A flexible cystoscope is a thin, flexible scope about as thick as a pencil. It has a fibre-optic tip that enables your doctor to see the inside of your bladder on a video screen. Because it’s flexible it can easily pass along the curves of your urethra. It’s generally used to help make a diagnosis or to see if a previous treatment has been successful.
A rigid cystoscope is a thin, solid instrument. Using a rigid endoscope enables the surgeon to see inside your bladder, use instruments to take biopsies (tissue samples) and carry out procedures. These may include destroying tumours with heat (diathermy), crushing and/or removing bladder stones, repairing bleeding vessels, removing an obstruction or treating bleeding. Because the instrument isn’t flexible, it can be uncomfortable, particularly in men and so you’ll probably be given a spinal or general anaesthetic.
If you have a suprapubic catheter in place due to problems with your bladder, the doctor may perform the cystoscopy through the suprapubic opening.
Flexible or rigid cystoscopy, which is best for you?
Both types of cystoscopy can be used to see the inside of your bladder.
Your doctor will probably recommend flexible cystoscopy for simple viewing and diagnostic procedures. As the discomfort is usually minimal, it’s normally done as a day procedure under local anaesthetic. You may also be able to watch on the video screen. It’s generally only useful for diagnosis, not treatment.
If you’re not having sedation with the local anaesthetic, you won’t need to fast and you’ll most likely be able to go home or back to work shortly afterwards. The disadvantage is, that depending on the results, you may need to come back for a rigid cystoscopy.
If your doctor wants to do a rigid cystoscopy, it’s probably because you need a procedure that can’t be performed with a flexible scope e.g. resecting a tumour. Rigid cystoscopy normally requires a spinal or general anaesthetic, so you won’t be able to drive afterwards and you’ll need to wait until the effects have worn off before going home. You’ll also need someone to accompany you home.