What Is a Cystourethroscopy?

Cystoscopy is a type of endoscope. Its shape is similar to that of a urethral probe. The electron microscope sheath, inspection scope, treatment and ureteral intubation scope, and the lens core constitute a set of four parts. Biopsy forceps and other accessories. In recent years, the lighting system of the cystoscope has changed. A cold light source box is provided. The reversed cold light is transmitted through the optical fiber to the inside of the bladder. It replaces the bulb lighting at the front end of the cystoscope sheath. It has good lighting and clear scenes. Dimming and other advantages.

Chinese name: Cystoscope
Foreign name: cystoscope

Category Name: Medical endoscope
Management category: Class II / III medical devices

Basic structure of cystoscope

Cystoscopy is a kind of optical endoscope with complicated structure. There are many types and different structures, but the main components are scabbard, endoscope, intubation scope, obturator, and accessories. ^{[1 ]} .

Cystoscopy sheath

Its function is to make the speculum be introduced smoothly, to flush the bladder and to provide a light source for illumination. The basic structure of a concave cystoscope and its name are three parts: the front end, the rod and the rear end. The front end is short, about 1.5 centimeters long, at an angle to the mirror rod. There are two types: concave and convex. The front end is the device part of the light source (and McCarthy cystoscope does not have a light source attached). The voltage of the light source bulb is fixed. 3 volts and 4.5 volts. A new type of cold light source fiber cystoscope in modern times uses a bromine tungsten lamp as the light source. A light guide fiber bundle is connected to the cystoscope, and then a light guide fixed in the mirror rod guides the light to the small front window of the sheath. Injected. Therefore, there is no bulb device at the front of the sheath, but the light is soft and extremely bright. This new type of light guide fiber cystoscope is also called a cold light source cystoscope because there is no light source at the front end and does not generate heat.

Inside the small window in the front of the ordinary cystoscope, there is a small tungsten light bulb. At the front end of the concave or convex mirror sheath, there is an oval-shaped small window equipped with sealed glass, and the light from the light bulb light source or the cold light source emerges from the small window, which is the illumination part of the field of vision. The top is a small metal screw cap that can be removed or tightened for replacement or inspection of the bulb. One end of the bulb is equipped with a tungsten wire, which is attached to the side of the metal pipe wall behind the bulb; this metal tube is insulated from the surroundings, but connected to an insulated metal wire; this insulated metal wire runs along the mirror rod and one pole at the rear The other end of the tungsten wire is in contact with the top metal cap, which is connected to the other end of the rear end by the mirror sheath itself ^[1] .

Cystoscope endoscope

It is the optical part of the cystoscope, which consists of multiple groups of magnifying lenses, such as objective lens, intermediate lens, eyepiece, and prism.

Objective lens
It is a plano-convex lens. The magnification of the objective lens and the diameter of the endoscope are the keys to determining the size of the inner field of view. If the magnification of the endoscope and the diameter of the endoscope increase, the internal field of view will also increase accordingly.
Middle mirror
In the early years, the direct speculum was simple in structure. There was only one intermediate mirror. The light reflected by the object required a longer tube diameter to reach the intermediate mirror. Most of the light was absorbed by the tube wall, so that the image of the object seen was blurred. In order to improve the shortcomings, modern cystoscopy has been composed of most of the re-enacted lenses (between the objective lens and the intermediate mirror Toyotomi), which minimizes the loss of luminosity, and pays attention to correcting chromatic aberration during production, and strives to achieve realistic image and color As usual.
eyepiece
It is also a plano-convex lens. After passing through the above-mentioned lenses, the object image forms a reduced and upright image before the eyepieces. A lens must be placed at the eyepiece for proper magnification to make the imaging clearer. The magnification of this lens is closely related to the disappearance of the amount of light. The larger the magnification, the more obvious the amount of light disappears. Generally, it is appropriate to magnify 10-20 times. Each type of cystoscope has its own magnification.
Triangular prism
Triangular prisms are used for endoscopes, which fundamentally change the shortcomings of large blind areas and small fields of view of direct cystoscopes. The prism used in the mirror is a right-angled triangular prism. The two short sides of the right angle are connected to the objective lens on one side and perpendicular to the mirror axis. The object image enters from a short edge, and is refracted into the speculum at a 90-degree angle through the long oblique surface. Through the middle mirror, the eyepiece is reflected into the field of vision, but the object image seen is upside-down and left-right reversed from the original object. Due to the continuous improvement of modern optical technology, various cystoscopes used in clinics are equipped with an Amici prism before the eyepiece.

In order to greatly eliminate the blind area during cystoscopy, in order to fully and correctly view the interior of the bladder, many authors have continuously improved on the basis of direct original speculums, and have designed and made various reflection angles. Different sight glasses, such as a 90-degree front-view mirror, a 115-degree front-view mirror, and a 25-degree reverse-view mirror. The surgeon can choose an appropriate reflection angle speculum according to the needs of the examination ^[1] .

Cystoscope ureteral intubation and surgical speculum

The optical structure principle of intubation and surgical speculum is exactly the same as that of inspection speculum, except that the field of view is smaller than that of inspection speculum. The front end of the intubation scope is equipped with a diverter, which can be lifted freely by a controller installed at the rear end: the direction of the ureteral catheter or surgical instrument can be changed at will according to the position of the ureteral orifice and the lesion. The rear end of the speculum is equipped with three small metal tubes. The two left and right small tube holes are used for ureteral intubation, and the larger tube hole in the middle can be used to insert various intravesical surgical instruments (such as electrocautery strips, foreign body forceps, biopsy forceps and scissors, etc.). A movable septum is attached to the endoscope for intubation, which can be installed during intubation inspection to prevent the left and right ureteral catheters from interlacing and bending. However, during surgery, it should be removed to enlarge the cavity and facilitate the accommodation of various surgical instruments ^[1] .

Cystoscope occluder

It is used for inserting the sheath and closing the window of the sheath, so that the cystoscope can be easily introduced or pulled out without damaging the urethral mucosa. The front of the obturator is often open with a small hole or slot. After the cystoscope is introduced into the bladder, urine overflows from the small hole or slot. The operator can use this to know whether the cystoscope has entered the bladder.

Cystoscopy accessory device

Each type of cystoscope has certain special accessories. Only the accessories inherent to general cystoscopy are described below:

Power supply wiring and plug switch: Usually, it can be connected to the cystoscope by the battery or power transformer through the power supply wiring. There are two types of latches: latch and rotary. Due to the different types of cystoscopes, the two types of latches are not interchangeable.
Rubber caps: there are big and small; some have holes, some have no holes, can be respectively put on the small metal tube at the back of the intubation scope to prevent water leakage.
Flusher: German-made Wolf cystoscope, using an automatic spring occluder mounted on the rear end of the sheath, which automatically closes when the scope is pulled out to prevent liquid from flowing out. You need to insert a metal flusher to fill or discharge. The British-made cystoscope flusher is installed on both sides of the rear end of the mirror sheath, and is connected by a three-way switch. During peeping, it can be flushed or discharged as desired, which is more convenient than Wolf cystoscope.
Cotton circle: The front end has a thread, which can be rolled up with cotton for cleaning or drying after cystoscope use.
Cold light source: Tungsten light box with bromine light source with brightness adjustment. After AC power is supplied, the bromine tungsten light can emit an extremely bright light source.
Beam guide: It is composed of countless tiny optical fibers, which is used to connect the cold light source and cystoscope, and transmits the extremely bright light to the front end of the cystoscope. It is an ideal lighting device in modern cystoscope ^[1] .

Cystoscopy indication

hematuria
Hematuria is one of the main clinical manifestations of many urogenital diseases. A large part of hematuria is a curable malignant tumor. The key lies in early detection, early diagnosis and timely treatment. Cystoscopy is of great significance in the diagnosis of hematuria.

Can find out the source of hematuria. Under direct vision, it can be seen whether the bleeding is from a lesion in the bladder or from the upper urinary tract. The latter can be determined by observing the color change of the urine ejected from the ureteral orifice.
Can identify the cause of hematuria. If it is bleeding in the bladder, it can not only clearly identify the bleeding site, but also often understand the cause of the bleeding. Even if the hematuria comes from the upper urinary tract, pelvic urine examination and retrograde pyelography can provide objective data for clinical diagnosis.

Urinary tract infection
All patients with urinary tract infections (including specific and non-specific infections) are not effective after anti-infective treatment; or those who have relapsed despite being cured are all subjects for cystoscopy.
Abnormal urination and dysfunction
Cystoscopy is especially important for adults or children with persistent urgency, frequent urination, or dysuria, especially when medications are difficult to see. Bladder mirroring (such as inflammation, ulcers, stones, or foreign bodies, deformities, etc.) combined with the results of retrograde pyelography (morphological changes or the appearance of destructive lesions) can provide extremely valuable clues for diagnosis.
For bladder system diseases
If there is a bleeding point or papilloma in the bladder, it can be treated with an electric cautery through cystoscope; the stones in the bladder can be crushed with a lithotripsy and washed out; small foreign bodies and diseased tissues in the bladder can be removed with forceps or biopsy; The ureteral orifice is narrow and can be cut through a cystoscope (or expanded with a dilator) ^[2] .

Cystoscopy contraindications

The urethra and bladder should not be examined during the acute inflammation period, because it can lead to the spread of inflammation, and the acute inflammation and congestion of the bladder can also make the lesions unclear.
Bladder volume is too small, below 60ml, indicating that the disease is serious, and patients can not tolerate this test, it is also likely to cause bladder rupture.
Phimosis, urethral stricture, incarceration of stones in the urethra, etc., can not be inserted into the cystoscope.
Bone and joint deformities cannot take lithotomy position.
Women's menstrual period or pregnancy for more than 3 months.
Patients with severely reduced renal function with signs of uremia, hypertension, and poor cardiac function ^[2] .

Preparation before cystoscopy

Cystoscopy can be sterilized by steam-sealing in 40% formalin (formaldehyde) solution for 20 minutes or soaking in 10% formalin solution for 20 minutes. The cystoscope cannot be sterilized by boiling method, alcohol, 0.1% new clean and soak method, so as not to damage the cystoscope.
The surgeon prepares to wash hands, wear disinfection clothes, and wear sterile gloves. Attention should be paid to the principles of aseptic operation to avoid complications such as iatrogenic urinary tract infections.
The patient is prepared to have the patient empty the bladder and take the lithotomy position. The vulva is sterilized with soapy water, sterile saline, and Syngel solution. Lay a sterile hole towel to expose the urethral opening.

Cystoscopy steps

Instrument preparation: Take out the disinfected speculum and various instruments, and wash the disinfection solution on the speculum with sterile saline. Check whether the eyepiece and objective lens are clear, adjust the height of the lens light, and apply sterilized glycerin on the outside of the lens sheath for smoothness. Liquid paraffin will form oil droplets in saline, which makes the vision unclear and affects the examination. It cannot be used. The ureteral catheter is inserted into the ureteral intubation scope in advance.
Before inserting a cystoscope, a male patient checks whether the urethra is normal or has stenosis, and then changes to a speculum and slowly pushes along the anterior wall of the urethra to the urethral membrane. In case of resistance, wait for a while and wait for the urethral sphincter. Relaxation can enter the bladder smoothly. Do not use violence when inserting, so as not to damage the urethra and form a false tract. It is easy for female patients to insert, but care should be taken not to insert the endoscope too deep, so as not to damage the bladder. If you use a concave mirror sheath, you need to rotate the cystoscope 180 °.
After examining the bladder and ureteral intubation endoscope into the bladder, the lens core is withdrawn to determine the residual urine volume. If the urine is turbid (severe hematuria, pyuria, or chyluria), it should be repeatedly washed until the fluid is clear, and then replaced in the inspection scope. Saline is filled into the bladder to gradually fill it to the extent that it does not cause the patient to feel a bladder (usually about 300ml). Withdraw the speculum slowly outward until you see the edge of the bladder neck. Push the endoscope into 2 ~ 3cm at the two lower corners of the bladder neck edge, you can see the ureteral intercondyle. At 5 o'clock to 7 o'clock on the clock and at the two ends of the ureter, the ureteral orifices on both sides can be found. If you observe carefully, you can see that the orifices have peristaltic urination, blood or chyle. Finally, all bladder should be examined systematically, comprehensively, from deep to shallow to avoid omissions.
If a ureteral intubation is needed, the ureteral intubation endoscope should be replaced, and the ureteral catheters No. 4 to 6 are inserted into the ureteral orifice until the renal pelvis, which is generally 25 to 27 cm deep. The back end of the ureter should be marked to distinguish left and right. If there is inflammation and congestion at the ureteral orifice that cannot be distinguished, indigo carmine solution can be injected intravenously, and the intubation can be guided by using the ureteral orifice to discharge blue.
After the cystoscopy and the ureteral catheter are inserted, insert the ureteral catheter into the bladder, and then withdraw from the cystoscope, and fix the ureteral catheter to the vulva with adhesive tape to prevent prolapse. The bladder operation must be gentle, and the examination time should not exceed 30 minutes.
Urine test Collect urine from the ureteral catheter for routine inspection, if necessary, for bacterial inspection and culture. When the urine is continuously dripping from the catheter quickly, such as suctioning urine from the catheter with a syringe, which can aspirate more than 10-20ml at a time, hydronephrosis should be suspected.
Renal function test If the indigo carmine test is not performed during the cystoscopy and the lateral renal function test is required, the phenol red or indigo carmine should be injected intravenously at the prescribed dose, and the color time and Concentration time.
Retrograde pyelography Connect the ureteral catheter to a syringe and inject contrast agent for pyelography. The commonly used contrast agent is a 12.5% sodium iodide solution, 5 to 10 ml on each side. The injection should be slow but useless. When the patient has low back pain, stop and maintain it immediately pressure.

Cystoscope anesthesia

Men use 5% to 10ml of 1% tetracaine to inject into the urethra and keep it for 10 minutes; women use cotton swabs to immerse 1% dicaine in the urethra for 10 minutes to achieve anesthesia. If necessary, anesthesia with cannabis or sacral canal block can be used.

Postoperative cystoscopy

Hematuria often occurs after cystoscopy, which is caused by intraoperative damage to the mucous membranes. It usually stops after 3 to 5 days.
Postoperative urethral pain can allow patients to drink more water and diuretic, and give analgesics, can be lightened after 1 to 2 days.
If aseptic operation is not strict, urinary tract infection, fever and low back pain will occur after operation, and antibiotics will be used to control it.
After cystoscopy, you must fill in the records you see.

Cystoscope cystoscope medical imaging workstation

Cystoscopy medical imaging workstation is also called "cystoscopy medical image management and transmission system". It consists of computer, printer, frame grabber and software. It mainly collects, prints, writes reports of cystoscopy images Archive, statistics and management of patient data. The main functions are as follows:

Digital acquisition to ensure clear and vivid images, support dual screen display;
With multiple image acquisition methods, foot switch acquisition, mouse acquisition;
Can measure length, perimeter, area, etc., the measured value is automatically placed;
Annotate any position, there are many methods, such as: text, arrow, box, line graph;
Editing reports is fast and convenient, with a large-capacity expert diagnosis thesaurus and templates, free editing and saving, handy;
Editing reports and collecting images can be performed simultaneously without affecting each other;
Report form can be set freely;
High-quality large-capacity dynamic video storage system;
High-speed photo quality printing with fast speed and clear images; free to make slideshows.
Perfect file management and statistics system:
The report is automatically generated in JPG format and stored, and the number of medical records is> 3 million;
Multiple query methods, including name, age, location, check number, department, etc.
Statistics of sent doctors, statistics of charges, diagnostic doctors, workload statistics, etc.
Multiple image workstations can be connected to form a network system;
Optional "Benin Demonstration and Broadcasting System" is optional for convenient teaching.

Cystoscopy considerations

In acute cystitis, cystoscopy should not be performed. Examination of acute cystitis, in addition to medical history and signs, need to do a mid-section urine test. There are pus and red blood cells in the urine. For timely treatment, the urine smear can be examined by Gram staining to initially determine the nature of the bacteria. At the same time, bacterial culture, colony count, and antibiotic sensitivity tests are performed to provide a more accurate basis for future treatment. Increased white blood cells in the blood.

Due to the invasiveness of cystoscopy, most patients will experience mild hematuria, frequent urination, and dysuria after the test. Patients should be told to drink plenty of water after the test and take appropriate antibacterials to prevent infection. As long as the indications for cystoscopy are strictly grasped and carefully manipulated, complications will generally not occur. But patients should also be advised that if fever, severe hematuria, pain, etc. occur, they should return to the hospital in time to avoid serious complications ^[3] .