Urethrocystoscopy

Disusun oleh : Eko Subekti

Urethrocystoscopy
Endoscopic examinations are one of the most
important tasks in urological diagnostics and
therapies.
Especially the endoscopy of the urethra and the
bladder are regarded as standard diagnostic
procedures in urology.

Indications for
Urethrocystoscopy
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.
Hohenfeller, (2005) Manual Endourology-Training for Residents pp 17-25

Indications for
Urethrocystoscopy
Diagnosis of female urethral diverticula.
Suspicion of vesicovaginal or vesicoenteric
fistula.
Suspicion of infravesical obstruction (bladder
outlet obstruction).
Detection of urethral or vesical foreign bodies.
Urethral inspection under suspicion of stricture,
tumour, diverticulum or fistula.
Hohenfeller, (2005) Manual Endourology-Training for Residents pp 17-25

Contraindications
Acute urethritis, acute prostatitis, acute
epididymitis.
Febrile urinary tract infection.
Strong coagulopathy.

Hohenfeller, (2005) Manual Endourology-Training for Residents pp 17-25

Cystourethroscopy

Cystourethroscopy
Rigid cystoscope
Flexible scope

Telescope.
Urethroscopy is best accomplished : 0-degree or 12-degree
lens providing a straight-ahead view.
In the bladder, a 30-degree lens is commonly used and
provides excellent visualization of the trigone, dome, and
posterior and lateral walls.
70-degree lens provide better visualization of the anterior
wall, dome, and inferior lateral walls. Telescopes with a 120degree lens are utilized for inspection of the bladder neck.

Advantages of rigid
cystoscopy:
Larger working channel for auxiliary equipment
Larger irrigation channel and therefore improved
vision, improved evacuation of blood clots and
detritus.
Facilitated manipulation and easy orientation during
inspection.

Flexible Instruments
Flexible instruments are available with a diameter of
16 Fr or less with bending of the instruments up to
210 upwards and 120 downwards, allowing
inspection of the total bladder.

Advantages of flexible
cystoscopy:
Convenient for patient, nearly pain free, well tolerated.
Total inspection of bladder with one optical
instrument.
Special indication in continent urinary diversion (i.e.
ileal neobladder).
Special indication of endoscopy of ileal conduit.
Special indication for patients who cannot be
positioned for rigid endoscopy due to contractures of
the lower extremities or cox arthrosis.
Special indication for patients with frozen pelvis.

Preoperative
Preparation
Positioning
Rigid cystoscopy: lithotomy position.
Flexible cystoscopy: supine or lithotomy position.
The genital area should be prepared and disinfected.

Anaesthesia
Generally well tolerated with local anaesthesia in
adults
In children general anaesthesia

Inserting the instrument:

Straighten the penis.
Use excessive lubricating gel.
Introduce the sheath, closed with the
obturator.
In the bulbar part, the urethra turns from an
almost horizontal direction to a steep rise
behind the symphysis towards the bladder
neck. The curvature at the bulb is easily to
overcome by lowering the instrument.

Inserting the instrument:

Remove the obturator and use the
telescope.
With continuous flow irrigation and
straightened urethra, gently move towards
the bladder.

In 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.
kissing lobes.
Estimate length of prostatic urethra.
Inspect the bladder neck opening.

In 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 (ureteral
orifices : position, number and form. colour
of urine jet).
Systematic evaluation of the base, lateral
walls, posterior wall and roof of the bladder
and bladder outlet.

Laporan operasi:
Posisi litotomi stadium anestesi asepsis
antisepsis medan operasi dengan betadine,
tutup duk steril.
Masukkan jelli 10 CC ke urethra.
Masukkan sheath no 15,5 f. lensa 700 (yang
telah dipasangkan light source dan kamera)
ke dalam urethra, masuk hingga vesica
urinaria.
Isi kandung kemih dengan Aquabidest
melalui sheath hingga 350 cc.

Buli (hiperemis/tak hiperemis), Mukosa (licin/tak licin)

Trabekulasi (Ringan/sedang/berat)
Saculasi (Ada/tidak, .. buah )
Divertikel (Ada/tidak, .. Buah, lokasi, leher
sempit/tidak, batu.., massa..)
Tumor (Ada/tidak, bentuk, Letak.., jumlah..,
ukuran..Rapuh/tidak,
Batu (Ada/tidak, buah, Warna )
Muara ureter kanan dan kiri (Tampak/tidak tampak,
tertutup.., bentuk..
Bladder neck (Tinggi/tidak)
Protrusi lobus medius (Ada/tidak)
Kissing lobe (Ada, . cm/tidak)
Verumontanum (Normal/tidak)
Perkiraan Volume kandung kencing

Common Complications
pain, dysuria.
Rarely bleeding or transient gross
hematuria.
traumatic lesion of the urethra with
perforation.
very rarely perforation of the bladder,
urethral strictures due to mucosal lesions.

TERIMA KASIH