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Cystoscopy Procedure

- May 07, 2018 -

Inspection steps

1. Instrument Preparation Remove the disinfected speculum and various instruments. Wash the disinfecting solution on the speculum with sterile saline. Check whether the eyepiece and objective of the scope are clear, adjust the height of the mirror, and apply sterilized glycerin on the outside of the scope to facilitate smoothness. The liquid paraffin will form oil beads in the salt water, making the visual field unclear, affecting the examination, and cannot be used. The ureteral catheter is inserted into the ureteral cannula to reserve the mirror in advance.

2. Insert a cystoscope Before inserting the cystoscope, examine the urethra for cystoscopy, check whether the urethra is normal or there is no stenosis, then use a speculum to slowly push along the anterior wall of the urethra to the urethral membrane. When there is resistance, you can wait for a while, etc. Relaxation of the urethral sphincter can successfully enter the bladder. Do not use violence when inserting, so as not to damage the urethra, the formation of false roads. The female patient is easy to insert, but it should be noted that the speculum should not be inserted too deep, so as not to damage the bladder. If all are concave mirror sheaths, rotate the cystoscope 180°.

3. After inspecting the bladder and ureter to insert the speculum into the bladder, the mirror core is withdrawn and the residual urine volume is measured. If the urine is turbid (severe hematuria, pyuria, or chyluria), it should be rinsed repeatedly until the fluid is clear and replaced with a speculum. The physiological saline is poured into the bladder to gradually fill it so as not to cause the patient to have a feeling of bladder swelling (generally about 300 ml). Slowly pull the speculum out and see the brim of the bladder. At the lower corners of the bladder neck, the speculum is pushed into the 2 to 3 cm, and the ureter can be seen. In the direction of the clock from 5 o'clock to 7 o'clock, both ends of the ureteral canal can be found on both sides of the ureteral orifice. If careful observation is made, it can be seen that the orifice has peristaltic urination, blood excretion or row of chyle. Finally, all bladders should be examined systematically, comprehensively, and from deep to shallow to avoid omissions.

If ureteral catheterization is required, the ureteroscope should be replaced with a speculum, and catheters 4 to 6 should be inserted into the ureteral orifice until it reaches the renal pelvis. Generally, the depth is 25 to 27 cm. The posterior end of the ureter should be marked to identify the right and left ureters. If the inflammation of the ureteral orifice can not be identified, intravenous injection of blush solution can be used to guide the catheter to use the blue ureter.

After cystoscopy and insertion of the ureteral catheter, the ureteral catheter is inserted into the bladder for a period of time, and then the cystoscope is withdrawn and the ureteral catheter is fixed to the vulva with a tape to prevent it from escaping. The operation inside the bladder must be gentle and the examination time should not exceed 30 minutes.

4. Urine examination Collection of ureter catheter derived urine for routine examination, if necessary, can also be used for bacterial examination and culture. When the continuous urine drip from the catheter is faster, if the urine is sucked from the catheter with a syringe, it can be suspected that there is stagnant hydronephrosis if it can be aspirated 10 to 20 ml at a time.

5. Renal function tests such as cystoscopy in the absence of rouge test but also need to do the side of renal function tests, should be prescribed dose intravenous injection of phenol red or rouge, were observed on both sides of the renal pelvis derived color in the urine Time and concentration time.

6. Retrograde pyelography: Connect the ureteral catheter to the syringe and inject the contrast agent for pyelography. The common contrast agent is 12.5% sodium iodide solution. Each side is injected with 5 to 10 ml. The injection should be slow but not available. The patient should stop immediately when having back pain. And maintain the pressure.



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