Photo by Julianne Blair

Cystinuria is an awful disease from start to finish. It can be difficult to diagnose, and getting the stones out can be tricky and usually includes major surgery and a bloody recovery. But a procedure called cystoscopy can make both the diagnosis and treatment of cystinuria easier and less risky.

Cystoscopy isn’t new—it’s been performed in people for more than 100 years—but has only been used in veterinary medicine relatively recently and is only available at some specialty hospitals. Cystoscopy is used to get a direct look at the urinary tract, just like colonscopy is used to look at the intestinal tract. With cystoscopy, a veterinary specialist threads a thin, lighted tube with a camera at its tip up the dog’s urethra and into the bladder. Like colonscopy, cystoscopy does not require surgery, although it does require anesthesia.

For cystinuria, cystoscopy can be used in several ways. First, it can be used to confirm that bladder stones are present. As many of us know, cystine stones can be very difficult to find. They often do not show up on x-rays; in fact, a 2025 article reports that vets miss cystine stones on x-ray two out of three times, even if they are looking for bladder stones.

Ultrasound is better at showing cystine stones in the bladder, but if the stones are in the urethra, “all bets are off,” writes Joseph M. Bruner, DVM, ACVIM (SAIM), Clinical Assistant Professor at the University of Illinois College of Veterinary Medicine, who provided information for this article. Cystoscopy can definitively show bladder stones both in the bladder and urethra.

So, if you have a dog with symptoms that quack like bladder stones, and act like bladder stones, but no stones are seen on x-ray or ultrasound, cystoscopy is a direct way to find out if stones are there.  

If bladder stones are present, then the veterinarian can use cystoscopy to collect a stone sample for analysis. That way, you can know if the stones are made of cystine before deciding to neuter your dog, so your dog only has to go through one surgery (for neutering).

But cystoscopy can do so much more. When bladder stones are present, the veterinarian using the cystoscope can thread a laser fiber through the scope and use laser light to break the stones apart (laser lithotripsy), thus avoid having to surgically remove the stones. Diagnosis and lithotripsy can be done during the same procedure.

Lithotripsy is especially effective in cases of cystinuria. According to Dr. Bruner, “Cystine stones are very easily shattered by laser lithotripsy. Unlike CaOxalate or struvite stones, cystine stones are inherently ‘soft’ in the crystalline matrix and easily break on laser energy application. I love cystine stones. It is so easy and I’m in and out in 30 minutes (which is not true with the other stones).”

Lithotripsy can be effective even if the stone is stuck to the bladder wall (mucosa) because the cystoscope operator often can grasp and dislodge the stone with the cystoscope and then disintegrate it with laser lithotripsy. However, if the bladder wall has grown around a stone and the stone is IMBEDDED into the wall, then surgery is the only option.

Cystoscopy and laser lithotripsy cost about the same as surgical removal. However, for most dogs, cystoscopy is a same-day procedure—the dog only needs to wake up from the anesthesia, and usually no overnight stay is needed. And the recovery is minimal, which is in direct contrast to surgery.

Not all specialty practices perform cystoscopies and lithotripsy, so if you want to take advantage of this procedure, you have to plan ahead. The American Society of Veterinary Nephrology and Urology maintains a list of facilities that can perform advanced urological procedures (which are listed under each institution). This list can get you started, but it isn’t complete, so if there is nothing on the list near you, contact the specialty hospitals in your area to see which ones do cystoscopies and laser lithotripsy so you know where to head in the event that your dog has a blockage or develops cystinuria symptoms.

Dr. Bruner writes, “With the newer urethrocystoscopes available, we are able to do cystoscopy and laser ablation [lithotripsy] on both male and female Deerhounds without surgical intervention. We can get all the way up into the urinary bladder… but more importantly, we have scopes small enough to get into their urethras and prostates. Technology is doing a lot better.”

We are all looking for the day when the genetic mutation that causes cystinuria in our breed is found and we can work to reduce or eliminate cystinuria from the breed, so that no Deerhound male has to suffer from this condition. In the meantime, cystoscopy is potentially helpful for both diagnosis and treatment.