Cystoscopy and ureteroscopy are diagnostic or therapeutic procedures, usually performed by urologists, or doctors who specialize in diseases of the urinary tract. These procedures use endoscopes to look into the organs of interest, and they are aimed at direct visualization of the interior of the ureters and the bladder in order to diagnose (and sometimes treat) urinary complaints.

Cystoscopy

Cystoscopy is a procedure that uses a long, thin optical instrument (also known as cystoscope), with an eyepiece and a small lighted lens at either end, connected by a tube. The tube may be either rigid or flexible, depending on whether it will be used for diagnosis or for treatment. The cystoscope transmits clear and detailed images of the inner mucous membrane that lines the urinary bladder and the urethra. A cystoscopy is performed to find the cause of conditions such as:

• Recurrent or chronic urinary tract infections
• Hematuria
• Urinary frequency
• Urinary urgency
• Urinary retention after voiding
• Urinary incontinence
• Dysuria
• Problems with initiating or completing urination
• Atypical cells found on urinalysis

Issues which can be picked up by cystoscopy include:

• Bladder stones
• Abnormal growths such as tissue, polyps or tumors
• Strictures of the urethra, as for instance, due to prostatic hypertrophy or urethral scarring

Cystoscopy may also be used to treat some problems, such as:

• Bladder or urethral stone
• Plugging a bleeding point in the bladder
• Removal of small tumors or growths
• Urethral or bladder biopsy
• Treatment of urinary leakage by injecting filler material
• Obtaining urine for testing from the ureters
• Removal of a stent from the ureter
• Retrograde pyelography which helps visualize urinary flow or obstruction

Ureteroscopy

Ureteroscopy is a method that uses ureteroscope, which is similar to a cystoscope, but still longer and thinner, so that it can be introduced into the ureters through the openings where they communicate with the bladder. It allows the urologist to see the interior of the kidneys and the ureters.

The main indications for ureteroscopy are:

• Evaluating the cause of urinary obstruction such as stones, tumors or growths
• Looking for other abnormalities of the ureters or kidneys
• The biopsy of ureter or kidney

After ureteroscopy occasional swelling of the ureter is observed. A small soft tube may be placed inside the ureter to ensure the free flow of urine while the edema goes down. The stent may remain in place for a few days, and may cause mild discomfort in the area of the kidney or bladder. Its removal may require a cystoscopy.

Both cystoscopy and ureteroscopy usually take less than half an hour, unless a treatment procedure is included. Ureteroscopy is done under sedation and general anesthesia. Cystoscopy may be done under sedation, while general anesthesia is required for cystoscopy with biopsy, and cystoscopy used to inject filler or medications into the bladder wall.

What to expect afterwards and what are the risks?

The following may be expected after either of these tests:

• Mild burning in the kidney or bladder area – especially during urination
• Insignificant bleeding in urine
• Urgency or frequency of urine

Such symptoms may be alleviated by fomentation of the urethral orifice with a warm, damp soft cloth, and by increasing the fluid intake for two hours after the procedure.

Like any test which involves entry into the body spaces, cystoscopy and ureteroscopy carry some risks, most notably:

• Urinary infections
• Excessive bleeding
• Pain
• Difficulty with urination due to the burning sensation
• Injury to nearby organs
• Urethral stricture due to scarring
• Retention of urine due to urethral swelling
• Anesthetic complications