A non invasive procedure to visualize the lower urinary tract system. Mainly credited to Kelly for developing the female cystoscopy. Hopkin’s introduce the fiberoptic telescopy in 1950’s.
Cystoscopy divided into:
- Urethroscopy
- Rigid cystoscopy
- Flexible cystoscopy
- Telescopy ( 0, 30, 70
degrees)
- Sheathes
- Bridges
- Rigid cystoscopy
- Distension media: Water or
Normal saline
- Other accessory instruments: biopsy forceps, grasping forceps, scissors, stone crusher, Ellipe hydrostatic bottle, electrocautery system.
Indications: Diagnostic or operative
Diagnostic: Investigative and diagnostic tool for symptoms & signs for urinary problems
- Investigation for microscopic or gross haematuria
- Infection ( acute or chronic, recurrent)
- Inflammation like Interstitial cystitis, radiation cystitis
- Overactive bladder symptoms
- Voiding dysfunction symptoms
- Suspected fistulas
- Assessment for staging of cervical cancer
Operative Procedures: Treat bladder conditions or diseases
- Periurethral collagen
injection for USI/ ISD
- Intravesicle injections of
steroids, botox for intractable DI/ IC
- Removal of small bladder
calculi
- Removal of foreign bodies
like sutures, tape/mesh, polyps & masses
- Biopsy of abnormal area / tumors
Procedure: https://www.youtube.com/watch?v=pjfXBximSBQ
Cystoscopy may be done using a local anesthetic using lignocaine jelly, under sedation or under general anesthesia in some cases esp patients requiring operative procedure
- Prior to cystoscopy, empty the bladder
- Assemble cystoscopy as required flexible or rigid (need to assemble the outer sheath, telescope & the bridge)
- Test the cystoscopy system in good working condition & white- balance it.
- Introduce the cystoscopy with slow water flow to expel any air & to facilitate the introduction of the tip of scope smoothly through the external meatus & the urethra. inflate the bladder with NS/water up to 200-400mls to get full view of the bladder.
- Inspect the bladder systematically from the doom & walk through the bladder in clock wise manner.
- look for the ureteric orifices & trigon area. The distance between the 2 ureteric orifices is about 4 cm
- inspect the bladder neck & as the scope is withdrawn, inspect the urethra ( usually abloy 4cm length)
- After the procedure, empty the bladder & apply local anaesthetic gels.
Normal appearance on cystoscopy
Complications:
- Injuries to the urethra, bladder wall
- Bladder perforation
- Bladder infection 3-5%
- Bleeding esp after biopsies/ operative procedures
- Pain
Reporting the findings:
Normal appearance of the bladder; the dome with bubble, bothe the ureteric orifices, trigon area & the bladder neck
Rain drop sign as in Interstitial cystitis
Foreign body- mesh /TVT tape, stone
Bladder perforation:
Bladder Polyp
Disclaimers: some pictures & video was uploaded from you-tube & google images
The above article is for teaching purpose
I would like to pay credit to all the contributors for the above pictures & videos
consent for exhibition of the pictures & video has been obtain from the patients
1. https://www.youtube.com/watch?v=q1gDwLaz8oI
