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CYSTOSCOPY AND BIOPSY.pptx
- 1. DISCRIBE THE PROCEDUREFOR 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 • isan 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 flexiblecystoscopes • 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 • Emptythe bladder • Pass urethral catheter • Antibiotics/ analgesics • Send labelled sample for laboratory examination
- 13. Complications. • Intraop • Mildabd. Discomfort • Strong urge to void • Bleeding may obsecure visual field • Post op • Haematuria • Painful/ frequent micturition • Infection • Urine retention
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