CystourethroscopyCystourethroscopy

CystoscopyCystoscopy

CystoscopyCystoscopy

Indications for CystoscopyIndications for Cystoscopy

• Hematuria

• Recurrent infections

• Voiding dysfunction

• After reconstructive pelvic surgery

EquipmentEquipment

• Telescope: 0 degree—best for urethra

• 30 degree –forward oblique view, best for bladder base and posterior wall

• 70 degree– lateral angle view, best for anteriolateral walls. Best general instrument

CystoscopeCystoscope

Operative ScopeOperative Scope

SheathsSheaths• 15 French– fluid flow is minimal

• 24 French--better for operative procedures

(one French is .33 mm)

• Sheath has two irrigating ports

• Sheaths range from 15-28 French

BridgesBridges

• Has ports for introduction of instruments

• May have a deflector mechanism

Light SourcesLight Sources

• High intesnity (Xenon ) light sources are best

Scope and light cordScope and light cord

Distending MediumDistending Medium

• Water of Saline are most common

Technique UrethroscopyTechnique Urethroscopy

• Scope placed into the urethra with fluid flowing to visualize the urethra and entrance into the bladder

• Observe the UVJ during a Valsalva Maneuver

• Observe closing of the UVJ

CystoscopyCystoscopy

• Generally performed with a 70 degree scope

• Obtorator generally not necessary if fluid flow is sufficient

• Begin at bladder dome (bubble)

• Full sweeps at 12, 4, 8, 12 o’clock

• Posterior bladder between 5 and 7 o’clock

• Observe trigones and ureteral orafaces

AntibioticsAntibiotics

• Antibiotics may be given but not proven to make a difference

• 5% will demonstrate a UTI

Normal UrethraNormal Urethra

• Urethral mucosa is pink

• UVJ is irregular but rounded in shape

• UVJ should close with “hold maneuvers”

UV JunctionUV Junction

UV JunctionUV Junction

Abnormal Urethral FindingsAbnormal Urethral Findings

• Urethritis looks red and may bleed

• Polyps do not often require treatment

• The urethra should not look scarred

• It should move with maneuvers

Normal BladderNormal Bladder

• Surface should be pale and smooth

• Submucosal vasculature should be regularly branching

• Trigones should be slightly more red and granular

Bladder domeBladder dome

Ureteral OrificesUreteral Orifices

Ureteral OrificeUreteral Orifice

Ureteral OrificeUreteral Orifice

Abnormal Cystoscopic FindingsAbnormal Cystoscopic Findings

• Peach colored macules or papules

• Active bleeding

• Polyps

• Glomerulations

• Trabeculations

InflammationInflammation

HypervascularityHypervascularity

PunctationsPunctations

TrabeculationTrabeculation

TrabeculationsTrabeculations

MetaplasiaMetaplasia

MetaplasiaMetaplasia

Interstitial CystitisInterstitial Cystitis

• Thank you for your attention!!!

Questions??????