1. Done by: Ms. Ahdab Faisal Eskandar
Umm Al-Qura University
Applied Medical Sciences Collage
Nursing Department
Medical Surgical Course II
Cystoscopy
Done by: Ms. Ahdab Faisal Eskandar

2. Objectives: 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.

3. Outline: 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 cystoscopy
Nursing managements of complication from Cystoscopy.

4. Anatomy

6. Definition
A 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.

7. Cystoscope is done by urologist to role out some conditions like :
Hematuria
Dysuria
Incontinence
urinary tract infection
suspected tumors in the bladder
bladder or kidney stones
signs or symptoms of an enlarged prostate
disorders of or injuries to the urinary tract
symptoms of interstitial cystitis

8. Cystoscopy procedure can be performed in one of two ways : 1- Pe-rcutaneously through small incision or

9. 2-Cystoscope inserted through urethra

10. Purpose of Cystoscopy
Allowing assessments of urethra , Urethral orifices, bladder, ureters, Pelvis of each kidney as well as prostatic urethra in male .

11. Purpose of Cystoscopy
Visualize 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.

12. Purpose of Cystoscopy
Also, 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.

15. Lower tract cystoscope Upper tract cystoscope
Types of cystoscopy
Lower tract cystoscope
Upper tract cystoscope
Start from urethra and bladder
Patient usually is awake.
Lidocaine is injected several minutes prior to study.
No more uncomfortable than catheterization.
Start from ureters and kidneys
General anesthesia before the procedure to ensure that there are no involuntary muscle spasm .
The scope is being passed through ureters or kidney.

16. Renal and urethral brush biopsy

17. Histopathology of carcinoma transurethral biopsy
For a biopsy, special forceps are inserted through the cystoscope:
to pinch off a tissue sample
a small brush-like instrument may be inserted to scrape off some tissue.
Histopathology of carcinoma transurethral biopsy

18. Nursing Role *Pre *Intra *Post

19. Pre cystoscopy Obtain valid consent for the procedure
Blood and urine studies
x 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 minutes
Expect any blood in the urine to clear up in one to two days .

20. Pre cystoscopy Start IV access
Keep the patient NPO for 7-10 hours from the night before
At the day of the procedure:
Ask the patient to remove underwear and provide him hospital gown.
Ask the patient to void before the procedure.

21. During 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.

22. Flexible cystoscopy

23. Rigid cystoscopy

24. During the procedure Maintain integrity of sterile field.
Assist the urologist during procedure.
Label biopsy or specimen:
Date & time
site taken from
patient file number
Physician name &Nurse initial
Handel cystoscope carefully and send it to sterilization unit.
Disconnect the patient from monitor and transfer it to the surgical ward .

25. Post 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

26. Post 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

27. Post Cystoscopy
Monitor patient for sign and symptoms of urinary tract infection:
Headache
muscle aches
dizziness
Fatigue
fever
nausea or vomiting
or difficult or painful urination

28. Post cystoscopy
Patients 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.

29. Complications Most common : burning on voiding blood tinged urine
urinary frequency
urinary retention

30. Complications Rarely: Risk from anesthesia: profuse bleeding
Damaged of urethra
perforated bladder
urinary tract infection
injured penis
Risk 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.

31. Nursing management for complication

32. urinary 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

33. If 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

34. Red 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

35. Bladder Irrigation
Through 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

36. Summary

37. References
BRUNNER & SUDDARTH text book of medical & surgical nursing 10 Edition 2003
Medical & Surgical Nursing critical thinking for collaborative care Volume 1By Ignatavicius and Workman-
counslt.com

38. Thank you