2. • Cystourethroscopy is one of the most
common procedures performed by a urologic
surgeon.
• It allows for direct visualization of the urethra,
urethral sphincter, prostate, bladder, and
ureteral orifices.
3. • It can be performed as a simple office
procedure or as a procedure in the operating
room with the patient under general
anesthesia.
• There are both flexible and rigid cystoscopes
and a variety of tools that can be incorporated
during cystoscopy, depending on the
situation.
4. Anatomy and Physiology
• The first structure encountered during
cystourethroscopy is the urethra.
5. Indications
• Presence of hematuria, gross or microscopic.
Gross hematuria is defined as blood in the
urine that can be seen with the naked eye.
• Microscopic hematuria is defined as 3 or
greater red blood cells per high-powered field.
• Another common indication for regular
cystoscopy is any history of malignancy,
including urethral, bladder.
6. • Lower urinary tract symptoms (LUTS) are another indication of
cystourethroscopy.
• These symptoms can include obstructive voiding symptoms,
irritative voiding symptoms, urinary incontinence, chronic pelvic
pain syndrome, or recurrent UTIs.
• Any trauma in which there is a concern for injury to the lower
urinary tract necessitates cystourethroscopy, as well as any bladder
abnormalities discovered during imaging studies.
• Removal of foreign bodies, for example, if a patient has an
indwelling urinary stent that requires removal, hematospermia,
azoospermia, or concern for a bladder or lower urinary tract fistula
are also reasons for cystourethroscopy.
7. Contraindications
• any evidence of acute urinary infection
• it is recommended to obtain a urinalysis 5 to 7 days
before any scheduled cystoscopy procedure. If a UTI is
identified, the patient should be treated appropriately
before the procedure.
• A contraindication for flexible cystoscopy in the office
would be any intolerance to pain or discomfort with
the procedure. This may necessitate a trip to the
operating room (OR) for cystoscopy under anesthesia.
A urethral stricture can sometimes make cystoscopy
impossible, as the scope will not be able to pass.
8.
9. Procedure
• Prior to the procedure, the skin should be
prepared with an antiseptic agent. Both
chlorhexidine gluconate and alcohol-based
solutions can be damaging to mucous
membranes and are therefore not recommended
for use on the genitalia.
• Betadine are safe on all skin surfaces and are
most commonly used for preparation.
• After application of the antiseptic agent, a
lubricating gel is injected into the urethra. A plain
or lidocaine gel may be used.
10. Complications of cystoscopy are generally minor
and may include urinary tract infection,
hematuria, dysuria, and injury to the bladder or
urethra.
The development of an iatrogenic urethral
stricture is a known possible complication of
instrumentation
