Ureteroscopy and Cystourethroscopy: Indications and Risks

The urinary system of your body consists of the kidney, a pair of ureter which connects the kidney to the urinary bladder and a urethra which carries the urine out from the bladder. A Cystourethroscopy is used to visualise the urethra and the bladder while an Ureteroscopy is used to look inside the urethra and the kidney. These procedures can be used for diagnostic and therapeutic purposes.

Procedure

An urologist will perform the cystourethroscopy or the ureteroscopy on an out patient basis. Your urologist will either apply an anaesthetic gel around the opening of the urethra or inject anaesthetic inside it. For some procedures like ureteroscopy, or a procedure requiring injection of medication into the wall of the urethra or the bladder, or taking a piece of tissue from the bladder or the urethra; you will be given a sedative and general anaesthesia. These will be given via an intravenous line. After the medications have taken effect a thin tube-like instrument with a camera and light source at its tip; a cystourethroscopy or a ureteroscope is inserted into your urethra. A sterile fluid is passed through the instrument which fills the bladder, this helps in better visualisation.

For a cystourethroscopy, the urologist will examine the lining of the bladder and the urethra. The urologist might ask you to bear down, and perform a valsalva manoeuvre to help in the diagnosis of incontinence. If a suspicious mass of tissue is encountered your doctor might take a piece for further evaluation by a pathologist. Stones in the bladder can be removed simultaneously. Medication can be injected in the wall of the urethra and the bladder as treatment for incontinence.

For ureteroscopy, the urologist will extend the instrument into the ureters up till the kidney. A biopsy can be taken to examine suspicious tissue. Your urologist can also remove a stone, dilate a stricture, and remove polyps or some types of tumours from the kidney and the ureters. After a ureteroscopy, a stent may be placed in the ureter to drain urine form the kidney to the bladder until the inflammation in the ureter subsides.

Indications for Ureteroscopy

Cystourethroscopy and ureteroscopy are performed for diagnosis and treatment of problems in the urethra, urinary bladder, ureter and kidney.

Cystourethroscopy is done for:

• Blood in urine
• Frequent infection of urinary tract leading to painful urination
• Urinary incontinence
• Urinary frequency: need to urinate more than eight times a day
• Urinary urgency
• Urinary retention
• Abnormal cells found in urine sample

Ureteroscopy is done for:

• Evaluating the cause of urinary obstruction
• Diagnose the problem in the ureter or the kidney

Preparation

To prepare for the procedure your doctor might ask you to drink plenty of water before the test. You will be asked to urinate before the procedure. Women will be asked to lie on the examination table with their knees bent and apart while men may sit upright during the procedure. Your doctor would like to know about the medications that you are taking and may ask you to stop taking some of them like blood thinners. Inform your doctor about any allergy that you might have to local anaesthetic of sedatives. It is advisable to arrange for someone to drive you home after the procedure.

Risks of Ureteroscopy

The complications following the procedure can be:

• Painful urination
• Blood in urine
• Difficulty in urination due to swelling of tissue
• Stricture formation in the urethra leading to narrowing
• Urinary tract infection
• Damage to ureter or bladder
• Abdominal pain
• Adverse reaction to the anaesthetic or sedative.

Recovery

You will be free to go home as soon as the effect of the sedative start to wear off. You might see blood in urine and experience discomfort while urination; these symptoms will resolve on 24 hours. Your doctor will advise you to drink plenty of water after the procedure. Taking a bath with warm water will help in alleviating the burning sensation. You may take an over-the-counter pain relief medication. On experience any of the following you ought to contact your healthcare provider immediately:

• Fever with or without chills
• Blood  or blood clots in urine
• Painful urination for more than two days
• Inability to urinate.

Resources:

• National Institute of Diabetes and Digestive and Kidney Diseases
• American Urological Association