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Cystoscopy and

UreteroscopyNational Kidney and Urologic Diseases Information Clearinghouse

U.S. Departmentof Health andHuman Services

NATIONALINSTITUTESOF HEALTH

What is a cystoscopy?A cystoscopy is an examination o the insideo the bladder and urethra, the tube thatcarries urine rom the bladder to the outsideo the body. In men, the urethra is the tubethat runs through the penis. The doctor per-orming the examination uses a cystoscopea long, thin instrument with an eyepiece onthe external end and a tiny lens and a lighton the end that is inserted into the blad-der. The doctor inserts the cystoscope intothe patients urethra, and the small lensmagnies the inner lining o the urethra andbladder, allowing the doctor to see insidethe hollow bladder. Many cystoscopes have

extra channels within the sheath to insertother small instruments that can be used totreat or diagnose urinary problems.

A doctor may perorm a cystoscopy tond the cause o many urinary conditions,including

requent urinary tract inections blood in the urine, which is called

hematuria

a requent and urgent need to urinate unusual cells ound in a urine sample painul urination, chronic pelvic pain,

or interstitial cystitis/painul bladdersyndrome

urinary blockage caused by prostateenlargement or some other abnormal

narrowing o the urinary tract a stone in the urinary tract, such as a

kidney stone

an unusual growth, polyp, tumor, orcancer in the urinary tract

Kidney

Urethra

Prostate

Bladder

Ureter

Male and emale urinary tracts.


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What is a ureteroscopy?A ureteroscopy is an examination or pro-cedure using a ureteroscope. A uretero-scope, like a cystoscope, is an instrumentor examining the inside o the urinarytract. A ureteroscope is longer and thinnerthan a cystoscope and is used to see beyondthe bladder into the ureters, the tubes thatcarry urine rom the kidneys to the blad-der. Some ureteroscopes are fexible like athin, long straw. Others are more rigid andrm. Through the ureteroscope, the doc-tor can see a stone in the ureter and thenremove it with a small basket at the end o a

wire inserted through an extra channel in theureteroscope. Another way to treat a stonethrough a ureteroscope is to extend a fexibleber through the scope up to the stone andthen, with a laser beam shone through theber, break the stone into smaller pieces thatcan then pass out o the body in the urine.How and what the doctor will do is deter-mined by the location, size, and composition

o the stone.The reasons or a ureteroscopy include theollowing conditions:

requent urinary tract inections hematuria unusual cells ound in a urine sample urinary blockage caused by an abnormal

narrowing o the ureter

a kidney stone in the ureter an unusual growth, polyp, tumor, or

cancer in the ureter

What are the preparationsfor a cystoscopy orureteroscopy?People scheduled or a cystoscopy or ureter-oscopy should ask their doctor about anyspecial instructions. In most cases, or cys-toscopy, people will be able to eat normallyin the hours beore the test. For ureteros-copy, people may be told not to eat beorethe test.

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

2 Cystoscopy and Ureteroscopy


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Because any medical procedure has a smallrisk o injury, patients must sign a consentorm beore the test. They should not hesi-tate to ask their doctor about any concernsthey might have.

Patients may be asked to give a urine samplebeore the test to check or inection. Theyshould avoid urinating or an hour beorethis part o the test.

Usually, patients lie on their back with kneesraised and apart. A nurse or technician

cleans the area around the urethral openingand applies a local anesthetic so the patient

will not experience any discomort during thetest.

People having a ureteroscopy may receivea spinal or general anesthetic. They shouldarrange or a ride home ater the test.

How is a cystoscopy orureteroscopy performed?

Ater a local anesthetic is used to take awaysensation in the ureter, the doctor gentlyinserts the tip o the cystoscope or uretero-scope into the urethra and slowly glides it upinto the bladder. A sterile liquidwater orsalt water, called salinefows through thescope to slowly ll the bladder and stretch itso the doctor has a better view o the bladder

wall.

As the bladder is lled with liquid, patientseel some discomort and the urge to urinate.The doctor may then release some o thefuid, or the patient may empty the bladderas soon as the examination is over.

The time rom insertion o the scope toremoval may be only a ew minutes, or itmay be longer i the doctor nds a stoneand decides to treat it. Taking a biopsyasmall tissue sample or examination with amicroscopewill also make the procedure

last longer. In most cases, the entire exami-nation, including preparation, takes 15 to30 minutes.



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What happens after acystoscopy or ureteroscopy?Patients may have a mild burning eeling

when they urinate, and they may see smallamounts o blood in their urine. Theseproblems should not last more than 24 hours.Patients should tell their doctor i bleedingor pain is severe or i problems last morethan a day.

To relieve discomort, patients should drinktwo 8ounce glasses o water each hour or2 hours ater the procedure. They may asktheir doctor i they can take a warm bath torelieve the burning eeling. I not, they maybe able to hold a warm, damp washcloth overthe urethral opening.

The doctor may prescribe an antibiotic totake or 1 or 2 days to prevent an inection.

Any signs o inectionincluding severepain, chills, or evershould be reported toa doctor.

Points to Remember Cystoscopy and ureteroscopy are

procedures used to view the insideo the bladder, urethra, and possiblythe ureters.

A cystoscope is an instrument usedto examine the urethra and bladder.

A ureteroscope is an instrument used to examine the ureters.

Beore a cystoscopy or ureteros-copy, patients should talk with their doctor to ask ques-

tions and receive instructions

sign a consent orm

avoid urinating or about an hourbeore giving a urine sample ione is required

arrange or a ride home i gen-eral or spinal anesthetic will be

used

Ater a cystoscopy or ureteroscopy,patients should

drink two 8ounce glasses owater each hour or 2 hours

ask about taking a bath or using awarm, damp washcloth to relievethe burning eeling

report any problems, such as

bloody urine that lasts morethan 24 hours ater the test

severe pain

chills

ever



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Hope through ResearchThe National Institute o Diabetes andDigestive and Kidney Diseases (NIDDK)has many research programs aimed atunderstanding kidney and urologic disorders,including urinary stones, enlarged prostate,urinary incontinence, and kidney ailure.The NIDDK sponsors researchers develop-ing advanced diagnostic equipment, such ascystoscopes that can examine bladder tissueat the microscopic level. This technologymay in some cases eliminate the need orbiopsy.

Participants in clinical trials can play a moreactive role in their own health care, gainaccess to new research treatments beorethey are widely available, and help others bycontributing to medical research. For inor-mation about current studies, visitwww.ClinicalTrials.gov.For More Information

American Urological Association Foundation1000 Corporate BoulevardLinthicum, MD 21090Phone: 1866RINGAUA (18667464282)

or 4106893700Fax: 4106893800Email: [email protected]: www.UrologyHealth.org

Interstitial Cystitis Association

110 North Washington Street, Suite 340Rockville, MD 20850

Phone: 1800HELPICA (18004357422)or 3016105300Fax: 3016105308Email: [email protected]: www.ichelp.org

AcknowledgmentsPublications produced by the Clearinghouseare careully reviewed by both NIDDKscientists and outside experts. This publica-tion was originally reviewed by Michael B.Chancellor, M.D., University o PittsburghMedical Center, and William D. Steers,M.D., University o Virginia.

You may also fnd additional inormation about thistopic by visiting MedlinePlus at www.medlineplus.gov.This publication may contain inormation about medications. When prepared, this publicationincluded the most current inormation available. For updates or or questions about any medications,contact the U.S. Food and Drug Administrationtoll-ree at 1888INFOFDA (18884636332) or visitwww.fda.gov. Consult your doctor or more inormation.



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National Kidney andUrologic DiseasesInformation Clearinghouse

3 Inormation WayBethesda, MD 208923580Phone: 18008915390TTY: 18665691162Fax: 7037384929Email: [email protected]: www.kidney.niddk.nih.gov

The National Kidney and Urologic DiseasesInormation Clearinghouse (NKUDIC)is a service o the National Institute oDiabetes and Digestive and Kidney Diseases(NIDDK). The NIDDK is part o theNational Institutes o Health o the U.S.Department o Health and Human Services.Established in 1987, the Clearinghouseprovides inormation about diseases o thekidneys and urologic system to people withkidney and urologic disorders and to theiramilies, health care proessionals, and the

public. The NKUDIC answers inquiries,develops and distributes publications, and

works closely with proessional and patientorganizations and Government agenciesto coordinate resources about kidney andurologic diseases.

This publication is not copyrighted. The Clearinghouseencourages users o this publication to duplicate anddistribute as many copies as desired.

This publication is available atwww.kidney.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICESNational Institutes of Health

NIH Publication No. 094800

August 2009

cystoscopy 508

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