cystoscopy and biopsy procedure

1. DISCRIBE THE PROCEDURE FOR
CYSTOSCOPY AND BIOPSY.
DR USMAN HARUNA KAMBA
SURGERY/UROLOGY UDUTH SOKOTO
19/08/2023.

2. • Introduction
• Definition
• Classification
• Indictions/ CONTRAINDICATIONS
• Therapeutic
• Diagnostic
• Procedure
• Pre op
• Intra op
• Post op
• Compliactions
• FOLLOWUP
• Conclusion
• References.

3. • Cystoscopy
• is an endoscopic visualization of bladder, urethra and ureteric
orifices via either flexible or rigid cystoscope.
• It may involve taking tissue for histology, instillation of therapeutic
agents, placement or removal of stents
• It may also be a component of other treatment modalities such as
ureteroscopy and lithotripsy.

4. Components of cystoscopy
• Cystoscopy procedure – bladder only
• Cystoscopy and biopsy
• Cystoscopy and stent removal.

5. Classification.
• Flexible cystoscopy
• has revolutionised outpatient assessment of the lower urinary tract
under local anaesthesia.
• Flexible cystoscopes can be classified as fibrescopes because they
contain fibre‐optic bundles within a flexible shaft that illuminate the
viewing area and transmit images to the eye piece.
• In these cystoscopes tip deflection is up to 210º.

6. • Digital flexible cystoscopes
• uses a video chip instead of fibres.
• Focusing is not necessary as video chip delivers a uniform‐focused picture
with a high optical resolution.
• The tip of these is only 9.8 F and hence easier to insert.
• Rigid Diagnostic Cystoscopy
• Photodynamic diagnostic cystoscopy (PDD) involves administration
of 5‐aminolevulinic acid (5‐ALA), which bypasses the rate limiting
step in the biosynthesis of heme.
• It induces high levels of proto‐porphyrin IX (PpIX) in mitochondria of
neoplastic or highly proliferating cells.

7. • Indications include:
• Hematuria, gross or microscopic.
• Surveillance/evaluation of malignancy (bladder, urethra, upper tract
UCC, abnormal cytology)
• Lower urinary tract symptoms (LUTS): The irritative voiding
symptoms, obstructive voiding symptoms,
• Urinary incontinence,
• Chronic pelvic pain syndrome,
• Recurrent UTIs.

8. • Stent removal
• Instillation of therapeutic agents – BCG, chemotherapeutic agents
• TURBT
• Lithotripsy
• Evaluation of urologic fistulas, urethral or bladder diverticulum
• Bladder neck procedures
• Treatment of incomplete urethral strictures.
Contraindicated in:
• Urosepsis
• Coagulopathy.

9. Purpose for cystoscopy
• Assist in obtaining biopsies
• Targetting of suspicious areas
• Guidance for systematic biopsies
• Collect urine sample from bladder
• Removal of previously inserted stent
• Treat certain bladder conditions.

10. Cystoscopy procedure
• Pre – operative preparation
• History – medications aspirin and other anticoagulants
• allergy to local anaesthetic agents, latex or iodine,
• Examination – palor , hypotention, signs of urosepsis, CKD
• Investigations – FBC, Urinalysis, urine mcs, clotting profile, CXR/ ECG,
urine cytology.
• Written informed Consent taken
• It is an office procedure.

11. Intraoperative.
• Anaesthesia: Local/ GA, prophylactic antibiotics. Analgesics.
• Position : Lithotomy
• Endoscopic tower and monitor
• Irrigation fluid – normal saline
• Cystoscopes , biopsy forceps, xylocaine jelly , urethral catheter, light source and
camera, sample bottle all are set
• Pt is cleaned and drapped
• Xylocaine jelly instilled into the urethra for L.A
• Well lubricated Cystoscope gently introduced into the urethra under vision on the
monitor
• Urethra and the entire bladder visualized, biopsies taken
• Proceeds depends on the indication for cystoscopy.

12. Post op
• Empty the bladder
• Pass urethral catheter
• Antibiotics/ analgesics
• Send labelled sample for laboratory examination

13. Complications.
• Intraop
• Mild abd. Discomfort
• Strong urge to void
• Bleeding may obsecure visual field
• Post op
• Haematuria
• Painful/ frequent micturition
• Infection
• Urine retention

14. References.

15. • Thank you