1. Cystourethroscopy

2. Cystoscopy

3. Cystoscopy

4. Indications for Cystoscopy Hematuria Recurrent infections Voiding dysfunction After reconstructive pelvic surgery

5. Equipment Telescope: 0 degree—best for urethra 30 degree –forward oblique view, best for bladder base and posterior wall 70 degree– lateral angle view, best for anteriolateral walls. Best general instrument

6. Cystoscope

7. Operative Scope

8. Sheaths 15 French– fluid flow is minimal 24 French--better for operative procedures (one French is.33 mm) Sheath has two irrigating ports Sheaths range from 15-28 French

9. Bridges Has ports for introduction of instruments May have a deflector mechanism

10. Light Sources High intesnity (Xenon ) light sources are best

11. Scope and light cord

12. Distending Medium Water of Saline are most common

13. Technique Urethroscopy Scope placed into the urethra with fluid flowing to visualize the urethra and entrance into the bladder Observe the UVJ during a Valsalva Maneuver Observe closing of the UVJ

14. Cystoscopy Generally performed with a 70 degree scope Obtorator generally not necessary if fluid flow is sufficient Begin at bladder dome (bubble) Full sweeps at 12, 4, 8, 12 o’clock Posterior bladder between 5 and 7 o’clock Observe trigones and ureteral orafaces

15. Antibiotics Antibiotics may be given but not proven to make a difference 5% will demonstrate a UTI

16. Normal Urethra Urethral mucosa is pink UVJ is irregular but rounded in shape UVJ should close with “hold maneuvers”

17. UV Junction

19. Abnormal Urethral Findings Urethritis looks red and may bleed Polyps do not often require treatment The urethra should not look scarred It should move with maneuvers

20. Normal Bladder Surface should be pale and smooth Submucosal vasculature should be regularly branching Trigones should be slightly more red and granular

21. Bladder dome

22. Ureteral Orifices

23. Ureteral Orifice

25. Abnormal Cystoscopic Findings Peach colored macules or papules Active bleeding Polyps Glomerulations Trabeculations

26. Inflammation

27. Hypervascularity

28. Punctations

29. Trabeculation

30. Trabeculations

31. Metaplasia

32. Metaplasia

33. Interstitial Cystitis

34. Thank you for your attention!!! Questions??????