What Is Flexible Cystoscopy?

Normal bladder pressure: 350-500ml

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 Figure 1. In recent years, the cystoscope's lighting system has been changed. A cold light source box is provided. The strong cold light is transmitted through the optical fiber to the inside of the bladder. Lighting has the advantages of good lighting, clear scenes, and free dimming.

Name

Cystoscopy

category

Endoscope

Cystoscopy normal

Normal bladder pressure: 350-500ml

Clinical significance of cystoscopy

Abnormal results:
(1) The condition of the bladder can be observed through inspection speculum for diagnosis; through the ureteral intubation speculum, an elongated ureteral catheter can be inserted into the ureter into the renal pelvis, and urine is collected separately for routine inspection and culture; indigo rouge is injected intravenously Solution, observing the blue discharge time on both sides of the ureter, the renal function on both sides can be estimated separately (blue discharge 5-10 minutes after normal injection); 12.5% sodium iodide contrast agent is injected into the renal pelvis or ureter through the catheter, and retrograde pyelography Surgery, you can understand the condition of the kidney, pelvis and ureter.
(2) For treatments such as bleeding points or papilloma in the bladder, it can be treated with an electric cautery through cystoscope; stones in the bladder can be crushed with lithotripsy and washed out; small foreign bodies and diseased tissues in the bladder can be clamped with foreign bodies Or remove it with biopsy forceps; the ureteral orifice is narrow and can be cut through a cystoscope (or expander with a dilator).
People who need to be checked: old and physically weak patients with comorbidities such as cardiovascular or diabetes. Transurethral resection of the prostate is suitable for the obstruction of the upper neck caused by various reasons, including patients whose tissue remains unreduced after open surgery.

Cystoscopy considerations

Unsuitable people:
(1) Examination of the urethra and bladder during the acute inflammation period should not be performed, because it can lead to the spread of inflammation, and the acute inflammation and congestion of the bladder can also make the lesions unclear.
(2) If the bladder volume is too small, below 60ml, it means that the disease is serious, and the patient can't tolerate this test.
(3) Phimosis, urethral stricture, incarceration of stones in the urethra, etc., who cannot be inserted into the cystoscope.
(4) Those with deformed bones and joints cannot adopt lithotomy position.
(5) Women's menstrual period or pregnancy for more than 3 months.
(6) Patients with severely reduced renal function with signs of uremia, hypertension, and poor cardiac function.
Contraindications before examination: 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.
Post-examination requirements: (1) Hematuria often occurs after cystoscopy, which is caused by injury of the mucosa during the operation, usually until 3-5 days.
(2) Postoperative urethral burning can allow patients to drink more water and diuretic and give analgesics, which can be lightened after 1-2 days.
(3) If the aseptic operation is not strict, urinary tract infection, fever and low back pain will occur after operation, and antibiotics should be used for control.

Cystoscopy procedure

Preoperative preparation:
(1) Cystoscopy can be sterilized by steaming 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.
(2) The surgeon prepares to wash hands, wear disinfection clothes, and wear sterilized gloves. Attention should be paid to the principles of aseptic operation to avoid complications such as iatrogenic urinary tract infections.
(3) The patient is prepared to let 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.
Surgery process:
(1) Preparation of instruments 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 the salt water, making the field of vision unclear, affecting inspection, and should not be used. Insert the ureteral catheter into the ureteral intubation scope in advance for backup.
(2) Before inserting a cystoscope, a male patient investigates whether the urethra is normal or has stenosis, and then uses a speculum to slowly push the urethral membrane along the anterior wall of the urethra to the urethral membrane. When there is resistance, wait for a while. After the urethral sphincter relaxes, it 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 all are concave, you need to rotate the cystoscope 180 °.
(3) After inspecting the bladder and ureteral intubation endoscope into the bladder, remove the lens core and measure the residual urine volume. If the urine is cloudy (severe hematuria, pyuria, or chyluria), it should be washed repeatedly until the fluid is clear, and then replaced in the inspection scope. Saline is filled into the bladder to gradually fill it so as not to cause the patient to have a bladder swelling (generally about 300 ml). Withdraw the speculum slowly outward until you see the edge of the bladder neck. Push the endoscope into the 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 of the clock, the two ends of the ureter can be found on both sides.
If you observe carefully, you can see that there is peristaltic urination, blood or chyle discharge at the nozzle. Finally, all bladder should be examined systematically, comprehensively, from deep to shallow to avoid omissions. A ureteral intubation is required. The ureteral cannula should be replaced. The ureteral catheter No. 4-6 should be inserted into the ureteral orifice until the renal pelvis. Generally, the back end of the ureter should be marked with a depth of 25-27cm to identify 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.
(4) Urine test Collect urine derived from the ureteral catheter for routine inspection, if necessary, for bacterial inspection and culture. Suspension of urine through the catheter is relatively fast, such as suctioning urine from the catheter with a syringe, which can aspirate more than 10-20ml at a time, should be suspected of hydronephrosis.
(5) Renal function test If the indigo carmine test is not performed during the cystoscopy and the lateral renal function test is needed, the phenol red or indigo carmine should be injected intravenously at the prescribed dose, and the appearance of urine in the renal pelvis on both sides should be observed. Color time and concentration time.
(6) Retrograde pyelography Connect the ureteral catheter to a syringe and inject a contrast agent for pyelography. The commonly used contrast agent is a 12.5% sodium iodide solution. 5-10ml is injected on each side. The injection should be slow and useless. When the patient has low back pain, immediately Stop and maintain pressure.

Cystoscopy related diseases

Female urinary fistula, interstitial cystitis, bladder neck contracture, pediatric urolithiasis, pediatric ureter prolapse, obstructive urinary tract disease, chyluria, prostate cysts, nematodesis, female bladder neck obstruction

Cystoscopy related symptoms

Drowning is frequent and frequent, redness and astringency, painless hematuria, hypertrophic nodular fibrous tissue hyperplasia, penile-like urethra, shrinking and hardening of the prostate, pain in the bladder area before and after urination, funnel-like changes in the urethral mouth, narrowing urine flow Interruption, no detrusor reflex