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

Downloaded from: Campbell-Walsh Urology (on 10 August :12 AM) © 2007 Elsevier 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