Cystoscopy and Ureteroscopy

Illustration of male and female urinary tracts, showing kidney, ureter, bladder, prostate (male), and urethra. Source:NIH.

Cystoscopy and ureteroscopy are procedures performed to examine the urinary tract. A camera or scope is inserted into the urethra to visualize the inside of the bladder (cystoscopy) or ureter and kidney (ureteroscopy).

Cystoscopy and ureteroscopy may be recommended for any of the following conditions:

• frequent urinary tract infections
• blood in the urine (hematuria)
• loss of bladder control (incontinence) or overactive bladder
• unusual cells found in the urine
• need for a bladder catheter
• painful urination, chronic pelvic pain, or interstitial cystitis
• urinary blockage such as prostate enlargement, urethral stricture, or narrowing of the urinary tract
• stones in the urinary tract
• unusual growths, polyps, tumors, or cancer

Preparation

Cystoscopies may be done in the office or the hospital. If the procedure is done in the office, patients can usually eat normally and return to normal activities after the test. Ureteroscopies require anesthesia. If the procedure is done under anesthesia, fasting beforehand is necessary. A ride home is generally required for outpatient procedures.

Since any medical procedure has a small risk of injury, consent forms are often required before the test.

A urine sample may be checked for infection before the test.

In the office, patients remove the clothing over the lower half of their bodies and are covered with a sterile drape. The test is usually done with the patient lying on his or her back with the knees raised and apart. A nurse or technician will clean the area around the urethral opening and apply a local anesthetic if needed.

Antibiotics are sometimes prescribed for 1 or 2 days to prevent an infection.

How Cystoscopy and Ureteroscopy Are Done

Rigid cystoscope and semirigid ureteroscope; Source:NIH.

Cystoscopy

A urologist inserts the tip of the cystoscope into the urethra and slowly glides it up into the bladder. Relaxing the pelvic muscles helps make this part of the test easier. A sterile liquid (water or saline) will flow through the cystoscope to slowly fill the bladder and stretch it so that the doctor has a better view of the bladder wall.

As the bladder reaches capacity, patients may feel some discomfort and the urge to urinate. They are able to empty the bladder as soon as the examination is over.

The time from insertion of the cystoscope to removal is typically only a few minutes. Taking a biopsy (a small tissue sample for examination under a microscope) may make the procedure last longer. In most cases, the entire examination, including preparation, will take about 15 to 20 minutes.

Ureteroscopy

Ureteroscopy is usually performed with general or regional anesthesia. The ureter is the tube that carries urine from the kidney to the bladder. The ureteroscope is a thin, long instrument used to look directly at and visualize the inside of the ureter. Some ureteroscopes are flexible like a small, very long straw. Others are more rigid and firm. Through the ureteroscope, the doctor can see stones or other abnormalities. The doctor can then remove stones, either by grabbing them with a small basket or by extending a flexible fiber that carries a laser beam to break the stone into smaller pieces that can then pass out of the body in the urine. How and what the doctor will do is determined by the location, size, and composition of the stone. Tumors may be biopsied and sometimes removed. The doctor may leave a stent, a flexible tube that keeps the ureter open for drainage after the procedure.

Side Effects

Patients may have a mild burning feeling when they urinate and may see small amounts of blood in the urine. These problems should generally not last more than 24 hours.

Discomfort may be relieved by drinking two 8-ounce glasses of water each hour for 2 hours or by taking a warm bath. Holding a warm, damp washcloth over the urethral opening may also help.

External Links

American Urological Association

National Kidney and Urologic Diseases Information Clearinghouse