Urethrocystoscopy
Last reviewed: 23.04.2024
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Urethrocystoscopy - examination of the urethra and bladder with an endoscope (cystoscope).
Indications for urethrocystoscopy
The ego is an additional, invasive method of investigation, therefore strict urine testimony exists for the performance of urstrocystoscopy:
- hematuria,
- a history of injury to the urogenital system and the perineal region;
- obstructive urination;
- with 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 are exhausted;
- in some cases with a therapeutic and diagnostic purpose - after the diagnostic stage of hydrostatic dilatation of the bladder under general anesthesia.
How is urethrocystoscopy performed?
The cystoscope consists of a tube through which a washing liquid is supplied, an obturator with a rounded end for the convenience of carrying out the instrument, an optical part with fiber illumination, and one or two working channels for conducting ureteral catheters and biopsy forceps. In addition to rigid cystoscopes, there are also fibroscopes, the bending of which can be changed during the study. They are especially convenient to conduct an examination of the anterior wall of the bladder.
In adults, the study is conducted under local anesthesia (sometimes under epidural anesthesia), in children - preferably under general anesthesia. In the bladder rigid tools can be blindly treated as women, hack and men. In complex cases, a visual obturator and 0-degree optics are used, the resulting urine is sent to the bacteriological, and if necessary - to a cytological examination (neoplasms of the bladder). The best visualization of the mucous bulbose, prostatic urethra, seed tubercle is provided using a 30-degree optics.
After inserting the instrument into the bladder, the optics should be changed to a 70-degree lens, with which it is better to examine the ureteral orifices. When examining the bladder, pay attention to the formation, the wall's trabecularity, diverticula, inflammatory changes, the physiological volume of the bladder (if the study is conducted under local anesthesia). In conclusion, it is undesirable to use the concept of "normal picture", it is necessary to describe even unchanged parameters (color, location, degree of opening of ureteral mouths), which will be invaluable for subsequent examination. At the end of the study, the bladder should be emptied and the instrument removed.
Urethrocystoscopy is an obligatory method of investigation with total hematuria, as it allows to establish the source of bleeding and to undertake further diagnostic procedures to establish its cause.
In this case, the study should be carried out immediately in the medical institution, where the patient turned with total macrogematuria. The emergency is due to the fact that the bleeding, once emerged, may soon cease.
Urethrocystoscopy is the main method of diagnosing bladder tumors. It allows not only to establish the diagnosis of the tumor, but also to determine the localization, prevalence and stage of the tumor process, the ratio of the tumor to the ureteral orifices. Cystoscopy in patients with a bladder tumor is often combined with taking a piece of tissue for histological examination.
Urethrocystoscopy is one of the leading methods of diagnosing tuberculosis of the urinary system. The characteristic type of tubercular tubercles, retract the guest of the ureteral mouth on the side of the lesion, sometimes his bulbar edema testifies to a specific process. The spread of the process through the paraurethral lymphatic vessels in the diagnosticly difficult cases is an indication for taking a piece of bladder tissue in the ureteral region of the ureter. In this case, it is often possible to detect signs of a specific process in a biopsy material, which makes it possible to establish a diagnosis in a timely manner and to conduct targeted therapy.
It is difficult to list all diseases of the urinary tract, in which urethrocystoscopy can provide valuable information. These are foreign bodies of the bladder and its diverticulum, vesicourous fistulae and leukoplakia, specific bladder lesions in parasitic diseases and many other pathological processes.
Contraindications to urethrocystoscopy
Contraindications to urethrocystoscopy - acute inflammatory diseases of the lower urinary tract (acute prostatitis, acute uregrit), which can lead to the development of urosepsis. Particular caution is needed in patients with congenital and acquired heart defects, as well as with artificial heart valves. In this group of patients, any urological intervention must be combined with antibiotic prophylaxis. The American Heart Association recommends the appointment, one hour before the study of broad-spectrum antibiotics, intramuscularly or intravenously, with repetition after 8-12 hours.
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