed by a pathologist, and not on the day of the examination.

What happens after the test?

After diagnostic cystoscopy, the patient can usually urinate immediately and after a short observation he returns home. During the first 24 hours, the following are typical and expected:

• burning or stinging when urinating,
• more frequent urination and a feeling of urgency,
• pink color of urine or a small amount of blood,
• feeling of discomfort in the lower abdomen.

Symptoms usually disappear gradually. Drinking more water helps, as it dilutes the urine and shortens the contact of irritating urine with the mucous membranes. Unless your doctor tells you otherwise, you can usually return to normal activities the same day or the next day. Recommendations regarding intercourse, physical exercise and possible medications are provided by the doctor performing the examination.

When should you urgently contact a doctor after cystoscopy?

Cystoscopy is an invasive test, so despite the principles of sterility, complications are possible. Most are mild and transient, but some symptoms should not wait:

• fever above 38 degrees or chills,
• inability to urinate despite a strong urge,
• severe bleeding, dark red urine or urine with clots,
• severe, increasing pain in the lower abdomen,
• pain in the lumbar region with fever,
• purulent or foul-smelling discharge from the urethra,
• burning sensation and frequent urination lasting longer than two or three days,
• deterioration of the general condition, weakness, confusion, especially in the elderly and people with reduced immunity.

The most common complication is urinary tract infection. Urinary retention, severe hematuria and urethral injury occur less frequently. The risk is greater in patients with weakened immunity, diabetes, urethral stenosis and after previous urological procedures.

The most common myths about cystoscopy

• "Cystoscopy is always a procedure in the operating room." No. Flexible cystoscopy for diagnostic purposes is usually an outpatient examination under local anesthesia.
• "Since the ultrasound showed nothing, cystoscopy is unnecessary." No. Ultrasound does not reliably assess the entire bladder mucosa and may not reveal flat or small lesions.
• "A cystoscopy means the doctor suspects cancer." Not always. There are many indications: strictures, urolithiasis, recurrent infections, post-treatment assessment, persistent symptoms.
• "Since the bleeding has stopped, there is no need to do anything." No. Removal of hematuria does not remove the cause. Hematuria always requires explanation.
• "This test is for men only." No. Cystoscopy is performed in both sexes. In women, the urethra is shorter, so the examination is better tolerated.
• "After cystoscopy you have to stay in bed for a few days." No. After the diagnostic test, most patients return to normal activities the same day or the next day.
• "Blood in your urine after the test means something went wrong." No. Pink color of urine for the first 24 hours is typical. What is worrying is the increased bleeding with clots.
• "It takes a few weeks to get the results." No. The doctor knows the cystoscopy image immediately. You only have to wait for histopathology if a biopsy has been taken.

Do you have blood in your urine, recurrent infections or a referral for cystoscopy?

A urological consultation allows you to determine whether the test is necessary in your case, how to prepare for it and what to do next with the results.

Urological diagnostics at the Island of Friendly Medicine in Gdańsk

In the Island of Friendly Medicine, Dr. Arthur Abbazov consults patients with hematuria, recurrent urinary tract infections, lower urinary tract symptoms and test results that require discussion. During the consultation, it is determined whether cystoscopy is needed, what tests should precede it and how to prepare the patient for further treatment.

If the patient has already had cystoscopy performed, the visit is intended to discuss the results and plan next steps: observation, treatment, control or referral to the center performing the procedure. The current scope of tests performed on site, doctor availability and prices must be confirmed during registration.

Find out more about the medicine. Arthur Abbazov Urological consultation Difficulty in peeing

What to ask the urologist before cystoscopy?

• Why do I need cystoscopy?
• Will the examination be performed with a flexible or rigid cystoscope?
• What anesthesia will be used?
• Should I stop or modify my anticoagulants?
• Is a urine test or culture needed before the test?
• Will I receive antibiotics as a preventive measure?
• How long will the examination and the entire visit take?
• Will the sample be taken and when will I know the result?
• Can I go home on my own?
• What symptoms after the examination are normal and what are not?
• When can I return to work, exercise and intercourse?
• When to go for a check-up and what number to call in case of disturbing symptoms?

FAQ - Flexible cystoscopy

What is flexible cystoscopy?

This is an endoscopic examination in which the urologist inserts a thin, flexible speculum with a camera through the urethra and examines the urethra and urinary bladder from the inside. They are usually performed on an outpatient basis, under local anesthesia.

How long does cystoscopy take?

Just looking at the bladder usually takes a few minutes. The entire visit, including preparation, waiting for the anesthetic gel to work and the conversation after the examination, usually takes significantly more time.

Does cystoscopy hurt?

The examination can be unpleasant. The most noticeable sensations are the insertion of the speculum and the feeling of pressure when filling the bladder. The anesthetic gel reduces the symptoms, but does not eliminate them completely. You should immediately inform your doctor about any pain during the examination.

Do you have to fast?

When examining under local anesthesia, this is usually not necessary. If sedation or general anesthesia is planned, separate recommendations apply. The final guidelines are provided by the center performing the test.

Will I get antibiotics?

Not in every patient. Antibiotic prophylaxis is considered individually, depending on the risk factors for infection, urine test results and the type of planned procedure. The qualifying doctor decides.

Is blood in urine after cystoscopy normal?

Pink urine or a little blood in the first day is typical. What is worrying is severe bleeding, dark red or clotted urine, and the inability to urinate.

Can I drive a car after the test?

After the examination under local anesthesia, usually yes, as long as the patient feels well. After sedation or general anesthesia, driving is contraindicated and an accompanying person is needed.

Can ultrasound replace cystoscopy?

Not entirely. Ultrasound is a valuable and non-invasive test, but it does not reliably assess the entire bladder mucosa. Flat and small lesions may remain invisible, therefore cystoscopy remains a key examination in the case of hematuria.

When will I know the result?

The doctor evaluates the image from the examination on an ongoing basis, so the patient receives initial information immediately after cystoscopy. If a biopsy was taken, you must wait for the histopathological result according to the deadline given by the center.

Is cystoscopy performed in women?

Yes. The indications are similar to those in men: hematuria, recurrent infections, suspected bladder lesions, chronic bladder pain. In women, the urethra is shorter, so the examination is usually better tolerated.

How often is surveillance cystoscopy repeated?

The follow-up schedule after bladder cancer treatment depends on the risk level determined by the treating physician and is determined individually. Inspection dates should not be extended on your own.

Who qualifies for cystoscopy at WMP?

On the WMP website, doctor. Arthur Abbazov is described as a urologist and andrologist engaged in the diagnosis and treatment of diseases of the urogenital system. The urological consultation includes an assessment of the indications for the examination and a discussion of the results.

Sources

• Island of Friendly Medicine, MD. Arthur Abbazov: https://www.wyspamedycynyPrzyjaznej.pl/pl/artur-abazzov
• Island of Friendly Medicine, urological consultation: https://www.wyspamedycynyPrzyjaznej.pl/pl/konsultacja-urologiczna
• Island of Friendly Medicine, difficulties in peeing: https://www.wyspamedycynyPrzyjaznej.pl/pl/trudnosci-w-sikaniu
• Wyspa Medycyny Przyjaznej, urology: https://www.wyspamedycynyPrzyjaznej.pl/pl/urologia
• European Association of Urology, Non-muscle-invasive Bladder Cancer Guidelines: https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer
• European Association of Urology, Urological Infections Guidelines: https://uroweb.org/guidelines/urological-infections
• NICE, Suspected cancer: recognition and referral (NG12): https://www.nice.org.uk/guidance/ng12
• NICE, Bladder cancer: diagnosis and management (NG2): https://www.nice.org.uk/guidance/ng2
• NHS, Cystoscopy: https://www.nhs.uk/tests-and-treatments/cystoscopy/
• NHS, Blood in urine: https://www.nhs.uk/conditions/blood-in-urine/
• NIDDK, Cystoscopy and Ureteroscopy: https://www.niddk.nih.gov/health-information/diagnostic-tests/cystoscopy-ureteroscopy
• British Association of Urological Surgeons, information for patients: https://www.baus.org.uk/patients
• Patient.gov.pl, hematuria: https://pacjent.gov.pl/jakleczyc/krew-w-moczu