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Urology · London · 6 min read

Cystoscopy, flexible or rigid camera examination of the urethra and bladder - the gold-standard test for haematuria.

Cystoscopy is a camera examination of the urethra and bladder. Flexible cystoscopy is an office-based test under local anaesthetic. Rigid cystoscopy is performed in theatre under GA / spinal, usually combined with biopsy or TURBT.

A stethoscope on a clinical desk

Key facts

  • 01

    Definition

    Endoscopic examination of the urethra and bladder using a fine camera.

  • 02

    Flexible cystoscopy

    Office-based, performed under local anaesthetic gel - typically 5–10 minutes.

  • 03

    Rigid cystoscopy

    Theatre procedure under GA or spinal - usually combined with biopsy or TURBT.

  • 04

    First-line for haematuria

    The gold-standard test alongside CT urogram for visible blood in the urine.

  • 05

    Narrow-band imaging

    High-sensitivity NBI available to improve detection of subtle bladder lesions.

  • 06

    Modern outpatient surveillance

    The backbone of contemporary bladder-cancer follow-up pathways.

Indicative pricing

What a private cystoscopy costs in London.

Indicative ranges across UK private providers.

In short

£450–£850, with findings discussed the same day.

Scan type Indicative range
Flexible cystoscopy (outpatient, LA) £450–£850
Flexible cystoscopy + narrow-band imaging £600–£1,100
Rigid cystoscopy + biopsy (theatre, GA/spinal) £2,200–£3,800
Rigid cystoscopy + TURBT £4,500–£7,500
Surveillance flexible cystoscopy (post-TURBT) £450–£850
Haematuria clinic (US, cystoscopy, urine cytology) £900–£1,600

Prices vary by clinic, whether narrow-band imaging is added, and whether a rigid procedure and TURBT are needed.

Preparation & procedure

From consultation to findings - what happens, in order.

One consultant urologist from first message to report - often within days.

  1. 01

    Before

    Urology consultation

    A consultant urologist reviews your symptoms, imaging and haematuria work-up before booking.

  2. 02

    Before

    MSU check for infection

    A midstream urine sample is checked - cystoscopy is postponed if there is active infection.

  3. 03

    Before

    Antibiotic prophylaxis

    A single prophylactic dose is given for selected patients with risk factors, per BAUS guidance.

  4. 04

    On the day

    Local anaesthetic gel

    Lidocaine gel is instilled into the urethra a few minutes before the scope is passed.

  5. 05

    On the day

    Flexible scope inserted

    A fine, flexible camera is passed gently through the urethra into the bladder.

  6. 06

    On the day

    Full bladder inspection

    The urethra, prostatic urethra, trigone, ureteric orifices and bladder walls are systematically examined.

  7. 07

    After

    Findings documented

    Any suspicious lesion is photographed and, if indicated, biopsied or scheduled for rigid TURBT.

Typical end-to-end: 3–7 days. Urgent haematuria cases: same week.

What it shows

What a cystoscopy actually finds.

Cystoscopy answers a specific set of questions about the urethra, prostate and bladder - the findings that matter, in order.

  • Bladder tumour

    Papillary or sessile lesions on the bladder wall - the primary target of cystoscopy.

  • Carcinoma in situ (CIS)

    Flat, red, velvety mucosal patches - often subtle, and best seen with narrow-band imaging.

  • Urethral stricture

    Narrowing of the urethra causing obstructive lower-urinary-tract symptoms.

  • Prostatic urethra hypertrophy

    Enlargement of the prostatic urethra contributing to bladder outflow obstruction.

  • Bladder stones

    Calculi within the bladder - often secondary to outflow obstruction or retention.

  • Diverticulum

    Out-pouchings of the bladder wall, sometimes harbouring stones or tumours.

  • Trabeculation

    Thickened, ridged bladder wall - the endoscopic signature of chronic outflow obstruction.

  • Red flag: high-grade tumour or diffuse CIS - urgent TURBT and MDT pathway

    Any high-grade or muscle-invasive appearance is escalated straight to the uro-oncology MDT.

Next steps

What happens after the scope.

The concrete options - from reassurance and surveillance through to intravesical therapy and radical surgery.

  • Reassurance if normal

    A clear cystoscopy with normal urine cytology is genuinely reassuring - discharge or interval follow-up.

  • Repeat surveillance cystoscopy

    Serial flexible cystoscopy on the NICE-recommended NMIBC surveillance schedule.

  • Rigid cystoscopy + TURBT

    Transurethral resection of bladder tumour under GA - the definitive first-line treatment.

  • Intravesical BCG / mitomycin

    Instillation therapy for intermediate- and high-risk non-muscle-invasive bladder cancer.

  • Urethral dilatation / urethrotomy

    Endoscopic treatment of urethral strictures - dilatation or optical urethrotomy.

  • Bladder-stone lithotripsy

    Endoscopic fragmentation and clearance of bladder calculi.

  • Radical cystectomy

    Bladder removal with urinary diversion - for muscle-invasive or refractory high-risk disease.

  • MDT review for advanced disease

    Uro-oncology multidisciplinary planning for staging, systemic therapy and reconstruction.

Red flags & safety

When the scope changes the pathway.

Cystoscopy is very safe - the practical points are the findings that escalate to urgent care and the complications that need same-day review.

  • High-grade bladder tumour

    Any high-grade appearance is escalated to urgent TURBT and uro-oncology MDT review.

  • Carcinoma in situ

    Diffuse red, velvety mucosa on NBI mandates biopsy and MDT discussion.

  • Muscle-invasive disease

    Deep, sessile or solid tumours raise concern for muscle invasion - staging MRI and MDT follow.

  • Post-cystoscopy urosepsis

    Fever, rigors or systemic illness after cystoscopy is a same-day emergency - A&E, not the clinic.

  • Urethral injury

    Rare, but suspected if there is persistent frank haematuria or acute retention after the scope.

  • Post-op bleeding

    Ongoing visible bleeding, clot retention or falling haemoglobin after TURBT needs urgent urology review.

  • Recurrent haematuria despite normal cystoscopy

    Persistent bleeding still requires upper-tract imaging (CT urogram) and cytology - the bladder is not the whole story.

  • Suspected upper tract urothelial cancer

    Positive cytology with a normal bladder warrants CT urogram and ureteroscopy.

  • Post-TURBT chemical cystitis

    Marked frequency, urgency and pain after intravesical chemotherapy - supportive care and specialist review.

Reading your report

A cystoscopy report can look intimidating. It isn’t.

Whatever the finding, the report keeps to the same four parts.

A consultant urologist reviewing cystoscopy images on a clinical workstation at a UK private clinic

A quiet reminder

The report is written for your doctor, not for you - and that’s normal.

If anything is unclear, ask the reporting clinician to talk you through it before your follow-up.

  1. 01 Header

    Indication and history

    Your details, the reason for the scope, and the haematuria or LUTS history that shapes interpretation.

  2. 02 Technique

    Scope, anaesthetic, imaging mode

    Flexible or rigid, local vs GA, and whether white light, narrow-band or PDD was used.

  3. 03 Findings

    Urethra, prostate, bladder - wall by wall

    Systematic description of the urethra, prostatic urethra, trigone, ureteric orifices and each bladder wall.

  4. 04 Impression

    The conclusion: read this first

    Normal, benign, or tumour - with the concrete next step (surveillance, TURBT or MDT).

Recognised by major UK insurers

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Frequently asked

Common questions about cystoscopy.

Quick answers on flexible vs rigid, pain, cost, haematuria work-up and what happens next.

  • What does a cystoscopy show?

    A cystoscopy shows the inside of the urethra and bladder in real time. It is the gold-standard test for detecting bladder tumours, carcinoma in situ, urethral strictures, bladder stones, diverticula and the endoscopic signs of outflow obstruction.

  • What is the difference between flexible and rigid cystoscopy?

    Flexible cystoscopy uses a fine, bendable scope under local anaesthetic gel - it is an office-based test, takes 5–10 minutes and you go home immediately. Rigid cystoscopy uses a straight scope under general or spinal anaesthetic in theatre, and is almost always combined with a biopsy or TURBT.

  • Is cystoscopy painful?

    Flexible cystoscopy is uncomfortable rather than painful - the lidocaine gel numbs the urethra and most patients describe a strong urge to urinate rather than sharp pain. Rigid cystoscopy is performed asleep, so you feel nothing during the procedure.

  • How much does a private cystoscopy cost in London?

    Rigid cystoscopy with biopsy in theatre is £2,200–£3,800, and rigid cystoscopy with TURBT is £4,500–£7,500.

  • Why do I need a cystoscopy for haematuria?

    Visible blood in the urine is a red-flag symptom. NICE (NG2) recommends cystoscopy plus CT urogram as the first-line work-up for visible haematuria - the two tests together are the gold-standard rule-out for bladder and upper-tract urothelial cancer.

  • What happens after the cystoscopy?

    After flexible cystoscopy you go home immediately and can drive, eat and work as normal - expect mild stinging on urination for 24 hours. After rigid cystoscopy and TURBT you stay overnight with a catheter, and the histology report follows within 7–10 days.

Sources & further reading

Last reviewed 2026-07-30 · Next review 2027-07-30

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In practice, in London

What cystoscopy looks like on the ground in London

With cystoscopy, the London question is usually about report turnaround and the radiologist reading it - not whether the scan is available. The wait for cystoscopy on the NHS depends heavily on where you live and how urgently the referral is graded. Central and West London private clinics can normally book within a week, with imaging or a procedure slot to follow shortly after. It’s worth being honest about the reason for going private: usually it’s time, not a fundamentally different test.

Once you’re in the private system for cystoscopy, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different - one person on the other end of the phone, not a switchboard. For cystoscopy specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.

Honesty about expectations is part of the job. A private cystoscopy appointment in London won’t change the underlying medicine - the guidelines, the consultants, and the equipment are largely the same as on the NHS. What it changes is speed, continuity, and the amount of time you get to actually talk through the findings. Check that any consultant you see is on the GMC specialist register and that the facility is registered with the CQC.