CYSTOSCOPY
A cystoscopy is a diagnostic procedure that allows a doctor to view the inside of the bladder and urethra in detail. It is performed using a thin, lighted instrument called a cystoscope. The cystoscope is inserted into your urethra and slowly advanced into your bladder.
A flexible cystoscope, rigid cystoscope, or resectoscope may be used.
Reasons for performing a cystoscopy include:
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Investigating causes of symptoms like blood in urine (hematuria), painful urination, incontinence, frequent urinary tract infections, or unexplained pain in the lower back or pelvic area.
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Diagnosing conditions like bladder stones, bladder tumors, and interstitial cystitis.
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Treating conditions like bladder tumors, bladder stones, or blockages in the urethra.
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Monitoring treatment progress for conditions affecting the bladder and urethra.
The bladder (cystoscopy)
Urethra (urethroscopy)
Ureteral orifices (ureteroscopy)
Collecting system (transurethral ureteropyeloscopy)
Anesthetic Implications for Cystoscopy
Anesthesia type: General anesthesia, topical anesthesia, regional anesthesia
Airway: ETT or LMA
Preoperative:
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X-rays and fluoroscopy are done during this procedure
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Paraplegics and quadriplegics present for multiple cystoscopies
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Assess for history and risk of autonomic hyperreflexia (patients with spinal cord injury above T10)
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Avoid succinylcholine in paraplegics and quadriplegics
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Muscle relaxation is not essential
Intraoperative:
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Suspect perforation if irrigation fluid fails to return
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Large perforations can lead to unexplained hemodynamic changes
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Lithotomy position
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Duration 15-45 minutes
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EBL minimal
Postoperative:
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Post-op pain usually minimal
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Short-acting narcotics
Complications:
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Bladder perforation
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Ureteral perforation
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Infection
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Bleeding
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Retained stones
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Autonomic hyperreflexia
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Peroneal nerve injury (foot drop)
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Fever
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Bacteremia
Sources:
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.