Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 10 September 2026
Of all the tests in urology, cystoscopy is the one people worry about most before it happens and think least about afterwards. It is a short examination that looks directly inside the bladder — and for questions like "is there a tumour causing this bleeding?", nothing else answers as definitively.
This guide explains why a cystoscopy is recommended, the difference between the flexible and rigid versions, exactly what happens on the day, what it feels like, and what to expect afterwards under the care of Dr Brendan Dias in Melbourne.
What Is a Cystoscopy?
A cystoscopy is an inspection of the urethra and bladder using a cystoscope — a narrow telescope with a camera and light at its tip. The scope is passed along the urethra into the bladder, which is gently filled with sterile fluid so the entire lining can be seen on a monitor.
It is a direct visual examination. Ultrasound and CT can suggest a problem in the bladder; cystoscopy shows it. More information about the procedure at our practice is on the cystoscopy service page.
Why a Cystoscopy Is Recommended
- Blood in the urine — visible or microscopic. This is the single most common indication, because cystoscopy is the only reliable way to exclude a bladder tumour
- Recurrent urinary tract infections — looking for stones, diverticula, poor emptying or an underlying abnormality
- Bladder cancer surveillance — regular checks after treatment for a previous bladder tumour
- Lower urinary tract symptoms — assessing the prostate and bladder neck before treatment for an enlarged prostate
- Suspected bladder stones or a foreign body
- Urethral stricture — confirming the site and length of a narrowing
- Painful bladder or persistent urgency not explained by other tests
- Stent changes and follow-up after stone or reconstructive surgery
Flexible vs Rigid Cystoscopy
| Feature | Flexible cystoscopy | Rigid cystoscopy |
|---|---|---|
| Anaesthetic | Local anaesthetic gel only | General or spinal anaesthetic |
| Where | Consulting rooms or day unit | Hospital operating theatre |
| Duration | 5–10 minutes | 15–30 minutes plus recovery |
| Main purpose | Diagnosis and surveillance | Treatment — biopsy, resection, stones, stents |
| Driving afterwards | Usually yes | No — you need an escort |
| Back to normal | Same day | 1–3 days, depending on what was done |
Preparing for Your Cystoscopy
- Urine test first — a sample is checked for infection, since cystoscopy is postponed if there is an active UTI
- Medication — tell the rooms if you take warfarin, apixaban, rivaroxaban, clopidogrel or similar. Blood thinners rarely need stopping for a flexible cystoscopy but often do for a rigid one
- Eating and drinking — normal before a flexible cystoscopy; fasting instructions apply for anything under anaesthetic
- Antibiotics — a single preventive dose is given in selected cases, not routinely
- Transport — you can usually drive yourself home after a flexible cystoscopy
What Happens During a Flexible Cystoscopy
- You empty your bladder and change into a gown, lying on your back on the couch
- The area is cleaned and local anaesthetic gel is instilled into the urethra; it needs a few minutes to work
- The flexible scope is passed slowly along the urethra into the bladder
- Sterile fluid fills the bladder so the lining can be inspected fully — this produces a feeling of needing to pass urine
- The whole lining, the ureteric openings and, in men, the prostate and bladder neck are inspected
- Small biopsies can occasionally be taken through the scope
- The scope is withdrawn and you pass urine before going home
You can watch the monitor if you wish, and Dr Dias will usually tell you what he is seeing as he goes. Most people find the anticipation worse than the reality — the uncomfortable part lasts seconds, not minutes.
After the Procedure
Normal and expected for the first 24–48 hours:
- Stinging or burning when passing urine, easing with each void
- Pink-tinged urine, particularly if a biopsy was taken
- Needing to pass urine a little more often
- Mild lower abdominal ache
Drinking plenty of water dilutes the urine and settles the stinging faster. Simple analgesia is enough for most people. Avoid strenuous exercise for 24 hours after a flexible cystoscopy, and longer if a treatment was performed.
When to Seek Medical Help
- Fever above 38°C or shaking chills — the main sign of infection after cystoscopy
- Heavy bleeding, or blood clots in the urine
- Inability to pass urine at all — this needs urgent attention
- Pain that worsens rather than improves after the first day
Results and What Comes Next
Because it is a direct visual examination, the findings of a flexible cystoscopy are known immediately and discussed with you before you leave. Where biopsies were taken, histology results take around one week and are reviewed at a follow-up appointment.
A normal cystoscopy in someone investigated for haematuria is a genuinely reassuring result and, combined with normal imaging, usually completes the assessment. Where an abnormality is found — a tumour, stone, stricture or an obstructing prostate — the cystoscopy defines it precisely, and the treatment plan follows from what was seen.
Frequently Asked Questions
What is a cystoscopy?
A cystoscopy is an examination of the inside of the bladder and urethra using a thin telescope called a cystoscope, passed along the urethra. It is the definitive test for looking directly at the bladder lining and is used to investigate blood in the urine, recurrent infections, bladder symptoms and to follow up bladder cancer.
Is a cystoscopy painful?
A flexible cystoscopy is uncomfortable rather than painful for most people. Local anaesthetic gel is instilled into the urethra beforehand, and the examination itself takes only a few minutes. Men commonly feel a brief stinging as the scope passes the prostate. Rigid cystoscopy is performed under general or spinal anaesthetic, so nothing is felt during the procedure.
How long does a cystoscopy take?
The examination itself usually takes five to ten minutes for a flexible cystoscopy. Allow about an hour in the rooms for preparation, the local anaesthetic to work, the procedure and a short recovery. A rigid cystoscopy under anaesthetic takes 15 to 30 minutes plus recovery time in hospital.
What is the difference between flexible and rigid cystoscopy?
Flexible cystoscopy uses a thin bendable scope under local anaesthetic in the consulting rooms and is used for diagnosis and surveillance. Rigid cystoscopy uses a straight scope under general or spinal anaesthetic in theatre, gives a wider working channel, and allows treatment such as biopsy, tumour resection, stone removal or stent changes at the same time.
What can I expect after a cystoscopy?
Mild stinging when passing urine and some pink discolouration of the urine are normal for 24 to 48 hours. Drinking plenty of water helps. You should contact your doctor if you develop fever or chills, heavy bleeding with clots, inability to pass urine, or worsening pain after the first day.
Do I need to prepare for a cystoscopy?
For a flexible cystoscopy you can eat and drink normally and can usually drive yourself home. A urine sample is checked beforehand to make sure there is no active infection. Tell the rooms if you take blood-thinning medication. For a rigid cystoscopy under anaesthetic you will be given fasting instructions and will need someone to drive you home.
Why has my GP referred me for a cystoscopy?
The most common reason is blood in the urine, whether visible or found on a urine test, because a cystoscopy is the only way to reliably exclude a bladder tumour. Other reasons include recurrent urinary infections, persistent urinary symptoms, suspected bladder stones, a urethral stricture, or surveillance after previous bladder cancer.
The Bottom Line
A flexible cystoscopy is a five to ten minute examination performed with local anaesthetic that answers questions no scan can. Mild stinging and pink urine for a day or two is the usual extent of it, and the findings are known straight away.
Dr Dias performs flexible cystoscopy across Melbourne's western and northern suburbs, and referrals are seen within two weeks. Ask your GP for a referral, or contact the rooms.