Urethrocystoscopy

Urethrocystoscopy is an examination of the urethra and bladder using an endoscope (cystoscope).

Indications for urethrocystoscopy

This is an additional, invasive research method, therefore there are strict indications for performing urstrocystoscopy:

• hematuria,
• history of trauma to the genitourinary system and perineal area;
• obstructive urination;
• in case of suprapubic pain as the leading manifestation of the disease and resistant to standard therapy; to exclude interstitial cystitis;
• for differential diagnosis with various diseases when the possibilities of non-invasive diagnostic methods have been exhausted;
• in some cases, for therapeutic and diagnostic purposes - after the diagnostic stage of hydrostatic dilation of the bladder under general anesthesia.

How is urethrocystoscopy performed?

The cystoscope consists of a tube through which the washing fluid is supplied, an obturator with a rounded end for ease of insertion of the instrument, an optical part with fiber illumination, and one or two working channels for inserting ureteral catheters and biopsy forceps. In addition to rigid cystoscopes, there are also fiberscopes, the bend of which can be changed during the examination. They are especially convenient for examining the anterior wall of the bladder.

In adults, the examination is performed under local anesthesia (sometimes under epidural anesthesia), in children - preferably under general anesthesia. Rigid instruments can be inserted into the bladder blindly in both women and men. In complex cases, a visual obturator and 0-degree optics are used, the urine obtained after the instrument is inserted is sent for bacteriological and, if necessary, for cytological examination (bladder neoplasms). The best visualization of the mucous membrane of the bulbous, prostatic part of the urethra, and the seminal tubercle is provided by using 30-degree optics.

After inserting the instrument into the bladder, the optics should be changed to a 70-degree one, which is better for examining the ureteral orifices. When examining the bladder, pay attention to formations, wall trabecularity, diverticula, inflammatory changes, and the physiological volume of the bladder (if the examination is performed under local anesthesia). In conclusion, it is undesirable to use the term “normal picture”; even unchanged parameters (color, location, degree of opening of the ureteral orifices) should be described, which will be invaluable for subsequent examination. Upon completion of the examination, the bladder should be emptied and the instrument removed.

Urethrocystoscopy is a mandatory method of examination in case of total hematuria, as it allows to establish the source of bleeding and undertake further diagnostic procedures to establish its cause.

In this case, the study should be performed immediately in the medical institution where the patient with total macrohematuria has applied. The urgency is due to the fact that bleeding, once it has occurred, may soon stop.

Urethrocystoscopy is the main method of diagnosing bladder tumors. It allows not only to establish a diagnosis of the tumor, but also to determine the localization, prevalence and stage of the tumor process, the relationship of the tumor to the ureteral orifices. Cystoscopy in patients with bladder tumors is often combined with taking a piece of tissue for histological examination.

Urethrocystoscopy is one of the leading diagnostic methods for tuberculosis of the urinary system. The characteristic appearance of tuberculous tubercles, the retraction of the ureteral orifice on the affected side, and sometimes its bullous edema indicate a specific process. The spread of the process along the paraurethral lymphatic vessels in diagnostically difficult cases is an indication for taking a piece of bladder tissue in the area of the ureteral orifice. In this case, it is often possible to detect signs of a specific process in the biopsy material, which allows for a timely diagnosis and targeted therapy.

It is difficult to list all the urinary tract diseases in which urethrocystoscopy can provide valuable information. These include foreign bodies in the bladder and its diverticula, vesicointestinal fistulas and leukoplakia, specific lesions of the bladder in parasitic diseases and many other pathological processes.

Contraindications to urethrocystoscopy

Contraindications to urethrocystoscopy are acute inflammatory diseases of the lower urinary tract (acute prostatitis, acute urethritis), which can lead to the development of urosepsis. Particular caution is required in patients with congenital and acquired heart defects, as well as with artificial heart valves. In this group of patients, any urological interventions must be combined with antibiotic prophylaxis. The American Heart Association recommends the administration of broad-spectrum antibiotics intramuscularly or intravenously one hour before the study, repeated after 8-12 hours.

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