Endoscopy of the urinary tract remains the cornerstone of urological therapy. Over the years, continued refinement of the endoscopic instruments has permitted a progressive increase in the number and methods of their application. The development of the smaller diameter, flexible endoscopes represents the greatest advance in urological endoscopy. Their characteristics permit greater versatility with less traumatic procedures, increasing patient comfort and minimizing iatrogenic injury. Spinal cord injury (SCI) patients are a select group, which require special attention when undergoing endoscopic procedures. Often a contracted bladder or poorly controlled muscle spasms make the SCI patient difficult to endoscopic using conventional rigid instruments. Furthermore, autonomic dysreflexia is a significant concern during traumatic urinary tract instrumentation. This communication will discuss the applications of flexible cystoscopy, including novel techniques, which can be useful in SCI patients.