Rigid Cystoscopy

What does this procedure involve?

Cystoscopy involves inspection of the bladder and urethra with a telescope passed along the penis in men or through the urethra (waterpipe) in women. Occasionally, we may take a small biopsy of an abnormal area and cauterise the biopsy site.

What are the alternatives?

Flexible cystoscopy – a similar procedure, but performed under local anaesthetic with a flexible (bendy) instrument
Observation – no treatment, but monitoring of any change in your symptoms over a period of time

What happens on the day of the procedure?

Your urologist (or a member of their team) will briefly review your history and medications, and will discuss the surgery again with you to confirm your consent.

An anaesthetist will see you to discuss the options of a general anaesthetic or spinal anaesthetic. The anaesthetist will also discuss pain relief after the procedure with you.

We may provide you with a pair of TED stockings to wear, and we may give you a heparin injection to thin your blood. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.

Details of the procedure

We normally use either a general anaesthetic (where you will be asleep) or a spinal anaesthetic (where you will be unable to feel anything from the waist down)
We may give you an injection of antibiotics before the procedure, after you have been checked for any allergies
We put a telescope into your bladder through the urethra (waterpipe) to inspect the interior of your bladder (pictured)
We may take small biopsies from any abnormal areas and cauterise the biopsy sites to stop any bleeding
Occasionally, we put in a bladder catheter which is removed subsequently; this is more likely if we have taken biopsies
Most patients go home on the same day as their procedure, provided they have passed urine satisfactorily

Are there any after-effects?

The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed very rare after-effects (occurring in less than 1 in 250 patients) individually. The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual:

After-effect	Risk
Mild burning on passing urine for a short time after the procedure	Almost all patients
Bleeding for a few days after the procedure	Between 1 in 2 & 1 in 10 patients
Infection of the bladder requiring antibiotic treatment	Between 1 in 2 & 1 in 10 patients
Temporary insertion of a bladder catheter	Between 1 in 10 & 1 in 50 patients
Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)	Between 1 in 50 & 1 in 250 patients (your anaesthetist can estimate your individual risk)

What is my risk of a hospital-acquired infection?

Your risk of getting an infection in hospital is between 4 & 6%; this includes getting MRSA or a Clostridium difficile bowel infection. This figure is higher if you are in a “high-risk” group of patients such as patients who have had:

Long-term drainage tubes (e.g. catheters);
Long hospital stays; or
Multiple hospital admissions.

What can I expect when I get home?

You will be given advice about your recovery at home
You will be given a copy of your discharge summary and a copy will also be sent to your GP
Any antibiotics or other tablets you may need will be arranged & dispensed from the hospital pharmacy
You should drink twice as much fluid as you would normally for the first 24 to 48 hours, to flush your system through and reduce the risk of infection
You may return to work when you are comfortable enough and when your GP is satisfied with your progress
If you develop a fever, frequent passage of urine, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately.

General information about surgical procedures

Before your procedure

Please tell a member of the medical team if you have:

An implanted foreign body (stent, joint replacement, pacemaker, heart valve, blood vessel graft);
A regular prescription for a blood thinning agent (warfarin, aspirin, clopidogrel, rivaroxaban or dabigatran);
A present or previous MRSA infection; or
A high risk of variant-CJD (e.g. if you have had a corneal transplant, a neurosurgical dural transplant or human growth hormone treatment).

Questions you may wish to ask

If you wish to learn more about what will happen, you can find a list of suggested questions called “Having An Operation” on the website of the Royal College of Surgeons of England. You may also wish to ask your surgeon for his/her personal results and experience with this procedure.

Before you go home

We will tell you how the procedure went and you should:

Make sure you understand what has been done;
Ask the surgeon if everything went as planned;
Let the staff know if you have any discomfort;
Ask what you can (and cannot) do at home;
Make sure you know what happens next; and
Ask when you can return to normal activities.

We will give you advice about what to look out for when you get home. Your surgeon or nurse will also give you details of who to contact, and how to contact them, in the event of problems.

Smoking and surgery

Ideally, we would prefer you to stop smoking before any procedure. Smoking can worsen some urological conditions and makes complications more likely after surgery. For advice on stopping, you can:

Contact your GP;
Access your local NHS Smoking Help Online; or
Ring the free NHS Smoking Helpline on 0300 123 1044.

Driving after surgery

It is your responsibility to make sure you are fit to drive after any surgical procedure. You only need to contact the DVLA if your ability to drive is likely to be affected for more than three months. If it is, you should check with your insurance company before driving again.