Flexible cystoscopy: the indications

Last updated: April 29, 2026

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Another service that patients more likely requested to do is “Flexible cystoscopy”. Before talking anything about that, let’s dive in its history first. The first truly function cystoscopy was invented in 1878 by Carl-Friedrich Nitze and Leiter, at that time, it is called “Rigid cystoscopy” its shape is solid couldn’t flex or curving by the urethral anatomy, so it was really pain when access the Rigid cystoscopy in awaked patient.

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That’s why the Flexible cystoscopy was invented in 1973 by Tsushida and Sugawara from the maturity in fiber optic technology. The Flexible cystoscopy is smaller diameter (size of drinking straw) and it is be able to curve follow by the urethral anatomy which make less discomfort leading us very compromised to access when patient awake under local anesthesia with urethral pain killer gel.

Indications of Flexible cystoscopy

1. Surveillance bladder and urethra for any abnormal anatomy lesions.
2. Evaluation the cause of bloody urination, voiding dysfunction, fistula-related issues, or any congenital anomalies.
3. Diagnosis of urethra or bladder neck stricture.
4. Urethral assessment for any suspected anomalies.
5. Ureteral stent removal.
6. Intraoperative assessment to facilitate ureteroscopy procedure smoother.

What should have done before accessing the Flexible cystoscopy?

• Tell your urologist for all your medical history and current medications.
• If you are currently taking any blood thinner medication – You must tell urologist in advance for any consideration of holding such medications due to risk of bleeding during the procedure.

What will happen during Flexible cystoscopy?

1. You will be placed with a supine position (lie on your back normally).
2. The urologist will clean your perineum with antiseptic agent.
3. The urologist will lubricate your urethra with pain killer gel for 10 minutes before starting the procedure.
4. Flexible cystoscopy will insert along the urethra, prostate, and bladder under visualization.
5. Lower urinary tract anatomy details will be carefully documented.
6. Totally the procedure should be completed within 5 minutes – requires experienced urologist.

How about after the Flexible cystoscopy procedure?

• You will meet with urologist again for reassessing all details from the procedure.
• Patient will be discharged with oral antibiotic prescription for several days and pain killer as well.
• In case patient has to use blood thinning – can be restarted if no bleeding detected.

You can see that the Flexible cystoscopy technology makes our life better. Any questions, please talk to your trusted urologist, or it would be pleasure if you text me. Take care!

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Frequently Asked Questions

Q1: What is flexible cystoscopy and how is it different from rigid cystoscopy?

Flexible cystoscopy uses a thin, flexible scope that curves along the natural anatomy of the urethra, allowing examination of the bladder and urethra under local anesthesia in awake patients. Unlike rigid cystoscopy, which cannot bend and causes significant discomfort, flexible cystoscopy is well-tolerated and can be completed within 5 minutes by an experienced urologist.

Q2: What are the main indications for flexible cystoscopy?

Flexible cystoscopy is indicated for surveillance of the bladder and urethra for abnormal lesions, evaluation of bloody urination or voiding dysfunction, diagnosis of urethral or bladder neck stricture, ureteral stent removal, and intraoperative assessment to facilitate ureteroscopy. It is also used to evaluate fistulas and congenital anomalies.

Q3: Is flexible cystoscopy painful?

Flexible cystoscopy is generally well-tolerated with minimal discomfort. Before the procedure, the urologist applies anesthetic lubricating gel inside the urethra for approximately 10 minutes to reduce pain. The flexible scope follows the natural curve of the urethra, making it far more comfortable than rigid cystoscopy. Most patients tolerate the entire procedure with only mild discomfort.

Q4: How should I prepare for flexible cystoscopy?

Before flexible cystoscopy, inform your urologist of all current medications, especially blood thinners, as these may need to be temporarily stopped to reduce bleeding risk. No special diet preparation is required. The procedure is performed as an outpatient under local anesthesia, so you can typically return home the same day.

Q5: What happens after flexible cystoscopy?

After flexible cystoscopy, your urologist will review the findings and discuss the next management steps. You will be prescribed oral antibiotics for several days to prevent urinary tract infection, along with pain relief if needed. Mild urinary discomfort or light bloody urination may occur for a short time after the procedure.

If you require flexible cystoscopy or have concerns about your urinary health, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. Book a Consultation.

Disclaimer: This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medical treatment.