cystoscopy

The cystoscope is a kind of endoscope. Its shape is similar to that of a urethral probe. The electroscope sheath, the inspection speculum, the treatment and the ureteral cannula and the mirror core are composed of four parts, and are equipped with an electrocautery, a clipper and a live. Tissue inspection pliers and other accessories [Figure 1]. In recent years, the illumination system of the cystoscope has been changed, and a cold light source box is provided. The reverse strong cold light is transmitted through the optical fiber guide beam to the inside of the bladder to replace the bulb illumination at the front end of the bladder mirror sheath, which has good illumination and clear vision. Dimming and other advantages. Treatment of diseases: bladder leiomyosarcoma, bladder leiomyomas, bladder stones Indication 1. For diagnosis: the intravesical condition can be observed by examining the speculum; the ureter can be inserted into the ureter by inserting a slender ureteral catheter into the renal pelvis, collecting urine for routine examination and culture; intravenous infusion of rouge Solution, observe the blue time of the ureter on both sides, can estimate the renal function on both sides (blue line 5-10 minutes after normal injection); inject a 12.5% sodium iodide contrast agent into the renal pelvis or ureter via catheter, perform retrograde pyelography Surgery, you can understand the kidney, renal pelvis and ureter. 2. For treatment: If there is bleeding point or papilloma in the bladder, it can be treated by electrosurgery with cystoscope. The stones in the bladder can be washed out with a lithotripter. Small foreign bodies and diseased tissues in the bladder can be removed with foreign body forceps or biopsy forceps; the ureteral stenosis can be cut open by a cystoscope (or dilated with a dilator). Contraindications 1. The urethra and bladder are not suitable for examination in the acute inflammatory phase, which can lead to the spread of inflammation, and the acute inflammation of the bladder is congested, and the lesion can be unclear. 2. The bladder volume is too small, below 60ml, indicating that the lesion is serious, the patient can not tolerate this test, it is also easy to cause bladder rupture. 3. Phimosis, urethral stricture, incarceration of stones in the urethra, etc., can not be inserted into the cystoscope. 4. The bone and joint deformity can not take the position of the stone. 5. Women's menstrual period or more than 3 months of pregnancy. 6. Renal function is severely degraded and there are signs of uremia, high blood pressure and poor heart function. Preoperative preparation 1. Cystoscopy disinfection: steam sterilization with 40% formalin (formaldehyde) solution for 20 minutes or soaking with 10% formalin solution for 20 minutes. The cystoscope cannot be disinfected by boiling, alcohol, 0.1% cleansing and soaking to avoid damage to the bladder speculum. 2. The surgeon prepares: wash hands, wear disinfection clothes, and wear sterile gloves. The principle of aseptic operation should be emphasized to avoid complications such as iatrogenic urinary tract infections. 3. Patient preparation: Let the patient empty the bladder and take the stone. The genital area is disinfected with soapy water, sterile saline and a new solution. Spread the disinfection hole towel to expose the urethra. Surgical procedure 1. Device preparation: Remove the disinfected speculum and various instruments, and wash the disinfection solution on the speculum with sterile saline. Check the eyepiece eyepiece and objective lens for clarity, adjust the height of the mirror lamp, and apply sterilized glycerin on the outside of the sheath to facilitate smoothness. Liquid paraffin will form oil beads in the salt water, making the field of vision unclear, affecting the inspection, and not being used. The ureteral catheter was inserted into the ureteral catheter for use in advance. 2. Insert the cystoscope: Before the male patient inserts the cystoscope, probe whether the urethra is normal or not, and then use the speculum to slowly push it along the anterior wall of the urethra to the urethral membrane. When there is resistance, wait for a while. When the urethral sphincter relaxes, it can enter the bladder smoothly. Do not use violence when inserting, so as not to damage the urethra and form a false road]. Female patients are easy to insert, but it should be noted that the speculum should not be inserted too deep to avoid damage to the bladder. If all are concave mirror sheaths, the cystoscope should be rotated 180°. 3. Check the bladder and ureteral cannula: After the speculum is inserted into the bladder, the lens core is withdrawn and the residual urine volume is measured. If the urine is turbid (severe hematuria, pyuria or chyluria), it should be washed repeatedly until the liquid is clear, and then transferred to the inspection speculum. The 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 bladder neck. The ureteral fistula can be seen by pushing the speculum at 2 to 3 cm at the lower corners of the bladder neck. At the 5 o'clock to 7 o'clock position, both ends of the ureteral fistula can be found on both sides of the ureteral orifice]. If you observe carefully, you can see the phenomenon of peristaltic urination, blood discharge or milk discharge. Finally, all bladders should be examined systematically, comprehensively, and from deep to shallow to avoid omissions. For ureteral intubation, the ureteral intubation should be exchanged, and the 4-6 ureteral catheter should be inserted into the ureteral orifice until the renal pelvis is generally 25 to 27 cm deep. The ureter should be marked at the back end to identify the left and right. If there is inflammation and congestion in the ureteral orifice that can not be distinguished, the rouge solution can be injected intravenously, and the intubation can be guided by the ureteral orifice. After cystoscopy and ureteral catheterization, the ureteral catheter was reinserted into the bladder, and then the cystoscope was withdrawn. The ureteral catheter was fixed to the vulva with a tape to prevent prolapse. The operation inside the bladder must be gentle and the inspection time should not exceed 30 minutes. 4. Urine examination: Collect urine from the ureteral catheter for routine examination and, if necessary, for bacterial examination and culture. When the catheter is continuously dripped quickly, if the urine is sucked from the catheter with a syringe, and 10 to 20 ml or more can be sucked out at a time, it is suspected that there is hydronephrosis. 5. Renal function test: If no sputum test is performed in cystoscopy and gradual renal function test is required, phenol red or rouge should be injected intravenously according to the prescribed dose, and the urine derived from the renal pelvis on both sides should be observed separately. Color time and concentration time. 6. Retrograde pyelography: the ureteral catheter is connected to the syringe, and the contrast agent is injected for pyelography. The common contrast agent is 12.5% sodium iodide solution, and each side is injected with 5-10 ml. The injection should be slow and not usable. The patient should have immediate back pain. Stop and maintain stress.