Patient Information

Flexible Cystoscopy (including bladder Botox injections)


What is a Flexible Cystoscopy?

This is a telescopic inspection of the bladder and urethra (the tube that carries urine out of the body).

We do this to identify any abnormalities or problems. At the same time, we may take a biopsy (small sample) of the bladder or administer Botox injections to relax the bladder (Botox is a treatment an overactive bladder or urge incontinence).

Flexible Cystoscopy is an outpatient procedure. You will stay awake whilst it is carried out.

In a small number of cases, we may need to stretch your urethra to enable the cystoscope (small telescope) to be passed through.

What are the benefits of this procedure?

It helps us to find out if there are any problems or abnormalities in your bladder or urethra, or to treat symptoms of an overactive bladder. Without any type of cystoscopy to help us, we would rely on observation and discussion about your symptoms.

What are the alternatives to this procedure?

A Rigid Cystoscopy, which is a similar procedure but carried out under a general anaesthetic.

What are the possible after-effects or risks?

Common (1 in 10 patients):

For a short period after the procedure, mild burning or bleeding when passing urine.

Less common (up to 1 in 50 patients):

A urinary infection requiring treatment with antibiotics.

Rare (less often than 1 in 50 patients):

  • Continued bleeding after the procedure, or bleeding starts after internal scabs fall off (if biopsies have been taken). If this occurs, we may need to remove clots from the bladder or carry out a further procedure to stop the bleeding.
  • Injury to the urethra itself during the cystoscopy leading to abnormal scar tissue which may require additional treatment in the future.
  • If bleeding is heavy or you cannot pass urine, we may need to insert a temporary urinary catheter (a tube passed up the urethra and into the bladder) to drain urine and blood.

What do I have to do before the procedure?

 You are welcome to bring somebody with you for support

 You may eat and drink normally

 Please bring a list of any medicines you are taking with you.

What does a flexible cystoscopy involve?

  • The clinician carrying out the procedure review your symptoms to confirm that you still need the cystoscopy procedure.
  • You will be asked to sign a consent form and will have time to ask any questions.
  • You will be taken to a private area where you will be asked to provide a urine sample (to rule out possible infection) and asked to change into a hospital gown; a nurse will help you if required.
  • You will then go to a procedure room and assisted onto the examination couch.
  • The area around your urethra will be cleaned and a local anaesthetic gel applied to reduce any discomfort.
  • Once comfortable, a clinician who is trained for perform this procedure will pass a bendy cystoscope (tiny camera) into your urethra and into your bladder. You will be able to see the inside of your bladder on the screen if you wish.
  • Sterile water may be pumped into your bladder so your doctor or nurse can see inside it more clearly.
  • If you are having Botox injections or a biopsy needs to be carried out at the same time, small devices can be passed down the cystoscope for this purpose.
  • You may feel a desire to pass urine, but it should not be painful. If you do experience pain, please let your clinician know. The cystoscopy can be stopped at any point.
  • The procedure itself lasts approximately 10 to 15 minutes, however, the total time may be up to 45 minutes.

What happens afterwards?

  • You will be allowed home straight away.
  • You may prefer not to drive after the procedure especially if you have had bladder wall Botox injections.
  • You may pass some slightly bloodstained urine at first and this may sting a little.
  • Over the next 24 hours, try to drink plenty of non-alcoholic fluids to flush your urinary system. We suggest 2 to 3 litres (or 4 to 6 pints).
  • You may also be given a short course of antibiotics.

How long does it take to recover?

You can resume normal activities, including driving, when you feel ready and after any discomfort has passed.

What else should I look out for?

 If you develop a fever, increased bleeding, or pain when passing urine you should contact your GP or ring NHS 111.

 If you become unable to pass urine at all, you should go to the nearest Emergency Department (A&E).

Further appointments or treatments

Before you leave hospital (after your cystoscopy), we will speak to you about any other treatments or procedures you may need.

For more information

You can find our more information from:

  • Your GP
  • Your Urogynaecology Consultant when you see them next.
You can read about the procedure on the NHS website at www.nhs.uk/conditions/cystoscopy/ or scan this QR code with the camera on a smartphone or tablet.


Urogynaecology Team 0208 934 6407

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