1. Chapter 6: Basic Instrumentation and Cystoscopy Peter Tran, D.O. Garden City Hospital 8/13/2008

2. Objectives Urethral Catherization Urethral Dilatation Cystourethroscopy Retrograde pyelography

3. Urethral Catherization For diagnosis and treatment –Collection of urine in females –Relief of obstruction BPH Clot retention –Instillation of chemo –Post-surgical

4. Catheter Types and Size Size –1 Fr = 0.33mm. Outside diameter not luminal. Types –Straight –Coude –Malecot –Foley –3-way

5. Downloaded from: Campbell-Walsh Urology (on 10 August 2008 03:12 AM) © 2007 Elsevier Catheter Types

6. Catheter Insertion Sterile Technique Use of Urojet Long-term use –Silicone better than latex or polyurethane Size –16-18 Fr for adults

7. Difficult Catherization Usually in males –BPH Use coude –Urethral Strictures –BNC May require the use of a glide-wire or filiform and followers In Females –Rare Obesity Unable to locate urethral meatus or difficult position –Use speculum

8. Difficult Catherization

9. Urethral Dilatation Typically in male –Urethral Stricture –BNC –Meatus for transurethal surgery Sterile techniques –Filiforms and followers –Urethral dilators –Amplatz dilators –balloon

10. Cystourethroscopy Diagnosis of lower urinary tract disease Sterile technique Rigid cystoscope –Better visualization –Larger working channel –Ease of orientation Flexible scope –More patient comfort –Pt. Stays supine –View from different angles

11. Cystourethroscopy Systematic Inspection –Meatus –Urethra Mucosal abnormalities Diameter –External sphincter –Veru –Prostate gland BPH? Middle lobe? Prior turp? –Bladder UO Trigone Dome Foreign Bodies Lesion/Neoplasm Stones Cystitis

12. Retrograde Pyelography Visualization of ureter and collecting system when other radiographic images are inadequate or when the patient is allergic to IV dye. –Hematuria –Filling defects –Positive cytology of ? source –? Obstruction Delayed films