Chapter 6: Basic Instrumentation and

Cystoscopy

Peter Tran, D.O.Garden City Hospital

8/13/2008

Objectives

• Urethral Catherization

• Urethral Dilatation

• Cystourethroscopy

• Retrograde pyelography

Urethral Catherization

• For diagnosis and treatment– Collection of urine in females– Relief of obstruction

• BPH• Clot retention

– Instillation of chemo– Post-surgical

Catheter Types and Size

• Size– 1 Fr = 0.33mm. Outside diameter not

luminal.

• Types– Straight– Coude– Malecot– Foley– 3-way

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Catheter Types

Catheter Insertion

• Sterile Technique

• Use of Urojet

• Long-term use– Silicone better than latex or

polyurethane

• Size– 16-18 Fr for adults

Difficult Catherization

• Usually in males– BPH

• Use coude– Urethral Strictures– BNC

• May require the use of a glide-wire or filiform and followers

• In Females– Rare

• Obesity• Unable to locate urethral

meatus or difficult position– Use speculum

Difficult Catherization

Urethral Dilatation

• Typically in male– Urethral Stricture– BNC– Meatus for

transurethal surgery

• Sterile techniques– Filiforms and

followers– Urethral dilators– Amplatz dilators– balloon

Cystourethroscopy

• Diagnosis of lower urinary tract disease

• Sterile technique• Rigid cystoscope

– Better visualization– Larger working channel– Ease of orientation

• Flexible scope– More patient comfort– Pt. Stays supine– View from different

angles

Cystourethroscopy• Systematic Inspection

– Meatus– Urethra

• Mucosal abnormalities• Diameter

– External sphincter– Veru– Prostate gland

• BPH?• Middle lobe?• Prior turp?

– Bladder• UO• Trigone• Dome• Foreign Bodies• Lesion/Neoplasm• Stones• Cystitis

Retrograde Pyelography

• Visualization of ureter and collecting system when other radiographic images are inadequate or when the patient is allergic to IV dye.– Hematuria– Filling defects– Positive cytology of ?

source– ? Obstruction

• Delayed films