cystourethroscopy. cystoscopy cystoscopy indications for cystoscopy hematuria recurrent infections...
TRANSCRIPT
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CystourethroscopyCystourethroscopy
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CystoscopyCystoscopy
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CystoscopyCystoscopy
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Indications for CystoscopyIndications for Cystoscopy
• Hematuria
• Recurrent infections
• Voiding dysfunction
• After reconstructive pelvic surgery
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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
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CystoscopeCystoscope
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Operative ScopeOperative Scope
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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
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BridgesBridges
• Has ports for introduction of instruments
• May have a deflector mechanism
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Light SourcesLight Sources
• High intesnity (Xenon ) light sources are best
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Scope and light cordScope and light cord
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Distending MediumDistending Medium
• Water of Saline are most common
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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
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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
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AntibioticsAntibiotics
• Antibiotics may be given but not proven to make a difference
• 5% will demonstrate a UTI
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Normal UrethraNormal Urethra
• Urethral mucosa is pink
• UVJ is irregular but rounded in shape
• UVJ should close with “hold maneuvers”
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UV JunctionUV Junction
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UV JunctionUV Junction
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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
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Normal BladderNormal Bladder
• Surface should be pale and smooth
• Submucosal vasculature should be regularly branching
• Trigones should be slightly more red and granular
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Bladder domeBladder dome
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Ureteral OrificesUreteral Orifices
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Ureteral OrificeUreteral Orifice
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Ureteral OrificeUreteral Orifice
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Abnormal Cystoscopic FindingsAbnormal Cystoscopic Findings
• Peach colored macules or papules
• Active bleeding
• Polyps
• Glomerulations
• Trabeculations
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InflammationInflammation
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HypervascularityHypervascularity
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PunctationsPunctations
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TrabeculationTrabeculation
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TrabeculationsTrabeculations
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MetaplasiaMetaplasia
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MetaplasiaMetaplasia
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Interstitial CystitisInterstitial Cystitis
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• Thank you for your attention!!!
Questions??????