Cystoscopy and Ureteroscopy

National Kidney and Urologic Diseases Information Clearinghouse

What is a cystoscopy?
U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH

A cystoscopy is an examination of the inside of the bladder and urethra, the tube that carries urine from the bladder to the outside of the body. In men, the urethra is the tube that runs through the penis. The doctor per forming the examination uses a cystoscope a long, thin instrument with an eyepiece on the external end and a tiny lens and a light on the end that is inserted into the blad der. The doctor inserts the cystoscope into the patients urethra, and the small lens magnifies the inner lining of the urethra and bladder, allowing the doctor to see inside the hollow bladder. Many cystoscopes have extra channels within the sheath to insert other small instruments that can be used to treat or diagnose urinary problems.

A doctor may perform a cystoscopy to find the cause of many urinary conditions, including frequent urinary tract infections blood in the urine, which is called
hematuria
a frequent and urgent need to urinate unusual cells found in a urine sample painful urination, chronic pelvic pain, or interstitial cystitis/painful bladder syndrome urinary blockage caused by prostate enlargement or some other abnormal narrowing of the urinary tract a stone in the urinary tract, such as a kidney stone an unusual growth, polyp, tumor, or cancer in the urinary tract

Kidney

Ureter

Bladder Prostate Urethra

Male and female urinary tracts.

What is a ureteroscopy?
A ureteroscopy is an examination or pro cedure using a ureteroscope. A uretero scope, like a cystoscope, is an instrument for examining the inside of the urinary tract. A ureteroscope is longer and thinner than a cystoscope and is used to see beyond the bladder into the ureters, the tubes that carry urine from the kidneys to the blad der. Some ureteroscopes are flexible like a thin, long straw. Others are more rigid and firm. Through the ureteroscope, the doc tor can see a stone in the ureter and then remove it with a small basket at the end of a wire inserted through an extra channel in the ureteroscope. Another way to treat a stone through a ureteroscope is to extend a flexible fiber through the scope up to the stone and then, with a laser beam shone through the fiber, 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 deter mined by the location, size, and composition of the stone. The reasons for a ureteroscopy include the following conditions: frequent urinary tract infections hematuria unusual cells found in a urine sample urinary blockage caused by an abnormal narrowing of the ureter a kidney stone in the ureter an unusual growth, polyp, tumor, or
cancer in the ureter

What are the preparations for a cystoscopy or ureteroscopy?

People scheduled for a cystoscopy or ureter oscopy should ask their doctor about any special instructions. In most cases, for cys toscopy, people will be able to eat normally in the hours before the test. For ureteros copy, people may be told not to eat before the test.

Rigid cystoscope (left) and semirigid ureteroscope (right).

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Because any medical procedure has a small risk of injury, patients must sign a consent form before the test. They should not hesi tate to ask their doctor about any concerns they might have. Patients may be asked to give a urine sample before the test to check for infection. They should avoid urinating for an hour before this part of the test. Usually, patients lie on their back with knees raised and apart. A nurse or technician cleans the area around the urethral opening and applies a local anesthetic so the patient will not experience any discomfort during the test. People having a ureteroscopy may receive a spinal or general anesthetic. They should arrange for a ride home after the test.

How is a cystoscopy or ureteroscopy performed?

After a local anesthetic is used to take away sensation in the ureter, the doctor gently inserts the tip of the cystoscope or uretero scope into the urethra and slowly glides it up into the bladder. A sterile liquidwater or salt water, called salineflows through the scope to slowly fill the bladder and stretch it so the doctor has a better view of the bladder wall. As the bladder is filled with liquid, patients feel some discomfort and the urge to urinate. The doctor may then release some of the fluid, or the patient may empty the bladder as soon as the examination is over. The time from insertion of the scope to removal may be only a few minutes, or it may be longer if the doctor finds a stone and decides to treat it. Taking a biopsya small tissue sample for examination with a microscopewill also make the procedure last longer. In most cases, the entire exami nation, including preparation, takes 15 to 30 minutes.

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What happens after a cystoscopy or ureteroscopy?

Patients may have a mild burning feeling when they urinate, and they may see small amounts of blood in their urine. These problems should not last more than 24 hours. Patients should tell their doctor if bleeding or pain is severe or if problems last more than a day. To relieve discomfort, patients should drink two 8-ounce glasses of water each hour for 2 hours after the procedure. They may ask their doctor if they can take a warm bath to relieve the burning feeling. If not, they may be able to hold a warm, damp washcloth over the urethral opening. The doctor may prescribe an antibiotic to take for 1 or 2 days to prevent an infection. Any signs of infectionincluding severe pain, chills, or fevershould be reported to a doctor.

Points to Remember
Cystoscopy and ureteroscopy are procedures used to view the inside of the bladder, urethra, and possibly the ureters. A cystoscope is an instrument used to examine the urethra and bladder. A ureteroscope is an instrument
used to examine the ureters.
Before a cystoscopy or ureteros copy, patients should
talk with their doctor to ask ques tions and receive instructions sign a consent form avoid urinating for about an hour before giving a urine sample if one is required arrange for a ride home if gen eral or spinal anesthetic will be used After a cystoscopy or ureteroscopy, patients should drink two 8-ounce glasses of water each hour for 2 hours ask about taking a bath or using a warm, damp washcloth to relieve the burning feeling report any problems, such as - bloody urine that lasts more than 24 hours after the test - severe pain - chills - fever

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Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has many research programs aimed at understanding kidney and urologic disorders, including urinary stones, enlarged prostate, urinary incontinence, and kidney failure. The NIDDK sponsors researchers develop ing advanced diagnostic equipment, such as cystoscopes that can examine bladder tissue at the microscopic level. This technology may in some cases eliminate the need for biopsy. Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For infor mation about current studies, visit www.ClinicalTrials.gov.

Acknowledgments
Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publica tion was originally reviewed by Michael B. Chancellor, M.D., University of Pittsburgh Medical Center, and William D. Steers, M.D., University of Virginia.

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov. This publication may contain information about
medications. When prepared, this publication
included the most current information available.
For updates or for questions about any medications,
contact the U.S. Food and Drug Administration
toll-free at 1888INFOFDA (18884636332)
or visit www.fda.gov. Consult your doctor for more
information.

For More Information

American Urological Association Foundation 1000 Corporate Boulevard Linthicum, MD 21090 Phone: 1866RINGAUA (18667464282) or 4106893700 Fax: 4106893800 Email: auafoundation@auafoundation.org Internet: www.UrologyHealth.org Interstitial Cystitis Association 110 North Washington Street, Suite 340 Rockville, MD 20850 Phone: 1800HELPICA (18004357422) or 3016105300 Fax: 3016105308 Email: icamail@ichelp.org Internet: www.ichelp.org

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National Kidney and Urologic Diseases Information Clearinghouse

3 Information Way Bethesda, MD 208923580 Phone: 18008915390 TTY: 18665691162 Fax: 7037384929 Email: nkudic@info.niddk.nih.gov Internet: www.kidney.niddk.nih.gov The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired. This publication is available at www.kidney.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

NIH Publication No. 094800 August 2009