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Chapter 6: Basic

Instrumentation andCystoscopy

Peter Tran, D.O.Garden City Hospital

8/13/2008

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Objectives

• Urethral Catherization• Urethral Dilatation

• Cystourethroscopy• Retrograde pyelography

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Urethral Catherization

• For diagnosis and treatment – Collection of urine in females

– Relief of obstruction• BPH• Clot retention

– nstillation of chemo – Post!surgical

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Catheter Types and Size

• "ize – # Fr $ %&''mm& (utside diameter not

luminal&• )ypes

– "traight – Coude

– *alecot – Foley – '!+ay

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Catheter Insertion

• "terile )echni,ue• Use of Uro-et

• .ong!term use – "ilicone better than late/ or

polyurethane

• "ize – #0!#1 Fr for adults

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Di icult Catherization• Usually in males

– BPH• Use coude

– Urethral "trictures – B2C

• *ay re,uire the use of aglide!+ire or filiform andfollo+ers

• n Females – Rare

• (besity• Unable to locate urethral

meatus or difficult position – Use speculum

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Di icult Catherization

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Urethral Dilatation

• )ypically in male – Urethral "tricture – B2C

– *eatus fortransurethalsurgery

• "terile techni,ues – Filiforms and

follo+ers – Urethral dilators – 3mplatz dilators – balloon

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Cystourethroscopy• "ystematic nspection

– *eatus – Urethra

• *ucosal abnormalities• Diameter

– 6/ternal sphincter – 7eru – Prostate gland

• BPH8• *iddle lobe8• Prior turp8

– Bladder • U(• )rigone• Dome• Foreign Bodies• .esion92eoplasm• "tones• Cystitis

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!etro"rade #yelo"raphy• 7isualization of ureter and

collecting system +henother radiographic imagesare inade,uate or +hen thepatient is allergic to 7 dye&

– Hematuria – Filling defects – Positi4e cytology of 8

source – 8 (bstruction

• Delayed films