2Objectives: At the end of this lab each student will be able to : Describe briefly anatomy of urinary tract system.Define Cystoscopy procedure.Enumerate purposes of Cystoscopy.Differentiate between lower and upper tract Cystoscopy procedure.Identify renal and urethral brush biopsy procedure.Demonstrate nursing role pre ,intra and post Cystoscopy.List complications that might happen from cystoscopy.Discuss nursing managements related to complication from Cystoscopy.
3Outline: Anatomy of urology system. Definition of Cystoscopy. Purposes of Cystoscopy.Types of Cystoscopy.Renal and urethral brush biopsy.Nursing role pre .intra and post Cystoscopy procedure.Complication of cystoscopyNursing managements of complication from Cystoscopy.
6DefinitionA cystoscope is a diagnostic procedure that uses a scope, which is especially designed for urological use to examine the bladder, lower urinary tract, and prostate gland. It can also be used to collect urine samples, perform biopsies, and remove small stones.
7Cystoscope is done by urologist to role out some conditions like : HematuriaDysuriaIncontinenceurinary tract infectionsuspected tumors in the bladderbladder or kidney stonessigns or symptoms of an enlarged prostatedisorders of or injuries to the urinary tractsymptoms of interstitial cystitis
8Cystoscopy procedure can be performed in one of two ways : 1- Pe-rcutaneously through small incision or
10Purpose of CystoscopyAllowing assessments of urethra , Urethral orifices, bladder, ureters, Pelvis of each kidney as well as prostatic urethra in male .
11Purpose of CystoscopyVisualize urethra and bladder, by optical lens system that provide and magnify view.High light intensity allows excellent visualization.Permits taken still and motion picture via digital camera.
12Purpose of CystoscopyAlso, permits urologist to obtain urine specimen from each kidney to evaluate its functions.(Cup forceps can be inserted through cyctoscope for biopsy).Removing calculi from urethra, bladder and ureters using cyctoscope.
15Lower tract cystoscope Upper tract cystoscope Types of cystoscopyLower tract cystoscopeUpper tract cystoscopeStart from urethra and bladderPatient usually is awake.Lidocaine is injected several minutes prior to study.No more uncomfortable than catheterization.Start from ureters and kidneysGeneral anesthesia before the procedure to ensure that there are no involuntary muscle spasm .The scope is being passed through ureters or kidney.
17Histopathology of carcinoma transurethral biopsy For a biopsy, special forceps are inserted through the cystoscope:to pinch off a tissue samplea small brush-like instrument may be inserted to scrape off some tissue.Histopathology of carcinoma transurethral biopsy
19Pre cystoscopy Obtain valid consent for the procedure Blood and urine studiesx rays of the kidneys, ureters, and bladder, may be performed before cystoscopy.The nurse describe the examination to patient and his family with doctor:A cystoscope typically lasts from 10–40 minutesExpect any blood in the urine to clear up in one to two days .
20Pre cystoscopy Start IV access Keep the patient NPO for 7-10 hours from the night beforeAt the day of the procedure:Ask the patient to remove underwear and provide him hospital gown.Ask the patient to void before the procedure.
21During the procedure Put the patient into lithotomy position (the patient lies on his or her back with knees up and apart).The flexible cystoscope does not require this position.Attach patient to the monitor.Check vitals signs Q5 minutes and record IV fluid.
24During the procedure Maintain integrity of sterile field. Assist the urologist during procedure.Label biopsy or specimen:Date & timesite taken frompatient file numberPhysician name &Nurse initialHandel cystoscope carefully and send it to sterilization unit.Disconnect the patient from monitor and transfer it to the surgical ward .
25Post Cystoscopy Monitoring vital signs (same as post op) Reliving pain or any discomfort from the examination by relaxation or medication.Prophylaxis antibiotic may be given only if prescribed by doctor.Monitor patient for signs and symptoms of obstruction of urine flow:Bladder distension and flank pain..etc
26Post Cystoscopy Measure intake and output and record it on the chart Encourage fluid consumption at least 3L/day, unless contraindicated.Avoid strenuous exercises during recovery
27Post CystoscopyMonitor patient for sign and symptoms of urinary tract infection:Headachemuscle achesdizzinessFatiguefevernausea or vomitingor difficult or painful urination
28Post cystoscopyPatients should contact their physician if they experience any of the following symptoms after the procedure, including pain, redness, swelling, drainage, or bleeding from the surgical site.
29Complications Most common : burning on voiding blood tinged urine urinary frequencyurinary retention
30Complications Rarely: Risk from anesthesia: profuse bleeding Damaged of urethraperforated bladderurinary tract infectioninjured penisRisk from anesthesia:particularly for people who are obese, smoke, or are in poor health. Those undergoing anesthesia must inform the doctor of any medications they are taking.
32urinary retention especially in patient with obstructive pathology such as (prostatic hyperplasia): Warm sitz bath and antispasmodic medication such as flavoxate(urispas) to relax urinary sphincter
33If some burning on voiding and urinary frequency from trauma to mucus membrane can be expected post cystoscopy:Moist heat to lower abdomen and warm sitz bath are helpful in reliving pain and relaxing the muscles
34Red urine or blood tinged urine can be expected especially if biopsy taken: Encourage patient to drink a lot of fluid or continuous bladder irrigation to wash out the bladder after procedure
35Bladder IrrigationThrough 2 way catheter(Indwelling) which is inserted from Operation Room.Patient will be on continues irrigation for few days until the out put will be clear.COLD IRRGATION SOLUTION TO GIVE VASOCNSTRICTION EFFECT
37ReferencesBRUNNER & SUDDARTH text book of medical & surgical nursing 10 Edition 2003Medical & Surgical Nursing critical thinking for collaborative care Volume 1By Ignatavicius and Workman-counslt.com