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CYSTOSCOPY
1.
2. Indication
Gross hematuria
Persistent hematuria
Suspicion of bladder carcinoma,
tumour infiltration from outside or
metastases.
Follow-up in superficial bladder
cancer
For patients with upper tract
transitional cell carcinoma to rule
out coexistent bladder tumours.
Inspection of orifices in
vesicoureteral/renal reflux or
ureterocele
Recurrent urinary tract infection
(UTI).
Diagnosis of interstitial cystitis.
Suspicion of urogenital
tuberculosis
Diagnosis of incontinence.
Diagnosis of female urethral
diverticula
Suspicion of vesicovaginal or
vesicoenteric fistula
Neurogenic voiding
dysfunction.
Suspicion of subvesical
obstruction (bladder outlet
stenosis).
Detection of urethral or vesical
foreign bodies.
Urethral inspection under
suspicion of stricture, tumour,
diverticulum or fistula.
4. Urethroscopy
Inspect all parts of the urethra (penile,
bulbar, membranous and prostatic).
Assess luminal size (strictures,
diverticula, fistulas)
Evaluate mucosa (lesions, tumours)
External striated sphincter (pass with
gentle pressure)
Prostatic urethra.
Verumontanum.
Side lobes.
Estimate length of prostatic urethra.
Inspect the bladder neck opening.
5. Cystoscopy
Start inspection with the 30° telescope,
supplement
with different telescopes (i.e. 70°) if
necessary to inspect all areas of the bladder
(i.e. roof, bladder neck)
Start with inspection of the trigone (position,
form, numbers of ureteral orifices, colour of urine
jet)
Systematic evaluation of the base, lateral
walls, posterior wall and roof of the bladder and
bladder outlet
Start at the base of bladder from left to right or
vice versa
6. Cystoscopy
By turning the instrument, inspect the roof of the bladder; sometimes it is necessary to
push the bladder with your free hand from the abdominal wall towards your instrument
In case of enlarged median lobe of the prostate, use a 70° telescope to inspect the
trigone and ureteral orifices.
Use inflow and outflow of irrigation fluid as necessary.▬
If vision is impaired (i.e. pus, blood), excessive
irrigation of bladder may be necessary before inspection.
Look for:
▬ Ureteral orifices (position and form).
▬ Tumours.
▬ Trabecula.
▬ Lesions of the mucosa.
▬ Diverticula and fistulas.
▬ Stones and foreign bodies.
7. Additional investigations:
Consider additional investigations as indicated:
Bladder washing.
Vaginal and/or rectal palpation.
Vaginal inspection.
Stress test and Marshall-Marchetti test
Normal findings:
Healthy bladder mucosa appears yellow to pink with small vascular branches.
Ureteral orifices.
Positioned within the trigonal rim.
Slit-like or a flat indentation.
Refluxive orifices are commonly lateralized and/or horseshoe-like in shape
Cystoscopy