🩺 Diagnostic Procedure (Urological)

Flexible cystoscopy: Nursing Guide

Flexible cystoscopy uses a small flexible scope to inspect the bladder through the urethra in patients with blood in urine, frequent urination, or concern for bladder cancer. Nursing priorities are urine infection screening, safe local anaesthetic workflow, fluid advice after the test, and rapid escalation when fever, retention, worsening pain, or heavy bleeding develops.

15 min read
Updated June 20, 2026
Medically Reviewed
Written by
Sid A. Abdala Balal
RN — Registered Nurse
Medically Reviewed by
Dr. Adam Sayedi
MD — Medical Doctor

Contents

Overview Safety Note Can / Cannot Safety Check Clinical Interpretation Related Tests Bedside Notes Workflow Mental Checklist Why It Is Ordered Patient Preparation Specimen / Procedure Results & Interpretation Urgent Findings Nursing Responsibilities Documentation Patient Education Flexible cystoscopy NCLEX practice questions FAQ References Related Topics Editorial Review

Quick Facts

Category
Diagnostic procedure
Why it is ordered
Evaluate haematuria and lower urinary tract
Main nursing risk
Post-procedure UTI
Turnaround
Visual findings usually discussed same

Key Takeaway

Flexible cystoscopy often needs no fasting or bowel prep, but safety hinges on UTI screening, post-test symptom surveillance, and clear escalation for fever, retention, or heavy bleeding.

Procedure Safety Checklist

Pre-procedure safety checks — confirm each item before the patient leaves the ward or clinic.

  1. Correct patient, indication, and consent verified before instrumentation

  2. No special prep required; confirm patient can eat and drink normally unless unit says otherwise

  3. Urine sample plan confirmed — many units ask for a full bladder for urinalysis on arrival

  4. Allergy history and local anaesthetic jelly tolerance checked

  5. Baseline vitals, pain score, and urinary symptoms documented

  6. Review antibiotics policy and whether prophylactic antibiotics are ordered for risk groups

  7. Recent urinary symptoms reviewed for active infection before procedure

  8. Escalation instructions explained for fever, shivers, retention, severe pain, or heavy bleeding

Sedation

Usually local anaesthetic urethral jelly only; driving advice follows local unit policy

What is Flexible cystoscopy?

Flexible cystoscopy is an endoscopic test where a thin, flexible cystoscope is passed through the urethra to inspect the urethra and bladder lining. NHS and hospital leaflet guidance describe no routine bowel prep or fasting for standard flexible cystoscopy, and many units request urine sampling before the test.

Overview

Flexible cystoscopy is commonly arranged for visible or persistent non-visible haematuria, recurrent lower urinary tract symptoms, or surveillance after prior bladder pathology. national clinical guidelines NG12 links haematuria pathways to urgent cancer referral decisions, while national clinical guidelines NG2 supports cystoscopy in diagnosis and follow-up pathways for bladder cancer.

Nursing interpretation combines procedural notes with symptom trends, urinalysis, and later tissue diagnosis when needed. A visually reassuring report does not exclude malignancy by itself because definitive diagnosis may require histology from biopsy or TURBT; biomarkers should not replace cystoscopy in suspected bladder cancer pathways.

Clinical Nursing Focus

Before flexible cystoscopy, screen for possible urinary infection and confirm local anaesthetic safety checks. After the test, mild dysuria or light blood staining can occur for up to 48 hours; promote oral fluids 2-3 litres over the next 1-2 days unless fluid restricted. Escalate fever, shivers, inability to void, severe worsening pain, or heavy bleeding.

UTI Screening, Local Anaesthetic, and Post-Procedure Infection Safety

Flexible cystoscopy is usually low complexity and often done with local anaesthetic jelly, but it is not risk-free. The key post-procedure dangers are urinary tract infection, urinary retention, and worsening bleeding. Most leaflets report infection risk around 1-2%.

Highest-risk scenarios
  • Fever or shivers after procedure with worsening dysuria
  • Inability to void with suprapubic pain or distension
  • Heavy bleeding or clots rather than light staining only
  • Worsening pain despite hydration and routine aftercare

Document: pre-test urine screening, local anaesthetic details, voiding outcomes, urine appearance, escalation actions, and evaluate outcomes after interventions.

What Flexible Cystoscopy Can and Cannot Tell You

This test can help identify:

  • Visible bladder and urethral abnormalities linked to haematuria
  • Inflammatory or erythematous mucosal findings needing follow-up
  • Structural causes of persistent lower urinary tract symptoms
  • Targets for biopsy or TURBT planning when suspicious lesions appear

This test cannot:

  • Confirm cancer diagnosis alone without histology where required
  • Replace biopsy or TURBT when lesion characterization is needed
  • Replace safety follow-up for UTI, retention, or bleeding after discharge
  • Justify replacing cystoscopy with urinary biomarkers in suspected cancer pathways

Pre-procedure Checks Before Flexible Cystoscopy

Verify

✓Correct patient and haematuria indication with consent confirmed
✓No special prep needed and patient informed they may eat and drink normally
✓Urine sample plan in place before procedure if requested by unit
✓Allergy and local anaesthetic jelly checks completed
✓Baseline urinary pain, voiding pattern, and vitals documented
✓Escalation advice prepared for fever, retention, severe pain, or heavy bleeding

Clarify before proceeding when:

  • Patient reports current fever, rigors, or severe urinary pain before instrumentation
  • No urine sample obtained where local protocol requires infection screening
  • Persistent heavy haematuria or clots suggest unstable bleeding pattern
  • Antibiotic prophylaxis indications are unclear for high-risk patient profile
  • Severe anxiety or pain plan is not addressed before start
  • Recent urinary retention episodes have not been communicated to urology team

Reading Cystoscopy Findings With Urinary Symptoms and Trends

Interpret flexible cystoscopy by integrating visual findings, symptoms, and trend data. A note of no visible mass does not overrule worsening fever, pain, tachycardia, retention, or bleeding after the procedure.

Report patternMay suggestNursing focus
No visible mass; mild mucosal erythemaIrritation or inflammation requiring symptom follow-upTrack dysuria, urine findings, and fever trend after discharge
Suspicious lesion visualizedNeed for biopsy or TURBT pathwayCoordinate urgent urology follow-up and document counseling
Fever and worsening urinary pain post testPossible post-procedure infectionEscalate quickly and evaluate outcomes after treatment starts
Unable to void with suprapubic painPost-procedure urinary retentionUrgent retention pathway and repeated reassessment
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Urological Tests That Pair With Flexible Cystoscopy

Related test / assessmentWhy it may be ordered
Upper tract imaging (CT urography where indicated)Haematuria workup beyond bladder visualization
Urine microscopy and cultureConfirm infection source when fever or dysuria worsens
CBC and inflammatory markersAssess systemic response with post-procedure deterioration
Bedside bladder scan and output trendDetect retention early when voiding is poor
Biopsy or TURBT pathology workflowDefinitive diagnosis when suspicious lesion is seen
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Urine Sample, Fluid Advice, and Recovery Monitoring at the Bedside

Bedside pointNursing note
Prep mythMost patients do not need fasting or bowel prep for routine flexible cystoscopy
Expected symptomsMild stinging and light blood can occur for 24-48 hours
Hydration teachingEncourage 2-3 L fluids over 1-2 days unless restricted
UTI riskLeaflets commonly cite around 1-2% infection risk after procedure
Escalation triggerFever, shivers, retention, worsening pain, or heavy bleeding need urgent review
Evaluate outcomesAfter escalation, reassess pain, temperature, heart rate, and urine output trend
↔ On a small screen, swipe or scroll sideways to see the full table.

Flexible Cystoscopy Pathway Across Clinic and Ward Settings

Diagnostic safety badge: Minimally invasive urologic procedure — low prep burden but meaningful infection, retention, and bleeding follow-up requirements.

Check-before-test protocol

  1. Confirm indication, consent, and symptom history
  2. Prepare urine screen and baseline observation set
  3. Check local anaesthetic and antibiotic policy requirements
  4. Complete procedure documentation and immediate voiding review
  5. Deliver hydration plus red-flag escalation teaching

Critical teach-back questions

  • “Which symptoms are expected for up to 48 hours?”
  • “When should you contact your care team urgently after today?”
  • “How much should you drink in the next 1-2 days if not fluid restricted?”

Care coordination: urology day unit, ward nursing, microbiology pathways, and on-call escalation teams for suspected post-procedural infection or retention.

Flexible Cystoscopy Quick Safety Checklist

  • Was pre-test urine screening completed and interpreted?
  • Were local anaesthetic and allergy details documented clearly?
  • Has the patient voided adequately after procedure?
  • Are fever, pain, or bleeding trends worsening and requiring escalation?
  • Has clear red-flag advice been taught and documented?

Why Flexible cystoscopy is Ordered

Flexible cystoscopy is ordered when clinicians need direct lower-urinary-tract visualization to clarify symptoms, investigate bleeding, or guide diagnosis and surveillance.

Clinical Indication What the Test Answers Nursing Rationale
Visible or recurrent non-visible haematuria assessment Is there a bladder or urethral lesion explaining bleeding risk? national clinical guidelines NG12 haematuria pathways support urgent investigation where cancer risk is relevant; direct visualization helps target further biopsy or imaging.
Persistent bladder pain and urgency syndromes Are there visual inflammatory or structural causes of chronic symptoms? Supports workup in chronic pain and urgency patterns, including interstitial cystitis when diagnosis remains unclear.
Suspected infection, obstruction, or retention complications Do findings explain persistent lower-tract symptoms despite treatment? Integrated with pre-test urine screening and bedside residual checks such as bladder scan when voiding difficulty is present.
Bladder tumour diagnosis and surveillance planning Is there suspicious mucosal change requiring biopsy or TURBT follow-up? national clinical guidelines NG2 pathways use cystoscopy for diagnosis and surveillance decisions. Visual findings guide next steps but do not replace tissue confirmation when malignancy is suspected.
↔ On a small screen, swipe or scroll sideways to see the full table.

Contraindications and Precautions

Few absolute contraindications exist, but defer or modify flexible cystoscopy when active urinary infection, severe urethral pain, unstable bleeding, or inability to pass the scope safely is present.

When flexible cystoscopy should be delayed or escalated
  • Fever with untreated symptomatic UTI before the procedure
  • Inability to provide urine sample when infection exclusion is required locally
  • Severe urethral pain, gross bleeding, or retention requiring urgent review first
Patient and procedure cautions
  • Recent urinary instrumentation or trauma may increase discomfort and bleeding risk
  • Anticoagulation does not always preclude procedure but requires team review if bleeding is ongoing
  • Immunosuppressed or high-risk patients may need prophylactic antibiotics per unit policy
Escalate If
  • Post-procedure fever or rigors suggesting UTI or sepsis progression
  • Inability to void with suprapubic pain or rising discomfort
  • Heavy persistent haematuria, clots, or worsening pain after discharge advice

Patient Preparation

Preparation for standard flexible cystoscopy is usually straightforward: no routine fasting, urine sample readiness, local anaesthetic checks, and clear post-procedure safety counseling.

Pre-test checks
✓Confirm order indication and explain that this test inspects bladder and urethra directly.
✓Reinforce no special diet prep for routine flexible cystoscopy unless local protocol differs.
✓Request arrival with a comfortably full bladder when urine sample testing is planned.
✓Obtain pre-procedure urine dip and follow local policy for urinalysis to identify possible infection.
✓Document allergies and confirm local anaesthetic jelly administration plan.
✓Teach expected stinging and mild blood-tinged urine for up to 48 hours, plus escalation cues.
Medications to Review or Hold

Review antithrombotics, immunosuppressants, and current antibiotics with the prescriber. Some units give prophylactic antibiotics selectively for high-risk patients; follow local protocol and document the rationale.

Where the test is performed

This page is a Tests & Diagnostics guide for Flexible cystoscopy. It emphasizes why the test is ordered, how to interpret results, when to escalate, and preparation factors that affect validity — not step-by-step performance technique (those live under Nursing Procedures when available).

Flexible cystoscopy is performed in urology outpatient or day-case units by urologists or trained nurse specialists with local anaesthetic urethral jelly. Ward and clinic nurses focus on urine infection screening before the list, consent and allergy review, post-procedure fluid teaching, urinary retention and UTI surveillance, and acting on haematuria pathway results — not cystoscope operation.

Use the preparation, results, and nursing responsibility sections below for safety checks, interpretation, escalation, and documentation — not equipment operation or departmental imaging protocols.

Result follow-up at a glance

Nursing workflow on this page — from order to safe action on results:

1
Confirm indication & correct order
2
Coordinate with laboratory or radiology per local policy
3
Document pre-analytic preparation & timing
4
Review result with trend & clinical picture
5
Escalate critical or discordant findings
6
Document communication & patient teaching

Results and Interpretation

Flexible cystoscopy reports are descriptive. Nurses interpret visual findings, symptom progression, urine tests, and escalation needs together. A normal-appearing bladder does not independently rule out all pathology without follow-on biopsy or TURBT when suspicion remains.

Reference Range Disclaimer

Reference ranges, critical values, and protocols may vary by laboratory, institution, patient population, and testing method. Always follow local policy and the reporting laboratory’s reference range.

Result Range / Finding Clinical Meaning Nursing Action
No acute critical finding / as expected for indication Bladder and urethral mucosa appear as expected for indication; no obstructing lesion documented No urgent procedural abnormality described at this visit Continue planned follow-up and reinforce return precautions for delayed infection or retention
Equivocal / indeterminate finding Mild erythematous or inflamed mucosa without visible mass; transient dysuria or light haematuria Could reflect irritation or inflammation; requires symptom trend review and infection surveillance Monitor urinary symptoms, hydration response, and urine testing; notify prescriber for worsening course
Abnormal finding — clinically significant Post-procedure fever, rigors, inability to void, severe pain, or heavy bleeding with clots Possible UTI, urinary retention, or significant complication requiring urgent review Escalate immediately; continue reassessment and complete blood count or other ordered tests while awaiting medical review
Not applicable Not applicable — flexible cystoscopy is not interpreted with low numeric threshold values Interpret by findings, trends, and follow-on pathology requirements Correlate report wording with urinary symptoms, urine results, and escalation criteria
↔ On a small screen, swipe or scroll sideways to see the full table.

Urgent Findings and Escalation

Flexible cystoscopy has no universal laboratory critical values. Nursing urgency is driven by clinical deterioration and post-procedural safety signals.

Critical Finding Threshold / Value Immediate Action
Fever with shivers after procedure Temperature elevation with systemic symptoms or tachycardia Escalate promptly for suspected infection or early sepsis; evaluate outcomes after treatment initiation
Inability to void with suprapubic discomfort No urine output despite urge and increasing pain Urgent review for retention and immediate bladder management pathway
Heavy ongoing haematuria or clots More than mild expected blood staining, worsening over time Escalate for urgent urology review and hemodynamic monitoring per local protocol
↔ On a small screen, swipe or scroll sideways to see the full table.
Stop and Escalate

Stop routine discharge progression and escalate when fever, rigors, inability to void, severe worsening pain, or heavy bleeding occurs after flexible cystoscopy.

Factors Affecting Results

Interpretation can be affected by pre-existing cystitis symptoms, recent urinary instrumentation, hydration status, and incomplete urine infection screening before the test.

False Positives
  • Mild expected dysuria interpreted as severe infection without systemic features
  • Small transient blood staining overcalled as major bleeding despite stable course
  • Urgency symptoms attributed to retention without objective voiding assessment
False Negatives
  • Post-procedure fever and dysuria dismissed as routine irritation
  • Heavy bleeding trends missed because only one urine observation was documented
  • Normal visual impression assumed to exclude malignancy without pathology plan
Interfering Factors
  • Active infection at baseline can confound post-procedure symptom interpretation
  • Analgesic use may mask pain progression after discharge
  • Delayed reassessment can miss early retention or sepsis deterioration
Test Limitations

Flexible cystoscopy provides direct visual inspection but cannot independently confirm all pathology. Cancer diagnosis may require biopsy or TURBT histology, and national clinical guidelines advises not substituting urinary biomarkers for cystoscopy in suspected bladder cancer pathways.

Nursing Responsibilities

Nursing responsibilities include pre-procedure infection screening, local anaesthetic safety, post-test hydration counseling, and escalation for infection, retention, and bleeding risks.

Before the Test
✓Confirm indication and explain expected test sensations in plain language
✓Screen urinary symptoms and follow local criteria for infection postponement
✓Document baseline vitals and urinary pain pattern
✓Prepare urine collection and specimen route if sample required pre-test
During the Test
✓Support sterile setup and local anaesthetic jelly administration workflow
✓Monitor comfort, procedure tolerance, and communication with urology team
✓Record immediate findings and post-procedure safety instructions
After the Test
✓Teach fluid intake targets for the next 1-2 days unless restricted and monitor for urinary tract infection symptoms
✓Trend urine color, voiding ability, pain, and temperature after discharge from unit
✓Clarify when mild stinging or light blood is expected up to 48 hours
✓Escalate fever, shivering, inability to void, severe painful urination, or heavy bleeding promptly

Documentation

Documentation should demonstrate pre-test safety checks, procedural tolerance, and explicit discharge escalation guidance.

Example Nursing Note

“Flexible cystoscopy completed in day unit with local anaesthetic jelly at 10:20. Pre-test urine dip completed; no nitrite flag at baseline. At 14:30 patient reports dysuria and visible blood with fever 38.6 C, HR 105/min. Urology team informed; urgent review requested and repeat observations started. Escalation advice reinforced for shivers, urinary retention, severe pain, or heavy bleeding.”

Key Documentation Points
  • Pre-test urine screening status and infection concerns
  • Local anaesthetic use and immediate procedure tolerance
  • Post-test voiding status, urine appearance, and pain trend
  • Temperature and vital trends with any deterioration
  • Provider notification details and escalation timing
  • Hydration advice, warning symptoms, and planned follow-up

Patient and Family Education

Education should normalize expected mild short-lived symptoms while clearly separating red flags that require same-day review.

✓Explain no routine fasting or bowel prep for standard flexible cystoscopy
✓Advise drinking 2-3 litres over 1-2 days after test unless fluid restricted
✓Review expected mild stinging or light blood in urine for up to 48 hours
✓Teach urgent reporting for fever, shivers, inability to pass urine, severe pain, or heavy bleeding
✓Clarify that suspicious findings may still require biopsy or TURBT for diagnosis
✓Provide written local aftercare instructions before discharge
📚

Flexible cystoscopy NCLEX practice questions

Practice NCLEX-style clinical judgment focused on Flexible cystoscopy safety and nursing judgment. Use the case tabs (orders, results, assessment, nursing notes), then answer eight Next Gen–style items (including an ordered workflow step) and evaluate outcomes with the answer key.

Select a tab to view orders, results, assessment, and nursing note details for this case.

  • Order: Flexible cystoscopy in urology day unit under local anaesthetic jelly
  • Indication: 62-year-old male with visible haematuria referred for urgent investigation
  • Timing: Four hours post-procedure in observation area
  • Related orders: Observe vitals, repeat urine sample, notify urology registrar for deterioration
Question 1 — Priority action

After reviewing the case tabs, what is the nurse’s priority first action?

Question 2 — Recognize cues

Which findings in the case tabs support urgent escalation? Select all that apply. Select all that apply

Question 3 — Trend interpretation

Which trend findings indicate deterioration despite initial observation? Select all that apply.

Trend snapshot
Pain and dysuria worsening with rising temperature and tachycardia

Select all that apply

Question 4 — Matrix judgment

Classify each finding for this post-cystoscopy patient:

Finding Expected — document and continue monitoring Requires follow-up — notify team / repeat test Urgent — immediate escalation
Mild stinging on first void, afebrile, improving
Visible haematuria with no clots but persistent dysuria
Fever 38.6 C with shivers and HR 105/min
Unable to void with worsening suprapubic pain

On a small screen, swipe or scroll sideways to see the full table.

Question 5 — Clinical judgment

Which discharge instruction is most accurate after local-anaesthetic-only flexible cystoscopy?

Question 6 — Documentation (cloze)

Complete the priority documentation phrase after flexible cystoscopy:

Post-flexible-cystoscopy safety documentation must include on the chart and in handoff communication.

Question 7 — Workflow (ordered response)

Before escorting a patient for flexible cystoscopy with visible haematuria, rank nursing actions (1 = first).

  1. Document fever, dysuria, and vital signs; clarify with urology if active UTI signs are present
  2. Verify identity, consent, and urine sample or dipstick for infection symptoms before the list
  3. Teach expected stinging, haematuria up to 48 hours, fluid intake, and return precautions
  4. Reassess the patient, verify the order and identity, and prepare for prescriber follow-up
Question 8 — Evaluate outcomes

Six hours after flexible cystoscopy, antibiotics were started for UTI but temperature remains 38.7 °C, heart rate 108/min, and the patient appears flushed and unwell despite ability to void small painful amounts. What is the best next nursing action?

Answer key & rationale

Next step Timed NCLEX Next Gen–style scenarios on NurseOnShift

Frequently Asked Questions

FAQ

Is special preparation required before flexible cystoscopy?

Most NHS and hospital leaflets state no special preparation is needed for routine flexible cystoscopy. Patients usually eat and drink normally unless the unit gives different instructions.

Why might the unit ask the patient to arrive with a full bladder?

Many units request a urine sample before the procedure to screen for infection and guide safety decisions.

Are antibiotics always given before flexible cystoscopy?

Not always. Prophylactic antibiotics may be used according to local policy and patient risk profile.

What symptoms are expected after flexible cystoscopy?

Mild stinging and a small amount of blood in urine can occur for up to 48 hours. Patients should drink extra fluids unless restricted and seek review if symptoms worsen.

When should nurses escalate urgently after the test?

Escalate fever, shivers, inability to void, severe worsening pain, or heavy bleeding, because these can signal UTI, retention, or significant complications.

Can flexible cystoscopy alone confirm bladder cancer?

No. Cystoscopy can identify suspicious lesions, but diagnosis may still require biopsy or TURBT histology depending on findings.

Can urine biomarkers replace cystoscopy in suspected bladder cancer?

national clinical guidelines does not support substituting urinary biomarkers for cystoscopy in suspected bladder cancer pathways.

References

References
  1. National Health Service. Cystoscopy. NHS.
    https://www.nhs.uk/tests-and-treatments/cystoscopy/
  2. National Health Service. Preparing for a cystoscopy. NHS.
    https://www.nhs.uk/tests-and-treatments/cystoscopy/preparation/
  3. MedlinePlus Medical Encyclopedia. Cystoscopy. U.S. National Library of Medicine.
    https://medlineplus.gov/ency/article/003903.htm
  4. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12).
    https://www.nice.org.uk/guidance/ng12
  5. National Institute for Health and Care Excellence. Bladder cancer: diagnosis and management (NG2).
    https://www.nice.org.uk/guidance/ng2
  6. North Bristol NHS Trust. Flexible cystoscopy information leaflet.
    https://www.nbt.nhs.uk/our-services/a-z-services/urology/flexible-cystoscopy
  7. Royal Free London NHS Foundation Trust. Flexible cystoscopy patient information.
    https://www.royalfree.nhs.uk/patients-and-visitors/patient-information-leaflets/flexible-cystoscopy
  8. NIDDK. Cystoscopy and Ureteroscopy. National Institute of Diabetes and Digestive and Kidney Diseases.
    https://www.niddk.nih.gov/health-information/diagnostic-tests/cystoscopy-ureteroscopy

Related Topics

Dysuria With Fever

Rapidly identify urinary infection red flags after instrumentation

Sign / Symptom

Clean-Catch Urine Specimen

Improve pre-procedure urine screening quality and contamination control

Nursing Procedure

Urinary Catheterization

Escalation pathway for retention when patient cannot void after procedure

Nursing Procedure

Urinary Output Measurement

Track voiding and detect early retention or deterioration

Nursing Procedure

Abdominal CT Scan

Adjunct imaging when haematuria workup needs upper tract assessment

Test / Diagnostic

Benign Prostatic Hyperplasia

Common differential in older men with urinary symptoms and voiding issues

Condition

Editorial Standards & Medical Review

About the author: Sid A. Abdala Balal, RN, writes evidence-based nursing education focused on diagnostic safety, clinical interpretation, and bedside nursing judgment.

Medical review: This guide is reviewed by Dr. Adam Sayedi, MD, for clinical accuracy, diagnostic safety, and alignment with current standards for Flexible cystoscopy.

Policies: Medical Review Process · Editorial Policy · Correction Policy

Evidence-based nursing education and clinical resources

Disclaimer: This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Reference ranges, critical values, and protocols may vary by laboratory, institution, patient population, and testing method. Always follow local policy and the reporting laboratory’s reference range. Content written by a Registered Nurse and medically reviewed by Dr. Adam Sayedi, MD. Last reviewed: June 20, 2026.