Cystoscopy

The urethrocystoscopy ( urethral and cystoscopy ) is a urological examination of the urinary bladder, at a particular endoscope to the cystoscope, the bladder is examined. In men, the urethra is always investigated.

History

The first modern Urethrozystoskop was presented on 9 May 1879 by the Dresden physician Maximilian Nitze in Vienna the public. This day is considered the birth of modern urological endoscopy.

Indications

Blood admixture in the urine ( hematuria or gross hematuria )
On suspicion of a bladder tumor
In the context of cancer follow-up after bladder tumors
In suspected foreign body in the urinary bladder or urethra
As part of the investigation with frequent bladder infections
In bladder emptying disorders, if you suspect that an outflow obstruction is
For urinary incontinence to assess the sphincter
In suspected fistula between the bladder and intestines or vagina
On suspicion of a urethral stricture

Contraindications

In the presence of infection of the urethra, bladder, prostate and epididymis a urethrocystoscopy should not be done. There is here the danger of cross-contamination and thus the acute exacerbation, or spread of infection. Nevertheless is a reflection for the diagnosis required, must be preceded by adequate antibiotic treatment.

Examination technique

For the cystoscopy are flexible or rigid Cystoscopes available. The investigation takes place lying down. An anesthetic is not necessary in adults in most cases. In children, the cystoscopy is performed under general anesthesia. The investigation is conducted in compliance with the sterility. The investigation is usually carried out as so-called video urethrocystoscopy. Here, the image of a patch on the optical camera is transferred to a screen. Patients may pursue the investigation with a second screen. By means of a video recorder, the examination can be recorded. In both methods, the bladder is filled and rinsed with sterile liquid over the instrument.

Rigid urethrocystoscopy

The rigid urethrocystoscopy is carried out in the so-called lithotomy position. The patient lies on the back and the legs are bent and spread outward. In men, the unit is advanced under direct vision through the urethra into the bladder. Until the bladder for this optics is used, the strictly straight looking (0 ° or 5 ° angle). Then, a bubble in the lens with a used 30 °, 70 ° or 120 ° angle. On examination, the urethra is judged to external sphincter first. This is followed by an assessment of the prostatic urethra. After changing the optics, the entire bladder is now systematically investigated. In women, the insertion of the device usually done blindly, ie the optical system is used only after the bladder.

Flexible urethrocystoscopy

In contrast to the rigid urethrocystoscopy the patient can in flexible urethrocystoscopy also lie flat on your back. The assessment is analogous to the rigid approach.

Advantages and disadvantages of both examination techniques

The rigid technique offers by larger Arbeitskänale better rinsing, and manipulation. The performance of the optics used, and the luminous efficiency is better. Compared to the flexible technology but it is often perceived as unpleasant to painful. The flexible process, in addition to the reduced deterioration of the advantage that it can also be applied when a lithotomy position is not possible. The flexible tip is a change of optics not necessary.

Complications

Possible complications of urethrocystoscopy are in addition to the spread of germs, especially direct, caused by the instrument, injuries of the urethra and bladder. In addition to the through-hole ( perforation ) small mucosal injury can occur which can lead to urethral stenoses in the urethra. Not infrequently performs a cystoscopy in men to chronic non-bacterial prostatitis.