this presentation deals with various types of endourology, upper urinary tract endoscopy, rigid and flexible endoscopy, lower urinary tract endoscopy, ureteroscopy, care and sterilization of instruments and endoscops. use as therapeutic and diagnostic modalities.

1. ENDOUROLOGY
Dr. Rachitha Radhakrishnan
Post graduate
Dept of General surgery
VMKVMCH

2. Various types
CYSTOURETHEROSCOPY
• Flexible
• Rigid
URETEROSCOPY
• Flexible
• Rigid

3. DIAGNOSTIC ENDOUROLOGY
 Follow up of TCC
 Biopsy from suspicious
sites
THERAPEUTIC ENDOUROLOGY
 Calculi – URSL
 Upper tract neoplasm
 Strictures
 Fistulas
 Benign lesions

4. CYSTOURETHROSCOPY
• Provides direct visualization- urethra and bladder
• Types : Rigid or flexible
• Rigid provides larger workshing channels, easier to control,
and better visualization
• Flexible provides patient comfort

6. Cystoscope
• Thin Telescope
• 2 types:
• Flexible - flexible, fibre-optic scope
• Rigid - solid, straight scope

7. Rigid Cystoscope
• Optical lenses come with tip angles ranging from 0 to 120 degrees.
• Visualization of the urethra is best performed with a 0- or 12-degree
lens.
• A 25- or 30-degree lens is commonly used for therapeutic purposes.
• A 70- or 120-degree lens may be required to completely inspect the
anterior and inferolateral walls, dome, and neck of the bladder.

9. Flexible Cystoscopes
• Contain fiberoptic bundles for illumination and visualization
• Has an irrigating channel and a working channel for passage of
instruments
• Can be deflected 180-220o
• Digital Flexible cystoscopes eliminate the need for fiber bundles
and the honeycomb pattern of the image

11. Advantages of rigid endoscope:
• Better optics
• Larger working channel allows
greater versatility in passage of
instruments
• Larger lumen for water flow, thus
improving visualization
• Ease of manipulation and
maintaining orientation during
inspection within the bladder
• Better for evacuating clots
Advantages of flexible endoscope:
• Greater comfort for the patient
• Ability to perform the procedure with the
patient in the supine position
• Ease of passing the instrument
over an elevated bladder neck
• Ability to inspect at any angle with
deflection of the tip of the instrumen

12. Lens
• 0O – for urethroscopy
• 30O - visualization of the base and anterolateral aspect of the
Bladder
• 70-90O - to view the bladder dome
• Retrograde lenses with an angle of view > 90O - visualize the anterior
bladder neck

13. Basiccomponents
ens
• Cystoscope bridge
• Sheath & obturator

15. BLADDER WITH TRABACULATION BLADDER WITH SACCULES

16. CALCULI SEEN ON CYSTOSCOPY

17. PAPPILLARY CA IN THE BLADDER

18. BLADDER DIVERTICULUM

19. NORMAL URETER ON URETEROSCOPY

20. URETHRAL STRICTURE
URETHROTOMY BEING PERFORMED

21. UPPER URINARY TRACT ENDOSCOPY
 Direct visualization of the upper urinary tract, facilitating
both diagnostic and therapeutic interventions
 Indication :
• Urolithiasis
• Upper urinary tract Transitional Cell Carcinoma
• Uretreropelvic junction obstruction
• Urethral stricture

22. Equipment
 Ureteroscopes
 Ancillary Equipment :
- Wires
- Ureteral Dilators
- Irrigation Systems
- Ureteral Access Sheaths
- Intracorporeal
Lithotriptors
- Stone Migration Devices

23. Instruments
• Telescope adapter
• Alligator Forceps
• Biopsy Forceps
• Scissor
• Hook Scissor

24. Common Supplies forUreteroscopy

27. PatientPreparation
• Informed consent must be obtained
• A urinalysis and urine culture, if indicated,
should be completed before cystoscopy  UTI
must be treated
• AUA : prophylaxis antibiotic is not recommended for
routine diagnostic procedure.
• For therapeutic  Chlorhexidine gluconate and
alcohol-based solutions are not recommended for use
on the genitalia

28. PatientPreparation

29. • In women, rigid cystourethroscope insertion is safest
using the sheath obturator
• In men, the penis should be angled 45 - 90° relative to
the abdominal wall while the scope is passed through
the anterior urethra.
• Visualization of the lateral walls is accomplished by
rotating the cystoscope while keeping the camera
orientation fixed.
• If a Foley catheter is to be placed after the procedure, it is
best to leave the bladder at least partially full before
removing the cystoscope.
Ureteroscopy Technique

30. Ureteroscopy Technique
• Upper tract imaging  IVP or helical CT scan
• UTI are treated preoperatively
• Routine preoperative antibiotic is give to all
patients fluoroquinolones or based on antibiotic
sensitivity test
• Patient in cystolithotomy position

31. Semirigid UreteroscopyTechnique
• Maneuvering the tip of the ureteroscope next to the
guidewire posterolaterally and elevate the wire 
propping the ureteral orifice open to allow scope
passage.
• If the intramural ureter is too tight to allow safe
passage of the ureteroscope, a dilating balloon
catheter can be used.

34. • Normal saline should be used for
irrigation to prevent accumulation and
absorption of hypotonic solution and
resultant TUR syndrome.
• Do not activate the laser unless the tip of
the fiber is seen to be contact with the
stone
Flexible UreteroscopyTechnique

35. Care andSterilization
• Scraped inner working channel  deflection of
flexible ureteroscope when the fiber is introduced
• Fired fiber within the working channel  to prevent the
tip must be seen in the central portion of the field of
view
• Should be cleased with warm water and a non
abrasive detergent after each use

36. THANKYOU