Cystoscopy for the gynaecologist

M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 3 – C O R E S U R G I C A L S K I L L S

Cystoscopy for the Gynaecologist: How to Do a Cystoscopy Lyttle M, Fowler G. Cystoscopy for the gynaecologist: how to do a cystoscopy. TOG 2017;19:236–240. doi:10.1111/tog.12396

2 ≥45 yrs 30° CYSTOSCOPE TYPES: RIGID & FLEXIBLE AGE THRESHOLD, UNEXPLAINED VISIBLE SEGMENT ROTATION, SYSTEMATIC BLADDER HAEMATURIA SURVEY

DO N' T-M IS S FA C TS

  1. Only true contraindication to cystoscopy: untreated UTI (BAUS)

  2. Haematuria referral ages: visible unexplained – ≥45yrs; visible + raised WCC, or non-visible + dysuria – ≥60yrs

  3. Rigid = GA/spinal, theatre; flexible = LA, outpatient, apron + sterile gloves (no full scrub)

  4. All rigid cystoscopy: single-dose IV gentamicin; flexible = selective (botox, recurrent UTI, prosthetic valve <6 months)

  5. Avoid overfilling bladder – distorts urothelium, thins wall (biopsy risk)

  6. Systematic survey: dome bubble landmark, ~30° segments back to bladder neck, right then left, anterior wall last

  7. Obvious TCC → refer urgently for TURBT, do not biopsy locally

  8. Urethral diverticulum easily missed – always inspect urethra on withdrawal

RIGID VS FLEXIBLE – AT A GLANCE

Rigid: GA/spinal, theatre, 0°/30°/70° lens options, IV gentamicin all cases

Flexible: LA, outpatient, no lens change, selective antibiotics, no torque on tip

ABBREVIATION KEY

UTI — urinary tract infection IV — intravenous

BAUS — British Association of Urological Surgeons TCC — transitional cell carcinoma

EAU — European Association of Urology TURBT — transurethral resection of bladder tumour

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Lyttle M, Fowler G. Cystoscopy for the gynaecologist: how to do a cystoscopy. TOG 2017;19:236–240. doi:10.1111/tog.12396

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