BackTable / Urology / Topic / Procedure
The goal of a cystoscopy, or cystourethroscopy, is to obtain a direct view of the urethra, urethral sphincter, prostate, bladder, and ureteral orifices. Rigid cystoscopes have large channels and can be used along with a wide variety of instruments. Additionally, rigid cystoscopes provide greater optical clarity. Flexible cystoscopes are smaller and can be easily passed when the patient is in the supine position. Flexible scopes also allow for easier navigation around the bladder neck and median lobe of the prostate.
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Once it is inserted using a sheath obturator, the cystoscope is directed anteriorly as it moves towards the bladder. While advancing the cystoscope, the operator evaluates the lower urinary tract, penile urethra, and bulbar urethra for signs of structure. The verumontanum and utricle can be identified when the scope reaches the prostatic urethra. The bladder, excluding the floor and trigone, are inspected for bladder stones, bladder lesions, erythematous patches, and other abnormalities. The bladder is drained through a catheter before the cystoscope is removed. Complications of a cystourethroscopy include urinary tract infection, hematuria, and dysuria.
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Cystoscopy is utilized when patients experience gross or microscopic hematuria, malignancy, lower urinary tract symptoms (LUTS), or trauma to the lower urinary tract. Patients with a history of malignancy are evaluated for urethral, bladder, or upper tract UCC malignancy on a surveillance basis. Lower urinary tract symptoms include obstructive voiding symptoms, irritative voiding symptoms, chronic pelvic pain syndrome, recurrent urinary tract infections, and urinary incontinence. Bladder abnormalities discovered in prior imaging may indicate the need for a cystoscopy and can lead to the removal of a foreign body, such as a stent, if necessary. In order to prevent the risk of sepsis, a cystoscopy should not be performed if the patient has a urinary tract infection.
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Blue light cystoscopy is useful in managing bladder cancer, both for complete tumor resection in the OR and as routine surveillance office cystoscopy to monitor bladder cancer recurrence.
 Engelsgjerd, J. S., & Deibert, C. M. (2021, April 20). Cystoscopy. StatPearls [Internet]. Retrieved September 19, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK493180/
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