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Flexible cystoscopy

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What is a flexible cystoscopy? 

Visual inspection of the lining of the bladder or the urethra (the waterpipe) using a tool called a flexible cystoscope. This is a flexible tube with a camera at the end.

In some cases, we can also use the cystoscope to take biopsies of the lining of your bladder, remove ureteric stents (which we would have put in previously), or to place a difficult catheter (bladder drainage tube).

Why may I need a flexible cystoscopy?

Some urinary symptoms are because of problems in the bladder or the urethra. These symptoms may include blood in the urine (haematuria), recurrent infections, difficulty urinating (peeing), or pain. To investigate further your doctor may recommend a flexible cystoscopy.

If your doctor has previously inserted a ureteric stent, this can be removed using a flexible cystoscope.

We also sometimes use the flexible cystoscope to assess a prostate before considering a prostate operation.

What do I need to do before my test?

No special preparation is required. You can eat and drink normally, and you can drive before and after the test. There is no need to rest afterwards. You may need to provide a urine sample before your cystoscopy so we recommend coming to the appointment with a full bladder, ready to give a urine sample. Please arrive 15 minutes before your appointment time.

What happens before the test?

  • You may need to provide a urine sample to test for a urinary tract infection (UTI). Please tell the nurse if you have symptoms of a UTI such as a fever, rigors (shivering), pain when urinating (dysuria), or frequent urination (going often).
  • We will ask you to sign a consent form, confirming you understand the reasons for the test, the benefit, the alternatives, and the risks (explained on page 5).
  • You will lie on an examination couch, and we will ask you to partially undress - usually from the waist down.
  • Your genital area will be cleaned with a mild antiseptic liquid.
  • Sterile drapes will be used to keep the procedure as clean as possible.
  • A lubricating jelly will be inserted into your urethra.

What happens during the examination?

  • The doctor will pass the cystoscope through the urethra into your bladder.
  • The scope may be connected to a screen, allowing you to see inside your bladder if you wish.
  • There should not be much discomfort, but there can be feelings you are aware of.
  • Sterile water is run through the scope to fill the bladder which allows us to see things better. This may make you feel like you need to pass urine or are passing urine backwards.
  • If you cannot tolerate this test you can request to have a general anaesthetic (you will be asleep). This is unusual but is sometimes necessary.
  • The test takes about 5 minutes.
  • You may be given some antibiotics either before or following the test, which you should take as prescribed.
  • After the cystoscopy, you will be able to discuss the results with the clinician, and any further management that may be required. Therefore it can be useful for you to bring someone with you to this appointment.

Will there be any after effects?

  • Having burning or bleeding on passing urine is very common following the test. We advise you to increase your fluid intake to flush your bladder through. Drink 2-3 litres a day for 1-2 days (unless you have been told to restrict your fluid intake for medical reasons).
  • There is a risk of a urinary tract infection (UTI) following this test, which can be experienced by 1-2% of patients. Symptoms of a UTI may include abdominal pain, pain or difficulty passing urine, and fevers/shivers/shakes. If you develop these symptoms, seek urgent medical advice (for example from your GP).

If you need any further information about the procedure before your appointment, please contact the team.

Valuables

Please do not bring in valuables, jewellery, or large sums of money. If this is unavoidable, please ask a relative to take them home for you. The hospital cannot accept liability for the loss of personal items.

Urgent enquiries or emergencies 

If you have any concerns about your recovery in the first 24 hours after your procedure, please contact your GP for advice. In an emergency phone 999 or attend an Emergency Department. 

Who can I contact with general queries and concerns?

For general queries or concerns after your cystoscopy please contact us using the details below: 

References and sources of additional information

Patients | The British Association of Urological Surgeons Limited

Flexible cystoscopy ± biopsy or stent removal | The British Association of Urological Surgeons Limited

© North Bristol NHS Trust. This edition published September 2025. Review due September 2028. NBT002149.

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Important Information for Overseas Visitors: Understanding NHS Healthcare Charges

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At North Bristol NHS Trust, we are proud to provide high-quality care to all who need it.  And visitors from abroad can expect the same high standards. However, it’s important for overseas visitors to understand that not all NHS healthcare is free.

If you are not “ordinarily resident” in the UK, meaning you do not live here on a lawful and settled basis, you may be charged for some NHS services. This applies to visitors, tourists, former UK residents now living abroad, and some students or workers on short-term visas.

At North Bristol NHS Trust, we are committed to treating all patients with compassion and respect. Understanding your healthcare rights helps ensure a smooth and stress-free experience during your time in the UK.

Please visit the NHS England website to understand which of our services are free to overseas patients and find out more about NHS charges.

Assisted birth videos

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This page has a series of videos about having an assisted vaginal birth, including what they are, what to expect, and how to decide if an assisted birth is right for you. 

An overview of assisted vaginal birth

Assisted vaginal birth and you

Assisted vaginal birth and your baby

After an assisted vaginal birth

Where you can have an assisted birth 

Deciding if an assisted birth is right for you

Dr Shalini Janagan - Rheumatology

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GMC Number: 7822307

Year of first qualification: 2011, University of Colombo

Specialty: Rheumatology

Clinical interests: Metabolic bone disease, Young adult rheumatology and connective tissue diseases

Secretary: Jessica Goodwin

Telephone number: 0117 414 2849

Dr Shalini Janagan is involved in all aspects of adult rheumatology.

Dr Janagan has particular interests Metabolic bone disease, Young adult rheumatology and connective tissue disease.

She is a member of the British Society for Rheumatology and the Royal College of Physicians

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Janagan

Cellular Immunology / Immunophenotyping Laboratory

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Leukaemia and Non-Hodgkin Lymphoma Diagnosis and Monitoring

The laboratory provides a comprehensive service in the investigation of Leukaemia and Non-Hodgkin Lymphoma. Immunophenotyping provides additional information to morphology and cytogenetics in the diagnosis, classification and monitoring of these disorders.

HIV Monitoring
Immunophenotyping is used serially to monitor CD4 levels.

Investigation of Cellular Immunodeficiency Disease
Wrong choice of tests, especially in the paediatric setting, can mean rare cases of immunodeficiency are missed. Vital information includes type and site of infections, family history, other pathology results, X-rays and clinical features. Please refer to the Clinical Immunologists; ward or clinic referral is the ideal.

  • Immunophenotyping

Identifies numerical defects in lymphocyte subsets, inherited or acquired, and are indicated in cases with recurrent viral, fungal or mycobacterial infection.

  • PNH Testing

​PNH testing performed on peripheral blood samples looking for the absence of GPI-linked proteins on neutrophils, monocytes and red blood cells.

  • Functional Leucocyte Assays

These assays are technically complex and require prior discussion with the laboratory. Abnormalities are rare, most commonly due to poor sample quality, testing during drug therapy or intercurrent infection.  Abnormal findings should always be confirmed on a second sample.  True abnormalities may need further, more specialised tests to specify the disorder.

Lymphocyte function studies are indicated in cases of recurrent viral, fungal and mycobacterial infections in whom no numerical lymphocyte defect has been defined. The investigation provides a measure of lymphocyte activation. Lymphocytes are cultured for 5 days with mitogens which mimic antigen activation.

Neutrophil function studies screen for defects in the metabolic burst and adhesion molecules and are indicated in cases with recurrent fungal or bacterial infection with a normal neutrophil count (>1x109/1).A normal result excludes major defects in neutrophil function.

 

Quantiferon Assay

The QuantiFERON-TB test is an interferon gamma release assay (IGRA) used for the diagnosis of latent Tuberculosis (TB). The assay requires special blood tubes and has specific sample handling requirements. The laboratory can issue guidance and sample tubes to requestors. Interpretation of the result needs to be in the context of clinical history and other laboratory and clinical investigations.  The antigens used in the test are absent from all BCG vaccine strains of TB and from most known non-tuberculoid mycobacteria, it is possible to have a reactions to M. kansasii, M. szulgai and M. marinarum.  If such infections are suspected, alternative testing should be sought.

The QuantiFERON-TB test (and other TB IGRAs) may give false negative results in immunosuppressed patients. The laboratory provides a positive control tube for all tests to ensure the validity of results. Where the positive control fails (indeterminate result) the laboratory may suggest alternative testing. Please see guide below for interpreting indeterminate results.

Guide to interpretation

•    Negative: A negative result indicates that latent infection with M. tuberculosis is NOT likely. This result does NOT exclude active TB infection. The investigation of suspected active TB requires clinical, radiological and microbiological assessment.
•    Positive: A positive result is consistent with latent or active TB. This result may be due to exposure to M.tuberculosis complex (except M. bovis BCG), M. kansasii, M. szulgai or M. marinarum.  IGRA should not be used for the investigation of suspected active TB. The investigation of suspected active TB requires clinical, radiological, and microbiological assessment.
•    Indeterminate: The likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided. Please see the guide to interpreting indeterminate results below:

Quick guide to interpreting Indeterminate QuantifFERON-TB results:

An indeterminate result from the QuantiFERON-TB assay means that the likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided.

The majority of indeterminate results are caused by a low T lymphocyte response to mitogen stimulation (reported as mitogen tube failure).  
This can be caused by:

•    An insufficient number of T lymphocytes in the blood sample. Is the patient immunosuppressed?
•    A functional inability of the patient’s lymphocytes to generate Interferon-gamma (IFN-γ) in response to mitogenic stimulation, for example if they are taking drugs that supress their immune system.
•    Reduced lymphocyte function due to improper sample handling.

Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a mitogen tube failure is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved. 

Rarely a high background in the negative control (Nil) tube generates an indeterminate result. 
This can be caused by:

•    Excessive levels of circulating IFN-γ or the presence of heterophile antibodies in the sample. Stimulating the cells further as part of the QuantiFERON-TB test does not produce a further IFN-γ response.

Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a high background is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved.

Other causes of indeterminate results can include:

•    Incorrect filling/mixing of the Lithium Heparin or QuantiFERON-TB tubes.
•    If the time between venepuncture and sample incubation in the laboratory is greater than 16 hours.

These indeterminate samples should be repeated using the correct sampling and handling procedures.

For further information please see:

https://www.qiagen.com/gb/tb-testing/what-is-quantiferon/how-does-qft-work/quantiferon-tb-test-result-interpretation

Related links

Test Information

Sample vials for testing

Includes details of sample types, volumes, special precautions, turnaround times & reference ranges.

Cellular Immunology/Immunophenotyping Laboratory

MUUTO Delphi Study - Participant Information

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Participant Information

Development of best practice standards for the clinical management of patients presenting with Malignant Upper Urinary Tract Obstruction (MUUTO)

We are inviting you to participate in our research study. Before you decide, we would like you to understand why the research is being conducted and what it would involve for you. Thank you for reading through this information.

What is the purpose of the study?

In this study, we are aiming to develop consensus-driven standards for the diagnosis, treatment, and ongoing management of patients with malignant upper urinary tract obstruction (MUUTO).
 

MUUTO is a blockage in the upper part of their urinary tract that some cancer patients can experience. This blockage can occur when cancer presses on or grows into the tubes that carry urine from the kidneys to the bladder. Although it is not known how common MUUTO is, it’s often linked to deterioration of the patient’s condition. MUUTO can happen in many types of cancer. To help relieve symptoms and possibly improve survival, medical staff may use treatments to relieve the blockage. Procedures such as the insertion of a tube into the kidney (a nephrostomy) or a stent can help improve kidney function, ease pain, and treat infections. Despite its seriousness, there’s little clear guidance for medical staff on how best to manage MUUTO. Different medics and hospitals may handle it in different ways, with no agreed standard on when or how to treat it, or which patients would benefit most. This makes it hard for patients and families to make informed choices with their doctors. In order to address this, we plan to distribute a series of anonymous surveys to a panel of medical experts on MUUTO to gather their opinions about how best to manage the condition. It is anticipated that by using this method we will be able to reach agreement on best practices, and create clear, expert-backed guidelines for diagnosing and treating MUUTO. These guidelines will help medical staff to make better, more consistent decisions, and improve care for patients facing this complex condition.
 

The study will utilize the Delphi methodology, a structured process designed to achieve consensus among experts in the field, and often used in healthcare studies. Service users helped develop the research topic and what research questions should be asked.
By gathering insights from experienced clinicians, we aim to improve clinical care pathways and patient outcomes. Before you decide whether to participate, it is important to understand the purpose of the study, what your involvement will entail, and any potential risks or benefits.
 

Why have I been invited?

You have been selected as a participant because of your expertise in urology, oncology, radiology, nursing, or palliative care, with relevant experience in managing malignant upper urinary tract obstruction. Your contribution is vital to ensuring the recommendations are evidence-based, practical, and applicable to real-world clinical practice.

What will I have to do if I take part?

We will invite you to complete two online surveys, and attend a final face-to-face meeting. We will use the online survey platform Qualtrics to develop and distribute surveys, over approximately 1-3 rounds:
 

  • First survey (Round 1/R1): We will ask you to vote on the importance of statements regarding the management of MUUTO. We will also ask you to provide your perspective on questions about the management of MUUTO where there is uncertainty amongst clinicians. Finally, you will have the opportunity to provide further suggestions for the management of MUUTO that have not been included. This survey will take approximately 15-20 minutes to complete. The survey will remain open for 2 – 3 weeks and reminders will be sent to anyone who has not responded, to ensure timely participation. After the first round, we will collate responses, and statements that have not met the pre-determined consensus thresholds will be progressed to Round 2, along with summary results from R1.
  • Subsequent Rounds: For Round 2 you will have the opportunity to review anonymised summarized responses from the previous round. Also, we will invite you to consider statements that did not meet consensus criteria in R1, re-evaluate each statement's importance and relevance, and provide feedback where necessary.
  • Final face-to-face meeting: The final Delphi round will be a virtual face-to-face meeting. At this meeting you will have the opportunity to discuss any statements that have not met consensus criteria in previous rounds or that require further refinement; to ratify statements that met consensus criteria; and to develop recommendations for the way forward.

How long will the study last?

The study will last for approximately 6 months, and your involvement would last for approximately 3 months.

Who is organising this study?

The main sponsor for this study is North Bristol NHS Trust.

Are there any risks or benefits to participation?

There are minimal risks associated with participation. The primary risk is the time commitment required to complete the survey rounds. While there are no direct benefits to you as an individual participant, your insights will contribute to the development of improved clinical guidelines, ultimately enhancing patient care.

Is participation voluntary?

Your participation is entirely voluntary, and you may withdraw at any stage without providing a reason. Withdrawing will not affect your professional standing or any future interactions with the research team. If you withdraw from the study, we will keep and continue to use all your previously collected data. We will, however not collect any further data from you.

How will my data be handled?

Your responses will be treated confidentially and anonymized before analysis. Only members of the research team will have access to your data. Findings from the study may be published in peer-reviewed journals or presented at conferences, but no identifiable information will be disclosed. We may share anonymised information with others in the future. Dating sharing with other researchers is important to ensure that research is open to peer scrutiny, to optimise the use of good quality research data and to support policy and other decision-making. The Chief Investigator is the data custodian.

How will we use information about you?

We will need to use information from you for this research project. This information will include your name, location and email address.
People will use this information to do the research or to make sure that the research is being done properly. People who do not need to know who you are will not be able to see your name or contact details. Your data will have a code number instead. We will keep all information about you safe and secure. Once we have finished the study, we will keep some of the data so we can check the results. We will write our reports in a way that no-one can work out that you took part in the study, unless you have provided consent for this.

International Transfers

Your data will not be shared outside the UK.

What are your choices about how information is used?

You can stop being part of the study at any time, without giving a reason, but we will keep information about you that we already have. You have the right to ask us to remove, change or delete data we hold about you for the purposes of the study. We might not always be able to do this if it means we cannot use your data to do the research. If so, we will tell you why we cannot do this.

Where can you find out more about how your information is used?

You can find out more about how we use your information:
• by asking one of the research team;
• by sending an email to Helen Williamson (Head of Information Governance) at helen.e.williamson@nbt.nhs.uk, or
• by ringing us on 0117 4147934

What if there is a problem?

If you have a concern about any aspect of this study, you should ask to speak to the study researcher first who will do their best to answer your questions. If you wish to complain formally, you can do this through the National Health Service complaints procedure, using the Patient Advice and Liaison Service (PALS http://www.pals.nhs.uk/). Their contact number is 0117 414 4569. This study does not involve any tests or treatment and it is highly unlikely that you will be harmed during the research. If something does go wrong and this is due to someone’s negligence, then you may have grounds for legal action for compensation against the NHS or the trial’s sponsor organisation North Bristol NHS Trust. You may have to pay your legal costs. The normal NHS complaints mechanisms will always be available to you.

What will happen to the results of the research study?

The study results will be presented at research meetings, and published in scientific journals. We will also make the results widely available to the public. You will not be identified in any report or publication.

What do I do now?

If you wish to take part, please access the link to an online consent form. After completion of the consent form please proceed to the first survey. Thank you very much for considering taking part in our research.

Date: 23rd May 2025/V1
IRAS ID: 357641

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Following a low-fat diet for the management of chyle leak

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What is a chyle leak?

Chyle is a milky substance which is normally carried around the body in the lymphatic system. A chyle leak happens when surgery or injury causes damage to a lymphatic duct. Chyle collects in different parts of the body such as the chest or abdomen causing swelling.

Chyle is made up of fats, proteins, and other important nutrients. If a chyle leak is left untreated it could lead to large nutritional losses. Chyle leaks may require drainage or surgical repair if the leak cannot be managed by diet alone.

Nutritional management of chyle leak

The aim of dietary management is to reduce the flow of chyle to allow the damaged lymphatic duct to heal. A low-fat diet contains less than 10g total fat per day. Food labelling will help you calculate this.

Altering the fat content of your diet can significantly reduce lymphatic flow of chyle. Most of the fat in the diet is from Long Chain Triglycerides (LCT). Keeping LCT to a minimum will reduce chyle production.

Focus on Medium Chain Triglycerides (MCT) instead as these fats are absorbed directly into the bloodstream and do not trigger lymphatic flow. It is important to eat MCT fats to make sure you get enough calories.

The aim is to keep LCT fats low whilst eating enough MCT to meet your nutritional needs and maintain weight.

This is a temporary diet. If following a low-fat diet for more than two weeks you should take a multivitamin tablet daily. One teaspoon of sunflower or walnut oil should be consumed daily to make sure you have enough omega 3 and 6. This will contain fat but is fine while following this diet.

Foods you can eat and foods to avoid

Food typeFood allowedFood to avoid

Carbohydrates

(pasta, flour, bread, potatoes, cereals, rice)

  • Plain bread (white or brown)
  • Crumpets
  • Matzos
  • Rice
  • Rye
  • Cornflour
  • Frosties
  • Sugar Puffs
  • Special K
  • Rice Krispies
  • Weetabix (1)
  • Any pasta including tinned spaghetti
  • Rice
  • Rice noodles
  • Boiled, jacket, mashed potato (made with no butter and skimmed milk)

 

  • Seeded or nut bread
  • Thins
  • Soya flour
  • Oats
  • Bran
  • Semolina
  • Cereals with nuts and seeds
  • All bran
  • Muesli
  • Readybrek
  • Granola
  • Pasta cooked in cream/white/cheese sauces
  • Egg noodles
  • Crisps, chips, low fat crisps, roast potatoes, potato salad

 

Fats and oils
  • MCT oils
  • 1g/d of walnut or sunflower oil

 

  • All other fats or oils (olive, rapesee, coconut, vegetable, palm oil)

 

Fruit
  • Most fresh, tinned, frozen, or dried

 

  • Ackee
  • Avocado
  • Olives

 

Vegetables
  • Most fresh, tinned, frozen or salads
  • Pickles
  • Chutneys

 

  • Fried vegetables
  • Canned vegetables in oil
  • Salad dressings

 

Protein (meat, fish, poultry, meat alternatives, beans and pulses)
  • Cooked and thin slice of roast beef, ham, chicken or turkey. No skin (2 slices a day)
  • Quorn
  • Seitan
  • Egg white
  • Egg replacer
  • White fish (no skin)
  • Crab
  • Lobster
  • Prawns
  • Shrimps
  • Crab sticks
  • Tuna in brine/water
  • Peas (chickpeas, split peas)
  • Beans
  • Lentils

 

  • Fatty meats (low fat included)
  • Dark chicken or turkey meat
  • Chicken nuggets
  • Chicken in breadcrumbs or batter
  • Salami
  • Burger meat
  • Paste pate
  • Meat/fish/poultry pies
  • Tofu
  • Tempeh
  • Egg yolks
  • Oily fish
  • Tuna steak
  • Fish in breadcrumbs

 

Dairy products
  • Skimmed milk
  • Condensed skimmed milk
  • Meritine chocolate or strawberry shake made with skimmed milk
  • Very low fat yoghurt or fromage frais (<0.2g/100g)
  • Quark/fat free cottage cheese

 

  • Whole or semi-skimmed milk
  • Dried whole milk
  • Cream (single, double, clotted)
  • Full or low fat yoghurt
  • Ice cream
  • Cheese

 

Desserts and confectionary
  • Boiled and jelly sweets
  • Marshmallows
  • Turkish delight (not covered in chocolate)
  • Mint sweets
  • Wine gums
  • Jelly
  • Sorbet
  • Custard made with skimmed milk
  • Ice cream wafers
  • Chocolate
  • Toffee
  • Fudge
  • Butter mints
  • Milk puddings made with whole milk
  • Trifle
  • Cake
  • Gateaux
  • Pastries
Sauces
  • Tomato ketchup
  • Brown/soy/oyster/BBQ sauce
  • Marmite/Oxo/Bovril
  • Fat free dressings
  • Fat free mayonnaise
  • Low fat sauces (like sweet chilli)
  • Honey

 

  • Salad cream
  • Mayonnaise
  • Pesto
  • Oil and vinegar dressings
  • Gravy granules

 

Miscellaneous
  • Sugar
  • Jam
  • Marmalade
  • Herbs and spices
  • Salt and pepper
  • Baking powder
  • Vanilla essences
  • Vinegar
  • Rice cakes (plain)

 

  • Chocolate
  • Lemon curd
  • Chocolate/nut spreads
  • Nuts
  • Guacamole
  • Hummus
  • Cream based soups

 

Drinks
  • Fizzy drinks
  • Squash
  • Fruit juice
  • Skimmed milk (1 pint a day)
  • Milk shake flavourings
  • Tea and coffee (skimmed milk)
  • Alcohol (beer, wine, spirits)

 

  • Instant chocolate drinks (cocoa, Horlicks, Ovaltine, malt drinks)
  • Irish cream
  • Cream liquers

Food labels

Choose foods which are less than 0.5g of fat per serving. Remember that most of the fat in the diet is LCT and this will be called “total fat” on the nutrition label. Be aware of the portion size on the plate, it could be different to the suggested serving size on the label.

Meal ideas for in hospital

If you are an inpatient, request a review with a Dietitian to discuss the choices from the menu.

(The menu is changed twice a year).

Meal ideas for home

MealOptions (from the allowed list)
Breakfast
  • Low fat cereal
  • 2 x toast (white bread) with jam/honey (no butter)
Lunch
  • Sandwich (tuna and sweetcorn/slices meat and tomato)
  • Very low-fat yoghurt
  • Pot of jelly and fruit
Dinner
  • White pasta with chicken in a tomato sauce
  • Roasted vegetables (no oil) and couscous
  • Stir fry with rice
Dessert
  • Sorbet with ice-cream
  • Marshmallows
  • Tinned fruit with fromage frais
Snacks
  • Fruit
  • Crumpet
  • Cereal bar
  • Crackers and low-fat cheese
  • Rice cakes

Milk alternatives

Typekcal/100mlsFat/100mls
Oat milk502.1
Rice milk501.0
Potato milk573.0
Soy milk391.8
Coconut milk200.9
Pea milk350.9
Almond milk221.1
Cashew milk231,1
Peanut milk251.9
Flaxseed milk101.0
Full fat cow’s milk663.7
Semi skimmed cow’s milk501,8
Skimmed cow’s milk370.5

Nutritional Supplements might be advised or prescribed by either a Doctor or a Dietitian to help meet your nutritional requirements. Some of these supplements will be low fat or may contain MCT fat. A Dietitian will advise on what are suitable options.

When you are advised to stop this diet, it is recommended that you gradually re-introduce fat back at each mealtime. Continue to build up gradually until you are back to eating a normal amount for you.

© North Bristol NHS Trust. This edition published May 2025. Review due May 2028. NBT003547

Nutrition and Dietetics

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Find out about shared decision making at NBT. 

Urodynamics

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The Urodynamics Unit at the Bristol Urological Institute, Southmead Hospital is an internationally renowned centre for urodynamics. It is the largest in the UK, performing about 1000 urodynamic studies a year. 

The unit is one of the most research-active centres in urodynamics with a multidisciplinary team including Urologists, Uro-Gynaecologists, Physiotherapists, Clinical Scientists, Nurses and Urodynamic Technicians.

Urodynamic tests

The word ‘urodynamics’ covers a range of tests designed to show how your bladder is working. This leaflet includes:

  • Standard urodynamics.
  • Video urodynamics (X-rays taken).

Both tests are described in this leaflet, but your healthcare team will tell you which test you are having. You will only be referred for urodynamics if the doctor or nurse feels that the test is important in deciding how to manage your symptoms.

You do not have to have the test, but it will help the doctor diagnose the cause of your problem and offer you the best treatment for your symptoms. Currently, there are no alternatives available that will give us the information provided by the test.

Information on how to prepare for your test and what to expect both during and afterwards is given in this leaflet.

Standard urodynamics

You should allow at least 1 hour 15 minutes for the test. You can eat and drink as normal before the test, but we would like you to come with your bladder comfortably full.

If you are currently taking any of the below tablets for your bladder symptoms you will need to stop taking these 7 days before your test unless you have been told otherwise:

  • Vesicare/solifenacin.
  • Regurin/trospium chloride.
  • Detrusitol/tolterodine.
  • Oxybutynin.
  • Betmiga/mirabegron.

Please complete the three day bladder diary and the questionnaires sent with your appointment letter. You must bring both of them with you to the clinic.

Before the test, please let us know:

  • If you have any allergies, especially to latex.
  • If you have any problems with your mobility.
  • If you feel you may have a urine infection. We are unable to perform urodynamics if you have a urine infection and have symptoms (for example foul-smelling urine or a burning sensation when you urinate).

If you are prone to urinary tract infections, please ensure you get your urine checked by your GP surgery five working days before the appointment so that it can be treated before your appointment.

What the urodynamics test involves

After you arrive, a healthcare professional will explain the test to you and ask some questions about the symptoms that you have been experiencing. You can ask any questions you have about the test.

You will then be asked to sign a consent form to make sure that you understand the procedure, the reasons why it is being done and any potential side effects.

In privacy, you will be asked to change and remove the lower half of your clothing (trousers/skirt/underwear). You will be given a hospital gown to change into and once you are on the couch you will be covered with a sheet.

The healthcare professional will also ask you to pass urine into a special toilet (flowmeter). This measures how fast the flow of your urine is and allows us to check you don’t have a urine infection.

After you have done this, the healthcare professional may examine you. This will include an internal examination, with a chaperone present.

During the test

You will be lying on a couch before one or two small tubes

(no more than 3mm in diameter) will be passed into your bladder. Another small tube will be placed into your rectum (back passage). If you do not have a rectum because you have had surgery and have a colostomy or stoma then that can be used, or the vagina can also be used as an alternative.

These tubes allow us to take measurements both inside and outside the bladder. You will then be asked to sit or stand and your bladder will be slowly filled with water through the tube until you feel full. If you are unable to sit or stand then you will remain lying down on the couch.

You will be asked to cough several times during the test to check the tubes are working. You will also be asked a series of questions such as your first desire to pass urine or whether you experience any urgency.

Once your bladder is comfortably full, one of the bladder tubes will be removed. The tube in your rectum and the very tiny tube in your bladder will be left in. You will then be asked to pass urine and the healthcare professionals will leave the room during this time.

After the test

You will be given time to get dressed in privacy after the test and the results will be explained to you. At this point, you will have the opportunity to ask any questions you may have.

A report will be written and a copy will be sent to your GP, the person who referred you, and yourself.

After the test, you may experience some discomfort where the tubes have been for a short time, but this should settle down. We suggest that you drink extra water during the 24 hours after the test to decrease the chances of you developing an infection.

Video urodynamics

Video urodynamics is similar to standard urodynamics (described above please read and follow the ‘before the test’ guidance above), however, we also take X-ray pictures of your bladder. Instead of using salt water to fill your bladder, we use an iodine-based fluid (this allows us to see your bladder on X-ray).

Before the test, please also let us know:

  • If there is any possibility that you are pregnant as we are unable to perform the test if you are. We may also perform a pregnancy test on the day of your appointment.
  • If you are allergic to Iodine.

What the urodynamics test involves

Unlike standard urodynamics, because we need to X-ray your bladder when you pass urine, we have to remain in the room. We are as discreet as possible and stay behind the curtains when possible.

Patient information

As part of routine clinical practice we process and store personal information relating to our service users. We are required to adhere to the legal requirements of the Data Protection Act 1998 and the General Data Protection Regulation to ensure appropriate patient safety and confidentiality, which we take very seriously. We ensure

the personal information we obtain in held, used, transferred and otherwise processed in accordance with applicable data protection laws and regulations.

Patient data used for research purposes helps improve healthcare such as monitoring patient safety, developing new treatment or developing NHS services. If you would like to opt-out of having your information used for further research, please inform your practitioner on the day of the test.

Useful websites for additional information and advice

© North Bristol NHS Trust. This edition published May 2025. Review due May 2028. NBT002646

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Post Exacerbation Pulmonary Rehabilitation

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What is an exacerbation?

When the symptoms of your lung condition suddenly get worse, it is called an exacerbation. This if often treated in hospital as an inpatient or by a change in your medicine (such as steroids or antibiotics).

What is Pulmonary Rehabilitation (PR)?

Pulmonary Rehabilitation (PR) is a course involving individually tailored exercises to help you manage your breathlessness, gradually increase your fitness level, and understand your lung condition more.

Classes are face to face, twice a week, for six weeks. Each session is up to two hours and involves both education and exercise.

Where are the classes?

We run our PR sessions at Cossham Hospital, Kingswood, Bristol. Sirona community team provide classes in various locations including Bradley Stoke Leisure Centre and the Greenway Centre in Southmead.

Your referral will be sent to the nearest location to where you live. You can tell us if you would prefer to go to another location.

Getting to classes: If you do not have your own transport and are unable to use public transport, please ask a member of the team for advice.

Why am I being offered PR now?

When you have an exacerbation, you may become less active. Even when you are starting to feel better, you may still find it harder to do your daily activities. Doctors have found that starting PR within four weeks of being in hospital after an exacerbation can help patients in the following ways:

  • Reduce your chances of going back into hospital.
  • Make it easer to do daily activities like walking, climbing stairs, or getting dressed.
  • Improve your quality of life.
  • Reduce the risk of another exacerbation.
  • Help you get back to how fit you were before going into hospital.
  • Improve your survival.

It is safe for me?

Your healthcare professional will refer you to PR if they feel it is appropriate for you at this time. The pulmonary rehabilitation specialists will then do a full medical review to check you are safe to participate, and to identify any precautions that need to be taken with you.

How do I get referred?

Your doctor, nurse, or physiotherapist may recommend PR while you are in hospital. If you are not sure if you have been referred please call us.

You should expect a phone call within one to two weeks from being referred to talk about the programme and book an assessment.

Please let us know if you have any questions about PR or why you were referred.

You can have the assessment even if your symptoms are worse than usual; the first part of this is normally done on the phone.

What happens at the assessment?

A specialist physiotherapist will arrange a time to call you. The call will include checking:

  • How your lung condition affects your walking and daily activities.
  • Your medical history and medications.

After the phone assessment you will be invited to a face-face assessment. The appointment will involve things like taking your blood pressure, completing a walking test, and filling in some questionnaires. You can bring a relative, friend, or carer with you to the appointment.

Once the PR team are happy that you are safe to participate, you will be given a date to start PR within one to two weeks.

We aim to get you started on PR within one month of your hospital admission as research suggests you get the most benefits by participating sooner.

What happens during the classes?

You will exercise alongside other patients with a lung condition. You will be fully supervised to make sure you are confident, safe, and progressing as you should.

Each two hour class is split into one hour of exercise and up to one hour of education about self-managing your condition. You will be required to attend the sessions twice a week for the six week course duration.

Exercise

The specialist physiotherapist and exercise specialists will design a programme specifically for you. This will be based on your goals, medical history, and physical ability from your assessment.

Your programme will include arm and leg exercises using exercise equipment like dumbbells. It will also include aerobic exercises such as walking or step-ups.

Education

The education sessions are designed to give you tools to better manage your condition. Topics include:

  • Information about how to manage your lung disease.
  • Breathlessness management.
  • Inhaler technique and medications.
  • How to manage a chest infection.
  • Benefits of exercise and how to exercise at home.
  • Managing your sputum.

Who can I contact for more information?

You can contact the Pulmonary Rehabilitation Team (LEEP):

Asthma and Lung UK

Further resources

NHS website

More information about COPD.

Chronic obstructive pulmonary disease (COPD) - NHS

Asthma and Lung UK

More information about COPD.

Chronic obstructive pulmonary disease (COPD) | Asthma + Lung UK

Right Breathe

Information about how to use your inhalers correctly.

RightBreathe

Support to stop smoking

Try the NHS Quit Smoking app, speak to your local pharmacy or GP, or find out about options for support in your area.

Quit smoking - Better Health - NHS

IAPT Talking Therapies

Get help with your mental health through NHS talking therapies.

NHS Talking Therapy | Vita Health Group

Do you have any questions or comments about your care?

If you have any concerns about the service that the nurses or doctors cannot resolve, you can contact our Patient Advice and Liaison Service (PALS).

PALS offer support and assistance for patients and their families. You can also share positive comments with them about your care.

© North Bristol NHS Trust. This edition published May 2025. Review due May 2028. NBT003628

Contact LEEP

The LEEP Team can be contact on 0117 4142010 or via email at leep@nbt.nhs.uk.  Referrals are accepted via emailed LEEP referral form*, on the ICE referral system or at: The LEEP Office, Physiotherapy Department, Cossham Hospital, Lodge Road, Kingswood, Bristol BS15 1LF.  

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Pneumothorax after a lung biopsy: what to do next

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Information for patients with a small pneumothorax after a lung biopsy at North Bristol NHS Trust

You have had a small sample taken of an abnormal area of your lung today, using local anaesthetic and image guidance. 

Following the procedure, you have a small pneumothorax (collapse of the lung). We are happy that you are safe to go home today, but would like you to come back for another chest X-ray in a few days so we can review your lungs. This is to make sure the pneumothorax (lung collapse) is stable, or improving.

When to come back to Gate 18 Radiology Department

We will give you a date and time to come back to Gate 18 for a chest X-ray. 

You can go home after the X-ray and we will phone you with the result. We will tell you what to do next.

If you have any of the following at home today/tonight, you should go to Southmead Emergency Department or call 999:

  • Severe pain when breathing.
  • Difficulty breathing.
  • Coughing up large amounts of blood (tablespoons).
  • Persistent fever (high temperature).

You can remove the dressing after 24 hours. 

If you have any questions following the procedure, please contact the Lung Cancer Nurse Specialists on 0117 414 1900

© North Bristol NHS Trust. This edition published March 2025. Review due March 2028. NBT003634. 

It's okay to ask

Illustration of 3 clinicians wearing blue scrubs with stethoscopes around necks

Find out about shared decision making at NBT. 

Support your local hospital charity

Southmead Hospital Charity logo

See the impact we make across our hospitals and how you can be a part of it. 

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