Cystoscopy & Ureteroscopy: Purpose, Preparation, Procedure and Risk


Cystoscopy and ureteroscopy are common procedures performed by a urologist to look inside the urinary tract.

August 31, 2018

Cystoscopy and ureteroscopy are common procedures performed by a urologist to look inside the urinary tract. A urologist is a doctor who specializes in urinary tract problems.
A cystoscope can be used during a cystoscopy to look inside the urethra and bladder. A cystoscope is a long, thin optical instrument with an eyepiece at one end, a rigid or flexible tube in the middle, and a tiny lens and light at the other end of the tube. The urologist can see detailed images of the lining of the urethra and bladder by looking through the cystoscope. The urethra and bladder are part of the urinary tract.
Ureteroscope can be used during a ureteroscopy to look inside the ureters and kidneys. Like a cystoscope, a ureteroscope has an eyepiece at one end, a rigid or flexible tube in the middle, and a tiny lens and light at the other end of the tube. However, a ureteroscope is longer and thinner than a cystoscope so the urologist can see detailed images of the lining of the ureters and kidneys. The ureters and kidneys are also part of the urinary tract.

The urinary tract is the drainage system of body for removing urine, which is composed of wastes and extra fluid. All body parts in the urinary tract need to work together in the correct order for normal urination to occur. The urinary tract consist of kidneys, ureters and bladders.
  • The kidneys are two bean shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine. 
  • Ureters are the thin tubes of muscle, one on each side of the bladder that carry urine from each of the kidneys to the bladder.
  • The bladder is located in the pelvis between the pelvic bones. It is a hollow, muscular, balloon shaped organ that expands as it fills with urine. Although a person does not control kidney function, he/she can control the bladder function. Bladder emptying is known as urination. The bladder stores urine until the person finds an appropriate time and place to urinate. A normal bladder acts like a reservoir and can hold 1.5 to 2 cups of urine.

How often a person needs to urinate depends on how quickly the kidneys produce the urine that fills the bladder. The muscles of the bladder wall remain relaxed while the bladder fills with urine. Signals are sent to the brain as the bladder fills to capacity to empty it. The bladder empties through the urethra, located at the bottom of the bladder during urination.
There are 3 sets of muscles that work together to keep urine in the bladder. The first set is the muscles of the urethra itself. The area where the urethra joins the bladder is the bladder neck. The second set of muscles known as the internal sphincter which is located in the bladder neck that helps urine stay in the bladder. The third set of muscles is the pelvic floor muscles, also known as the external sphincter, which surround and support the urethra. The brain signals the muscular bladder wall to tighten, squeezing urine out of the bladder to urinate. At the same time, the brain signals the sphincters to relax. Urine exits the bladder through the urethra as the sphincters relax.

Purpose of a Cystoscopy & Ureteroscopy:

A Cystoscopy & Ureteroscopy is performed to find the cause of, and sometimes treat, urinary tract problems.

Cystoscopy:

A urologist performs a cystoscopy to find the cause of urinary tract problems such as

  • frequent urinary tract infections (UTIs)
  • hematuria, that is blood in the urine
  • urinary frequency, that is urination eight or more times a day
  • urinary retention which is the inability to empty the bladder completely
  • urinary urgency which is the inability to delay urination
  • urinary incontinence which is the accidental loss of urine
  • trouble starting urination, completing urination, or both
  • pain or burning before, during, or after urination
  • abnormal cells, such as cancer cells, found in a urine sample

During a cystoscopy, a urologist can see

  • stones or solid pieces of material in the bladder that may have formed in the kidneys or in the bladder when substances that are normally in the urine become highly concentrated.
  • abnormal tissue, polyps, tumors, or cancer in the urethra or bladder.
  • stricture, a narrowing of the urethra. Stricture can be a sign of an enlarged prostate in men or of scar tissue in the urethra.

During a cystoscopy, a urologist can treat problems such as bleeding in the bladder and blockage in the urethra. A cystoscopy is also used to

  • remove a stone in the bladder or urethra.
  • remove or treat abnormal tissue, polyps, and some types of tumors.
  • take small pieces of urethral or bladder tissue for examination with a microscope called a biopsy.
  • obtain urine samples from the ureters.
  • inject material into the wall of the urethra to treat urinary leakage.
  • inject medication into the bladder to treat urinary leakage.
  • perform retrograde pyelography which is an x-ray procedure in which a urologist injects a special dye, called contrast medium, into a ureter to the kidney to create images of urinary flow. The test can show causes of obstruction, such as kidney stones and tumors.
  • remove a stent that was placed in the ureter after a ureteroscopy with biopsy or stone removal. A stent is a small, soft tube.

Ureteroscopy:

A ureteroscopy is performed to find the cause of urine blockage in a ureter or to evaluate other abnormalities inside the ureters or kidneys.
During a ureteroscopy, a urologist can see

  • a stone in a ureter or kidney
  • abnormal tissue, polyps, tumors, or cancer in a ureter or in the lining of a kidney

During a ureteroscopy, a urologist can treat problems such as urine blockage in a ureter. The procedure can also be used to

  • remove a stone from a ureter or kidney
  • remove or treat abnormal tissue, polyps, and some types of tumors
  • perform a biopsy of a ureter or kidney

The urologist may need to place a stent in a ureter to drain urine from the kidney to the bladder after a ureteroscopy. The stent may cause some discomfort in the kidney or bladder area which is generally mild. The stent may be left in the ureter for a few days to a week or more. A cystoscopy may be performed to remove the stent in the ureter.

Preparation of a Cystoscopy & Ureteroscopy:

In most of the cases a patient does not need special preparations for a cystoscopy. A health care provider may ask the patient to drink plenty of liquids before the procedure, as well as urinate immediately before the procedure. The patient may need to give a urine sample to test for a UTI. UTI should be treated with antibiotics before performing a cystoscopy or ureteroscopy if a patient has infection.
The below instructions will be provided by the health care provider before the cystoscopy or ureteroscopy. These instructions may include

  • when to stop certain medications, such as blood thinners
  • when to stop eating and drinking
  • when to empty the bladder before the procedure
  • arranging for a ride home after the procedure

The medical history of patient, current prescription and over the counter medications, and allergies to medications, including anesthetics should be informed to the urologist before the procedure.

Procedure of a Cystoscopy & Ureteroscopy:

A cystoscopy or ureteroscopy is perforemed during an office visit or in an outpatient center or a hospital. The urologist will apply an anesthetic gel around the urethral opening or inject a local anesthetic into the urethra for some patient, while other patients may require sedation or general anesthesia. Sedatives and general anesthesia may be required for:

  • ureteroscopy
  • cystoscopy with biopsy
  • cystoscopy to inject material into the wall of the urethra
  • cystoscopy to inject medication into the bladder

An intravenous (IV) needle in a vein in the arm or hand can be placed by a nurse or technician to give the medication for sedation and general anesthesia. Sedation helps the patient relax and be comfortable. General anesthesia puts the patient into a deep sleep during the procedure. During both procedures, a woman will lie on her back with the knees up and spread apart. During a cystoscopy, a man can lie on his back or be in a sitting position. The urologist then gently inserts the tip of the cystoscope or ureteroscope into the urethra and slowly glides it through the urethra and into the bladder. A sterile liquid water or salt water, called saline, flows through the cystoscope or ureteroscope to slowly fill the bladder and stretch it so the urologist has a better view of the bladder wall. The patient may feel some discomfort and the urge to urinate as the bladder fills with liquid. Some of the liquid from the bladder may be removed by the urologist during the procedure. The urologist may remove the liquid from the bladder or the patient may empty the bladder as soon as the procedure is over.
The urologist examines the lining of the urethra as the cystoscope passes into the bladder in a cystoscopy. The lining of the bladder will be examined. A small instruments through the cystoscope can be inserted to treat problems in the urethra and bladder or perform a biopsy. The urologist passes the ureteroscope through the bladder and into a ureter for a ureteroscopy. The lining of the ureter can be examined and the ureteroscope will be passed all the way up into the kidney. A small instruments can be inserted through the ureteroscope to treat problems in the ureter or kidney or perform a biopsy.
Both procedures including preparation takes 15 to 30 minutes. If the urologist removes a stone in the bladder or a ureter or if he or she performs a biopsy, the time may be longer.
After a cystoscopy or ureteroscopy, a patient may

  • have a mild burning feeling when urinating
  • have mild discomfort in the bladder area or kidney area when urinating
  • need to urinate more frequently or urgently
  • see small amounts of blood in the urine

These problems should not last more than 24 hours. If bleeding or pain is severe or if problems last more than a day, the patient should tell a health care provider right away. The following things are recommended by a health care provider for a patient after the procedure:

  • drink 16 ounces of water each hour for 2 hours after the procedure
  • take a warm bath to relieve the burning feeling
  • hold a warm, damp washcloth over the urethral opening to relieve discomfort
  • take an over-the-counter pain reliever

An antibiotic can be prescribed to take for 1 or 2 days to prevent an infection. Any signs of infection including severe pain, chills, or fever should be reported right away to the health care provider.
Recovery depends on the type of anesthesia. A patient who receives only a local anesthetic can go home immediately while a patient who receives general anesthesia may have to wait 1 to 4 hours before going home. The patient is usually asked to urinate before leaving. The patient may need to stay overnight in the hospital in some cases. A health care provider will provide discharge instructions for rest, driving, and physical activities after the procedure.

Risk of a Cystoscopy & Ureteroscopy:

The risks of cystoscopy and ureteroscopy include:

  • UTIs
  • abdominal pain
  • abnormal bleeding
  • injury to the urethra, bladder, or ureters
  • a burning feeling or pain during urination
  • urethral narrowing due to scar tissue formation
  • the inability to urinate due to swelling of surrounding tissues
  • complications from anesthesia