The goals of testing are two-fold. The first is to determine if there is an abnormality of the bladder and the second is to evaluate the upper urinary tract (kidneys, ureters which are the tubes that carry the urine to the bladder). A cystocope is used to look at the bladder. This visual check of the bladder is done with a fiber optic camera. The upper urinary tracts are reviewed with imaging such as an ultrasound or CT scan.
Doctors use guidelines about the risks to decide what kind of testing is needed for each person. A person at low risk may be able to avoid a lot of testing since their risk for cancer is low. A person at high risk needs a more in-depth testing.
Since patients at low risk rarely have cancer, doctors will likely discuss the benefits and drawbacks of more testing. A common option is to repeat a urine test within 6 months. If that test shows blood in the urine, then more testing is performed. If the repeat test does not show blood, then the patient is simply watched for symptoms. If the patient prefers testing right away, then a cystoscopy and renal ultrasound may be performed.
Patients who are told they have an intermediate risk will be recommended to have a cystoscopy procedure to look at the bladder and a renal ultrasound to look at the kidneys.
Those who are at high risk often have a have test with a cystoscope to look at the bladder and a computed tomography (CT scan) of the abdomen and pelvis to look at the lining of the urinary tract. The main difference between a CT scan and ultrasound is that the CT scan can find small abnormalities in the kidney and ureters that may be missed by ultrasound.