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Cystoscopy and ureteroscopy

A cystoscopy is a procedure that lets the doctor look at, take samples from or treat problems in the bladder and urethra. The doctor uses an endoscope (called a cystoscope) with a camera on the end. The cystoscope can be straight and stiff (called a rigid cystoscope) or it can bend (called a flexible cystoscope). Doctors most often use a flexible cystoscope. They may need to use a rigid cystoscope, which has more tools for different procedures.

Ureteroscopy uses a flexible endoscope (called a ureteroscope) to examine the ureters and renal pelvis in the kidney, as well as the prostate gland in men. The ureteroscope is smaller and thinner than a cystoscope.

Why a cystoscopy or ureteroscopy is done

A cystoscopy or ureteroscopy may be done to:

  • look for problems that cause blood in the urine (called hematuria), frequent urinary tract infections, pain while urinating or a frequent and urgent need to urinate
  • follow up when abnormal cells are found in a urine sample
  • find a blockage or a narrowing of the urethra or ureters
  • put in special tubes (called stents) to help urine flow from the kidneys to the bladder
  • look for and remove polyps, stones or tumours
  • collect biopsy samples for diagnosis
  • examine the prostate in men
  • diagnose cancer that has grown into the bladder wall (called invasive bladder cancer)
  • follow up after being treated for bladder cancer

How a cystoscopy or ureteroscopy is done

These tests are done in a hospital on an outpatient basis. Depending on what doctors need to do during the test, it can take 15–30 minutes.

Your healthcare team may ask you to do special preparation before having a cystoscopy or ureteroscopy. These tests cannot be done if you have a urinary tract infection. The healthcare team will ask you for a urine sample and will test it for infection before the procedure.

You will need to take off your clothes and put on a gown to wear during the test. The healthcare team may offer you a sedative to help you relax.

To begin, you lie on your back with your knees bent and legs open. The doctor puts a numbing jelly into the opening of the urethra (at the end of the penis in men and just above the vagina in women). This will help the doctor to put the scope into the urethra with as little discomfort as possible. If the doctor needs to use a rigid cystoscope, you may be given a general or regional (spinal) anesthetic.

During the procedure, the doctor gently pushes the scope up the urethra and into the bladder. To help the doctor see the bladder more clearly, it is filled with water through the cystoscope. Having a full bladder makes you want to urinate, which may be uncomfortable.

The doctor will carefully examine the bladder and look for any abnormal areas. The doctor may also pass instruments through the scope to collect biopsy samples, to remove polyps or stones and to open blockages.

A ureterscopy is done much like a cystoscopy, except the doctor will look at the ureters and renal pelvis.

After the doctor is finished the exam, the cystoscope is removed, and you can empty your bladder. If you were given a sedative, you need to wait for 12 hours before you can drive. Even if you don’t have a sedative, it’s a good idea to have someone drive you home. Make sure you drink 6–8 glasses of water a day for a week to 10 days after the test to help reduce side effects.

Side effects

Cystoscopy or ureteroscopy usually doesn’t cause any serious side effects. It is normal to see a small amount of blood in your urine after the procedure. Tell your healthcare team if you still have blood in your urine after you’ve urinated 3 times or if your urine starts to smell unpleasant or turns cloudy.

Cystoscopy may also cause:

  • bladder cramping
  • burning feeling during urination
  • severe pain during urination
  • frequent need to urinate
  • difficulty urinating because of blood clots
  • chills, fever and back pain, which are symptoms of infection

What the results mean

An abnormal result may mean:

  • bladder cancer
  • bladder stones or polyps
  • prostatitis
  • benign prostate hyperplasia
  • ureteral abnormalities such as a narrowing, or stricture
  • blockage of the ureters
  • an abnormal opening between the bladder and other organs (called a fistula)
  • small bulging pouches on the urethra (diverticula)

What happens if a change or abnormality is found

Based on the results of the cystoscopy or ureteroscopy, your healthcare team will decide if you need to have more tests, procedures, follow-up care or treatment. The doctor will send biopsy samples and polyps removed during the test to the pathology lab. A pathologist will look at the sample to see if there are cancer cells in it. If cancer is found, you will have more tests to help your healthcare team find out the type of cancer and how advanced it is.

Special considerations for children

A child may need to have a cystoscopy or ureteroscopy to look for any abnormalities in the urinary tract or to find what is causing an inability to control bowel movements or urination (called incontinence) during the day. The test is done in an operating room while the child is under general anesthesia.

Preparing children before a test or procedure can lower anxiety, increase cooperation and help them develop coping skills. Preparation includes explaining what will happen during the test, including what they will see, feel and hear.

The preparation for cystoscopy depends on the age and experience of the child. Find out more age-specific information to help children cope with tests and treatment.

endoscope

A thin, tube-like instrument with a light and lens used to examine or treat organs or structures in the body.

An endoscope can be flexible or rigid. It may have a tool to remove tissue for examination. Specialized endoscopes may have tools designed to examine or treat specific organs or structures in the body.

Specialized endoscopes are named for the organ or structure they are used to examine or treat.

ureter

The tube that carries urine from the kidney to the bladder.

renal pelvis

The centre part of the kidney where urine collects and is funnelled into the ureter (the tube that carries urine from the kidney to the bladder).

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