CYST2 Undertake biopsy using a flexible cystoscope


This standard covers the use of a flexible cystoscope to take tissue samples from the inside of the bladder. It also covers requests for histopathology investigations and the initial handling of the tissue samples.

This standard covers biopsy procedures using a flexible cystoscope for adults only.  Paediatric services are excluded.

Users of this standard will need to ensure that practice reflects up to date information and policies.

Version No 1

Knowledge and Understanding

You will need to know and understand:

  1. The clinical conditions appropriate for bladder biopsy
  2. The indications and contra-indications for bladder biopsy
  3. Tissue specimen criteria for histopathology examinations
  4. Emergency indications of use of cystodiathermy
  5. The complications of undertaking a biopsy using flexible cystoscopy and the appropriate remedial strategies
  6. Sensations resulting from use of biopsy forceps
  7. The safe operation of biopsy forceps
  8. The importance of timely equipment fault recognition and local procedures for dealing with these
  9. The limits of one’s own knowledge and experience and the importance of not operating beyond these

Performance Criteria

You must be able to do the following:

  1. assess patient for contra-indications for biopsy
  2. explain the intended procedure to the patient, its reason and purpose and the possible sensation during the procedure
  3. check the location and availability of emergency equipment
  4. prepare and introduce a diathermy compatible cystoscope into the urethra
  5. recognise abnormal areas which need to be biopsied and seek advice when required
  6. maintain communications with the patient throughout the procedure and respond to any questions or needs
  7. select appropriate biopsy forceps and check that they are in working order
  8. insert biopsy forceps through the appropriate channel of the cystoscope and identify the forceps as they enter the bladder and field of vision
  9. use the cystoscope controls to orientate the biopsy forceps over the tissue to be sampled
  10. open the jaws of the forceps or instruct assistant to operate attachment controls to open jaws
  11. take tissue sample ensuring sufficient tissue is grasped to provide an adequate specimen
  12. withdraw forceps with attached tissue and deposit sample into appropriate fixative in a patient labelled sample container
  13. clean forceps after discharging each sample before taking any further samples
  14. visually check biopsy sites for obvious bleeding and take appropriate action
  15. recognise the need for immediate management of acute emergencies associated with the procedure and respond appropriately
  16. complete histopathology request form stating any previous histopathology, relevant clinical details and reasons for biopsy, noting and recording any landmarks to indicate the location of the area biopsied
  17. document the outcome of the examination and record all biopsies taken
  18. recognise when you need help and/or advice and seek this from appropriate sources

Additional Information

This National Occupational Standard was developed by Skills for Health.

This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004):

Dimension: HWB6 Assessment and treatment planning
CYST2 Undertake biopsy using a flexible cystoscope
Final version approved June 2010 © copyright Skills For Health
For competence management tools visit tools.skillsforhealth.org.uk