Cystoscopy

Cystoscopy is a look inside the urethra and bladder with a thin, lighted camera passed through the urethra. Most are done in the office with numbing gel, take about 5 minutes, and you go home right after.

Also called cysto, flexible cystoscopy, office cystoscopy, cystourethroscopy, rigid cystoscopy, surveillance cystoscopy, bladder scope, camera in the bladder

Where: Clinic procedure room
Anesthesia: Numbing gel in the urethra; you are awake
Time in the room: 2 to 5 minutes for the look itself; about 30 minutes in the office
Hospital stay: Go home right after
Back to normal: The same day or the next day
Back to work: The same day

See the steps

BladderUrethraBladder neckTumor

Where it happens. The highlighted part is what this procedure treats.

Overview

Cystoscopy lets your urologist look directly at the inside of your urethra (the tube that carries urine out of your body) and your bladder. A flexible cystoscope, a soft, bendable tube a little thinner than a pencil with a camera and light at its tip, is passed gently through the urethra into the bladder. The picture shows on a screen, and you can often watch.

Most cystoscopies are done in the office with numbing gel while you are awake. The look itself takes about 2 to 5 minutes. There are no cuts or stitches, and you can go back to your normal day.

It is the main test for finding the cause of blood in the urine and for checking for bladder cancer, because scans can miss small or flat growths on the bladder lining. People who have had bladder cancer have regular cystoscopies to catch any return early. It also helps explain urinary symptoms, repeated infections and a weak stream.

A rigid cystoscopy, with a straight metal scope, is done in the operating room under anesthesia when the urologist needs to take larger biopsies, remove a tumor, place a stent or treat a stone. This page focuses on the common office test.

The parts of your body involved

The bladder is a stretchy, muscular bag low in your pelvis that stores urine. Urine arrives from each kidney through a ureter, which opens into the bladder through a small slit called the ureteral orifice. The two openings and the bladder outlet form a triangle at the base called the trigone. Urine leaves through the bladder neck and the urethra. In men, the urethra is about 8 inches (20 centimeters) long and passes through the prostate and a ring of sphincter muscle, which can feel tight as the scope goes by. In women, the urethra is about 1.5 inches (4 centimeters) long, so the scope reaches the bladder almost at once. The bladder lining, called the urothelium, is where most bladder cancers start, which is why seeing it directly matters.

Urethra
The tube from the bladder to the outside. The scope enters here after numbing gel.
Prostate
In men, a gland just below the bladder that wraps around the urethra. Its shape can be seen as the scope passes.
Bladder neck
The outlet where the bladder joins the urethra.
Bladder lining
The smooth, pink inner surface. The urologist looks over all of it for growths, red patches, stones or pockets.
Ureter openings and trigone
The two small openings where urine enters from the kidneys, at the corners of the triangle at the base of the bladder.

Why it’s done

Cystoscopy answers questions that urine tests and scans cannot fully answer, because it lets your urologist see the lining of the bladder and urethra directly.

Blood in the urine
Visible blood in the urine, or blood found only under a microscope in people at higher risk, is usually checked with cystoscopy plus imaging of the kidneys. Age, smoking history and other factors guide who needs it.
Bladder cancer follow-up
After bladder cancer treatment, regular cystoscopies catch any return early, while it is small and easier to treat.
Repeated urinary infections
To look for a stone, a pouch in the bladder wall, a narrowing, or anything else that lets bacteria settle.
Trouble urinating
A weak stream, straining, or a stream that stops can come from a narrowed urethra or an enlarged prostate. Cystoscopy shows which, and helps plan treatment.
Bladder pain or ongoing symptoms
Pain, urgency or frequency that has not improved with treatment, to look for inflammation, stones or other causes.
Before or after other procedures
To plan prostate procedures, check healing after surgery, or remove a ureteral stent.

Other options

Urine tests for cancer cells or markers
These can add information, especially during bladder cancer follow-up, but they miss many tumors and do not replace looking.
Imaging scans
A CT scan or ultrasound shows the kidneys and ureters well but can miss small or flat growths in the bladder. For blood in the urine, imaging is often done along with cystoscopy.
Repeating the urine test
For people at low risk who have only microscopic blood, AUA guidelines allow repeating the urine test within about 6 months instead of going straight to cystoscopy, after a shared discussion with your urologist.
Cystoscopy under anesthesia
For people who cannot have the office test, or when a tumor needs to be removed, cystoscopy can be done asleep in the operating room.

Getting ready

Tick items off as you go. Your checklist is saved on this device only.

Days before

Medicines

Most people keep taking all their usual medicines, including blood thinners, for a simple office cystoscopy. Tell the team what you take in case a biopsy is planned.

Infection

If you have burning, fever or signs of a urine infection, call ahead. The test is usually postponed until an infection is treated.

Health history

Tell the team about heart valve problems, recent joint replacements, a weak immune system, or allergies to numbing medicine or latex.

The day of

Eat and drink normally

No fasting is needed for an office cystoscopy.

Driving

You can usually drive yourself, since no sedation is used.

A urine sample

You will be asked to urinate when you arrive. The sample is checked for infection before the scope.

In the exam room

Changing

You undress from the waist down and put on a gown. A sheet covers you except for the small area needed.

Position

Men usually lie flat on their back. Women usually lie on their back with knees bent and apart, or with legs in supports.

Questions

Ask anything before you start, including whether you can watch the screen. Some people find music helps them relax.

The procedure, step by step

Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.

YouScrub nurseVideo screen

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1. Getting comfortable

You lie on the exam table with a sheet over you. A nurse or assistant stays in the room. The scope and screen are set up beside the table.

You lie on the exam table with a sheet over you. A nurse or assistant stays in the room. The scope and screen are set up beside the table.
The opening of the urethra is cleaned with a cool antiseptic. Numbing gel is squeezed gently into the urethra and left for a few minutes. It can sting or feel cold for a moment.
More detail
The gel contains lidocaine, a numbing medicine, and also acts as a lubricant so the scope slides easily.
The flexible scope is guided slowly into the urethra while sterile water flows through it to open the way. You will feel pressure. In men, there can be a brief squeeze as the scope passes the sphincter muscle and prostate.
More detail
Breathing out slowly, or relaxing as if you were about to urinate, loosens the sphincter and lets the scope pass more easily.
On the screen, a healthy urethra looks like a pink tunnel. The urologist checks for narrowing from scar tissue on the way in.
In men, the scope passes through the prostate. An enlarged prostate looks like two lobes touching in the middle, like curtains drawn together. The urologist notes its length and shape. In women, this step is skipped because the urethra is short.
Water fills the bladder so its walls stretch smooth and every part can be seen. You will feel a growing urge to urinate. This is expected, and the water is drained at the end.
The urologist moves and bends the scope to look over the entire bladder lining, wall by wall. The tip can turn back on itself to see the area right around the bladder outlet.
More detail
A healthy lining is smooth and pale pink with fine blood vessels. The urologist looks for growths, red velvety patches, stones, pouches and signs of long-term strain such as ridges in the wall.
The two small openings where urine enters from the kidneys are checked. Often you can see a small squirt of urine come out of each one.
If the urologist sees a growth or an unusual patch, they will tell you what it looks like. A small biopsy can sometimes be taken through the scope in the office. Larger growths are usually removed later in the operating room.
More detail
A biopsy uses tiny forceps passed through the scope. It feels like a brief pinch or cramp. Some small, previously treated growths can also be sealed in the office with a laser or electric probe.
The scope is slowly withdrawn. The water may be drained through the scope, or you will be shown to the bathroom to empty your bladder. Most urologists tell you what they saw before you leave.

After the procedure

Right afterward

Your results
Your urologist usually explains what they saw right away. If a biopsy was taken, results often come back in about a week.
Urinating
You may be asked to urinate before you leave. The first time often burns and may be pink.
Antibiotic, if given
Some people get a single dose of antibiotic, especially those with risk factors for infection.
Heading home
You can dress and leave within minutes, and usually drive yourself.

At home

Burning
Burning when you urinate is common for 1 to 2 days and is usually worst the first few times.
Pink urine
A little blood for a day or two is normal, a bit more if a biopsy was taken.
Frequent urges
You may need to urinate more often for the rest of the day.
Drink extra
Drink a few extra glasses of water for a day or two to flush the bladder, unless you have been told to limit fluids.
Easing discomfort
Acetaminophen and a warm bath can help. Your urologist may suggest phenazopyridine for a day, which turns urine orange.
Activity, work and sex
Return to normal activity and work the same day. Sex is fine once you feel comfortable, usually within a day or two. After a biopsy, your urologist may ask you to avoid heavy exercise for a day or two.
Your follow-up plan
Make sure you know when your next visit or next cystoscopy is due, and how you will get biopsy results.

Recovery timeline

Minute 0
Numbing gel
A cool sting, then numbness after a few minutes.
Minutes 1 to 5
The look
Pressure as the scope passes, then a growing urge as the bladder fills.
Right after
First results
Your urologist usually tells you what they saw before you leave.
That evening
Burning and urges
Burning and pink urine are common. Drink extra water.
Days 1 to 2
Back to normal
Burning fades. Urine clears.
About 1 week
Biopsy results
If a biopsy was taken, results usually come back within about a week.
Months later
Your next check
After bladder cancer, repeat cystoscopies are often every 3 to 6 months at first, then less often. For other reasons, your urologist will tell you if another is needed.

What it feels like

Many people dread a cystoscopy more than they need to. Most say afterward that it was uncomfortable and a little embarrassing, but quick and easier than they expected.

The night before
Worry about pain and embarrassment, and for people with blood in the urine or a history of cancer, fear of what will be found.
What helpsWrite down your questions. Bring someone with you if it helps, even if they wait outside.
Undressing and lying down
Feeling exposed or embarrassed, especially with a new team.
What helpsAsk for a sheet or extra covering. The team does this every day and will keep you covered except for the small area needed.
The gel
A cold, slightly stinging feeling, then numbness.
What helpsTake a few slow breaths. Ask the team to give the gel a few minutes to work.
The scope passing
Pressure and a sense of fullness. Men often feel a brief tight squeeze near the base of the penis as the scope passes the sphincter and prostate.
What helpsBreathe out slowly and let your pelvic muscles go loose, as if you were about to urinate. Wiggling your toes can help you relax.
The bladder filling
A strong urge to urinate that can feel urgent. Some people worry they will leak.
What helpsRemind yourself that the water is supposed to be there and will be drained soon. Tell the team if it becomes too much.
Watching the screen
Some people find it interesting and reassuring to see their own bladder. Others prefer to look away.
What helpsChoose whatever feels better. Your urologist can point out what they are looking at.
The first time you urinate after
Burning at the tip of the urethra and pink urine, which can be startling.
What helpsDrink extra water. The burning is usually much better by the next day.
Hearing the results
Relief when all is normal. If something was found, worry and a lot of questions.
What helpsAsk what it looks like, what happens next, and when. Write it down or have someone with you to listen.

How well it works

A normal cystoscopy shows an open urethra, a smooth, pink bladder lining with fine blood vessels, and two normal ureter openings. Your urologist can usually tell you what they saw before you leave.

A normal result
For blood in the urine, a normal cystoscopy together with normal imaging is reassuring. Your urologist will advise whether any follow-up urine tests are needed.
Something found
A growth is usually removed and examined in the operating room with a procedure called TURBT. Other findings, such as a stone or a narrowing, have their own treatments.
Bladder cancer follow-up
Your schedule depends on the risk level of your tumor. Many people have cystoscopy every 3 to 6 months for the first 1 to 2 years, then every 6 to 12 months, then yearly.
Working with other tests
Cystoscopy is often combined with a CT scan or ultrasound of the kidneys, and sometimes with urine tests, to give a full picture.

Risks

Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.

Common

Burning with urinationMost people

For 1 to 2 days.

Pink urine

For a day or two, more if a biopsy was taken.

Frequent urges

For the rest of the day.

Less common

Urinary infection

Signs are burning that gets worse after 2 days, cloudy or foul-smelling urine, or fever. It is treated with antibiotics.

Feeling lightheaded during the test

Some people feel faint from nerves or discomfort. Lying still and breathing slowly helps, and the team will pause if needed.

Not able to finish in the office

If the urethra is narrow or the test is too uncomfortable, it may be finished under anesthesia on another day.

Rare

Unable to urinate afterward

Short-term trouble urinating, most often in men with a large prostate. A catheter may be needed for a short time.

Injury to the urethra or bladder

Very rare with a flexible scope.

Serious infection

A kidney or blood infection that needs prompt treatment.

Call your care team or go to the emergency room if

Fever of 101°F (38.3°C) or higher, or shaking chills
Burning that gets worse after 2 days or lasts more than 3 days
You cannot urinate, or your bladder feels full and painful
Bright red urine, clots, or bleeding that continues beyond 2 days
Pain in your side or back
Lower belly pain that acetaminophen does not ease

Questions to ask your surgeon

Why do I need this test, and what are you looking for?
Will it be done in the office with numbing gel, or under anesthesia?
Should I stop any of my medicines, including blood thinners?
Will I get an antibiotic?
Can I watch on the screen?
Will you take a biopsy if you see something?
When and how will I get my results?
Do I also need a CT scan, an ultrasound, or urine tests?
How often will I need cystoscopy in the future?

Words you may hear

Cystoscopy: A look inside the urethra and bladder with a thin camera.
Flexible cystoscope: A soft, bendable scope used for office cystoscopy with numbing gel.
Rigid cystoscope: A straight metal scope used in the operating room, usually under anesthesia.
Urethra: The tube that carries urine from the bladder to the outside.
Bladder neck: The outlet where the bladder joins the urethra.
Trigone: The triangle at the base of the bladder between the two ureter openings and the outlet.
Ureteral orifice: The small opening where a ureter brings urine from the kidney into the bladder.
Urothelium: The lining of the bladder, ureters and kidney drainage system, where most bladder cancers begin.
Hematuria: Blood in the urine, either visible or seen only under a microscope.
Lidocaine gel: A numbing gel placed in the urethra before the scope.
Biopsy: Taking a small piece of tissue to look at under a microscope.
Fulguration: Sealing or destroying a small area of tissue with an electric probe or laser.
Surveillance: Regular checkups to catch a cancer coming back early.
TURBT: Transurethral resection of bladder tumor: removing a bladder growth through a scope in the operating room.

Common questions

Does it hurt?

Most people describe it as uncomfortable rather than painful: a sting from the gel, pressure as the scope passes, and a strong urge to urinate while the bladder fills. Men often feel more pressure because the urethra is longer and passes the prostate. It is over in a few minutes.

Will I be asleep?

Not for an office cystoscopy. You are awake with numbing gel. If you need biopsies, tumor removal or other treatment, a rigid cystoscopy may be done under anesthesia in the operating room.

Can I drive myself home?

Yes, for an office cystoscopy without sedation.

Do I need antibiotics?

Not always. AUA guidance does not call for routine antibiotics for a simple office cystoscopy in healthy people. Your urologist may give one dose if you have risk factors for infection.

My CT scan was normal. Why do I still need a cystoscopy?

Scans show the kidneys and ureters well but can miss small or flat growths on the bladder lining. Looking directly is the most reliable way to check the bladder.

Can I have it during my period?

Usually yes. Let the team know, because blood can make the urine test harder to read.

How often will I need it after bladder cancer?

It depends on the risk level of your tumor. Many people have a cystoscopy every 3 to 6 months for the first 1 to 2 years, then less often, eventually once a year. Your urologist will set your schedule.

What happens if you find something?

Your urologist will explain what it looks like. Small areas may be biopsied in the office. A growth is usually removed in the operating room with a TURBT, which also gives the full diagnosis.

Sources this page draws on

American Urological Association and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, Microhematuria: AUA/SUFU Guideline (2020)
American Urological Association and Society of Urologic Oncology, Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline
American Urological Association, Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Cystoscopy & Ureteroscopy
Urology Care Foundation, Cystoscopy
MedlinePlus (U.S. National Library of Medicine), Cystoscopy

Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.