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Cystoscopy: Difference between revisions
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(Created page with "<section begin="urology" />'''Cystoscopy''', also called '''cysturethroscopy''', is a procedure where a cystoscope (an endoscope) is inserted into the urethra to examine the urethra, urethral sphincter, prostate, urinary bladder, and uretral orifices. The endoscope can visualise the organs, take biopsy samples, and perform a limited number of therapeutic interventions like cauterisation. It's one of the most common procedures performed in urology. == Indications == * Ha...") |
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<section begin="urology" />'''Cystoscopy''', also called '''cysturethroscopy''', is a procedure where a cystoscope (an endoscope) is inserted into the urethra to examine the urethra, urethral sphincter, prostate, urinary bladder, and uretral orifices. The endoscope can visualise the organs, take biopsy samples, and perform a limited number of therapeutic interventions like cauterisation. It's one of the most common procedures performed in urology. | <section begin="urology" /><section begin="urology2" />'''Cystoscopy''', also called '''cysturethroscopy''', is a procedure where a cystoscope (an endoscope) is inserted into the urethra to examine the urethra, urethral sphincter, prostate, urinary bladder, and uretral orifices. The endoscope can visualise the organs, take biopsy samples, and perform a limited number of therapeutic interventions like cauterisation. It's one of the most common procedures performed in urology. | ||
<section end="urology2" /> | |||
== Indications == | == Indications == | ||
* Haematuria | * Haematuria | ||
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Performing cystoscopy on a patient with urinary infection may lead to [[sepsis]]. | Performing cystoscopy on a patient with urinary infection may lead to [[sepsis]]. | ||
<section begin="urology2" /> | |||
== Technique == | == Technique == | ||
* Disinfection of urethral area | * Disinfection of urethral area | ||
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* Insert the cystourethroscope | * Insert the cystourethroscope | ||
* Inspect all parts of the urethra, bladder, and ureteral orifices | * Inspect all parts of the urethra, bladder, and ureteral orifices | ||
== Enhanced imaging == | |||
Not all bladder tumours are easily visible with the naked eye using a cystoscope (called white light cystoscopy), especially carcinomas in situ. Two techniques allow for improved detection of bladder cancer. | |||
Photodynamic diagnosis (PDD), also called fluorescent cystoscopy, is often used, where a fluorescent dye (photosensitiser) called hexyl aminolevulinate (HAL, Hexvix®) is administered into the bladder before the procedure. Cancer cells absorb this dye and glow red or pink when special fluorescent light is shone from the cystoscope, making them easier to see. | |||
Narrow band imaging (NBI) is a similar technique which uses a specific wavelength of light with makes blood vessels more visible. As tumours often are hypervascularised, this can help detect tumours. No photosensitiser is required. | |||
<section end="urology" /> | <section end="urology" /> | ||
== Bladder biopsy == | |||
Bladder biopsy is frequently performed in the evaluation of suspected urinary tract malignancy, especially bladder cancer. A urine cytology must be performed beforehand, to look for malignant cells. | |||
If no tumours are visible with "normal" white light cystoscopy but the cytology is positive, one may use photodynamic diagnosis or narrow band imaging to try to detect the tumour. One can also perform a "mapping biopsy", where biopsies are taken blindly from high predilection areas. | |||
If a tumour is visible on cystoscopy, transurethral resection of bladder (TUR-B), also called transurethral resection of bladder tumour (TURBT) may be performed, which is both diagnostic and therapeutic. This involves resecting the entire visible tumour by cystoscopy. | |||
A standard technique for tumour biopsy (if the entire tumour cannot be resected) is the method of Bressel: | |||
* 1 sample from tumour | |||
* 1 sample from muscular layer of bladder | |||
** To look for muscle invasion – important for further treatment | |||
* 4 samples of the sides of the tumor | |||
** To determine the border of the tumor | |||
<section end="urology2" /> | |||
[[Category:Urology]] | [[Category:Urology]] | ||