CYSTOSCOPY

The endoscopical inspection of the lower urinary tract is called cystoscopy. It requires illumination, irrigation and optics.
A systemic approach is required when evaluating the urethra, prostate, bladder walls, dome, neck and urethral orifices cystoscopically.

Indication:
Direct visualization of the anterior and posterior urethra, bladder neck, and bladder.
Diagnosis of lower urinary tract disease.
To directly visualize the lower urinary tract anatomy and microscopic pathology
Both cytologic and histologic examination can be abtained cystoscopically.
Gross haematuria
Evaluation of voiding symptoms(obstructive and irritative)
Antibiotic :
Inj. Gentamycin 80mg /inj.cefotaxim 1gm iv

Anaesthesia
Under spinal anaesthesia
Position
The patient positioned on the operating table in a comfortable lithotomy position

Patient preparation:
It must be ensured that the patient does not have on UTI before cystoscopy.

Skin preparation
The skin is usually cleaned with an antimicrobial solution (eg.betadine solution)
In women:
Begin from the umbilical region, covering the pubic area, the inner thighs, the vaginal vault, cervix, perineum and anus.
In men
Begin from the umbilical region, covering the pubic area, the inner thighs, the scrotum and anus.

Draping
1 small drape sheet under the thighs
2 leggings, one for each leg
1 small sheet over the abdomen

Things for the procedure
Instrumentation for the procedure
Cystoscopy sheath with obturator 17fr/20fr/22fr
Telescope 0 degree and 30 degree
Bridge
Endo camera
Light source cable
Biopsy forceps
Bug bee
Urethral dilators




Miscellaneous things
Xylocaine jelly 2%
Disposable syringe 10ml
i.v.set
normal saline 1 litre bottle
foleys catheter 16fr
urobag
procedure:
Any urologic irrigants can be used for cystoscopy most often sterile water (or) saline is used.
If electrocoagulation is planned, it is necessary to avoid solutions containing electrolytes.
The choice of an endoscope with respect to size should be the same as for catheter size.
If diagnostic cystoscopy is performed a small instrument of 16fr/17fr is adequate and the larger endoscope is chosen for biopsy devices.
Systematic inspection of the entire urethra and bladder should be performed
during cystoscopy.
Before insertion of the instrument the urethral meatus should be inspected and meatatomy or dilatation should be performed if the meatal

size appears inadequate to accept the endoscope
The sheath of the cystoscopy is generally lubricant and the endoscope can be passed under direct vision with a 0 and 30 degree telescope.
In male, the penis should be grasped and straightend and the endoscope is passed through the fossa navicularis and the instrument is

generally passed after inspecting the anterior urethra
If there is resistence to the passage of the endoscope a smaller instrument should be passed or the urethra should be dilated
After entering the bulbar urethra the endoscope and penis are lowered and the instrument is passed into the membranous urethra
The external sphincter is identified and the scope is passed by the gentle pressure
Then, the instrument passes through the prastatic urethra and vermontanum
is noted, so that the prostatic urethra is inspected.
At the level of the bladder neck endoscpe is gently depressed in order to pass the instrument into the bladder over the bladder neck.
Inspection of the female urethra is easily performed by inserting endoscope under direct vision into the urethral meatus
After entering the bladder, the bladder surface , inter ureteric ridge, bladder neck along the trigone is inspected using the 30 degree

telescope after filling the bladder.
Using the 70-90 degree lens the lateral walls of the bladder finally, the dome and anterior bladder wall are evaluated
After complete inspection of the urethra and bladder the bladder is drained and the instrument is generally removed.