hysterectomy is the second most frequent major surgical procedure among reproductive age women with approximately 600,000 hysterectomies performed annually in the united states . it is currently undisputed that cystoscopy is required after each hysterectomy to confirm the integrity of the urinary tract before leaving the operating room . we are reporting a case of asymptomatic bladder cancer discovered incidentally during a posthysterectomy cystoscopy . a 42 year old patient , gravida 0 , with a known fibroid uterus and history of menometrorrhagia is admitted for definitive surgical treatment . her endometrial biopsy shows mild endometrial hyperplasia and her pap smear is within normal limits . so , laparoscopic hysterectomy is performed with uterine morcellation and as routinely done at the end of the operation cystoscopy is performed . this reveals an exophytic bladder tumor above the ureteral orifice on the right side ( figure 1a ( fig . biopsies are taken with three passes of a cup biopsy forceps and sent for pathology . the bleeding site is fulgurated with point cautery using the 20/20 cautery setting which gives good hemostasis with no evidence of bladder injury ( figure 1b ( fig . papillary transitional cell carcinoma , histologic grade i with no evidence of invasion .  the specimen labeled  uterus and cervix because the bladder is the final storage cistern for excreted toxins , there are many risk factors for bladder cancer including smoking , occupational exposures , drinking water with arsenic contamination , chemo- and radiotherapy and chronic cystitis . the american cancer society estimates that 68,810 new cases of bladder cancer will be diagnosed in the united states during 2008 of which 14,100 people will die of the disease . the chance of a woman having this cancer is about 1 in 85 . for men , fortunately , most people with bladder cancer will not die of the disease . upon diagnosis , most patients have their cancer confined to the bladder ( 74% ) . in 19% of the cases , females , however , are approximately twice as likely as males to die from the disease because of delay in diagnosis . a conscientious gynecologist should not be timid about biopsying bladder abnormalities detected at the time of postoperative cystoscopy . superficial mucosal biopsies of papillary lesions will not bleed significantly and can yield important diagnostic information . it is easier to treat bladder cancer if it is caught early . at this point , there is insufficient evidence that a decrease in mortality from bladder cancer occurs with hematuria or urinary cytology testing . this case illustrates the additional merit of performing posthysterectomy cystoscopy as a screening test for bladder cancer .
it is currently undisputed that cystoscopy is required after each hysterectomy to confirm the integrity of the urinary tract before leaving the operating room . 
 sometimes , secondary findings are detected on cystoscopy like interstitial cystitis and exophytic tumors . 
 we are reporting a case of asymptomatic bladder cancer discovered incidentally during a posthysterectomy cystoscopy . 
 the chance of a woman having this cancer is about 1 in 85 . 
 this demonstrates the additional merit of performing cystoscopy after hysterectomy as a screening test for bladder cancer .