Cystoscope

Cystoscope, a type of endoscope, similar to a urethral probe, consisting of an electrosurgical sheath, an examination mirror, a treatment and a ureteral cannula, and a mirror core, with an electrocautery, a clipper, and Accessories such as biopsy forceps. In recent years, the illumination system of the cystoscope has been changed, and a cold light source box is provided. The reverse strong cold light is transmitted through the optical fiber guide beam to the inside of the bladder to replace the bulb illumination at the front end of the bladder mirror sheath, which has good illumination and clear vision. Dimming and other advantages. Basic Information Specialist classification: urinary examination classification: endoscope Applicable gender: whether men and women apply fasting: fasting Analysis results: Below normal: Female urinary fistula, urachal fistula and other examination results are lower than normal. Normal value: Bladder pressure: 350-500ml Above normal: Non-bacterial prostatitis, urethritis and other examination results are higher than normal. negative: Positive: Tips: Drink plenty of water after surgery. Normal value The normal value of bladder pressure is 350-500 ml. Clinical significance Abnormal result 1. Diagnosing the inside of the bladder can be observed by examining the speculum. Through the ureteral intubation, the elongated ureteral catheter can be inserted into the ureter to the renal pelvis, and the urine is collected for routine examination and culture. Intravenous injection of rouge solution, observing the blue time of the ureter on both sides, can estimate the renal function on both sides (blue line 5-10 minutes after normal injection), and inject 12.5% ​​sodium iodide contrast agent into the renal pelvis or ureter via catheter. Retrograde pyelography can be used to understand the kidney, renal pelvis and ureter. 2. For treatment, such as bleeding points or papilloma in the bladder, can be treated by electrosurgery with cystoscope. The stones in the bladder can be washed out with a lithotripter, and foreign bodies and lesions in the bladder can be clamped with foreign bodies or The biopsy forceps are removed and the ureteral orifice is narrowed and can be cut open by a cystoscope (or dilated with a dilator). The people who need to be examined are old and debilitated, and have comorbidities such as cardiovascular or diabetes. Transurethral resection of the prostate is suitable for a variety of causes of bladder neck obstruction, including patients with residual tissue after open surgery can still make symptoms can not be alleviated. Low results may be diseases: bladder stones, pheochromocytoma crisis in the elderly, bladder cancer, high prostate hyperplasia in the elderly may be diseases: bladder tuberculosis, bladder pheochromocytoma, congenital bladder neck contracture, urethral syndrome , bladder transitional cell carcinoma, bladder internal hemorrhoids, cervical invasive cancer, bladder urethra foreign body matters needing attention Contraindications before examination: The surgeon is prepared to wash his hands, wear sterile clothes, and wear sterile gloves. The principle of aseptic operation should be emphasized to avoid complications such as iatrogenic urinary tract infections. Requirements after inspection: 1. There is often hematuria after cystoscopy, which is caused by intraoperative mucosal damage, usually after 3 to 5 days. 2. Postoperative urethral burning pain, can allow patients to drink more water diuretic, and give analgesics, can be light after 1 to 2 days. 3. If the aseptic operation is not strict, urinary tract infection, fever and low back pain will occur after surgery, and antibiotic control should be applied. Inspection process Preoperative preparation: 1. Cystoscopy disinfection can be steamed with a 40% formalin (formaldehyde) solution for 20 minutes or soaked in a 10% formalin solution for 20 minutes. The cystoscope cannot be disinfected by boiling, alcohol, 0.1% cleansing and soaking to avoid damage to the bladder speculum. 2. The surgeon is ready to wash his hands, wear sterile clothes, and wear sterile gloves. The principle of aseptic operation should be emphasized to avoid complications such as iatrogenic urinary tract infections. 3. The patient is prepared to have the patient empty the bladder and take the stone. The genital area is disinfected with soapy water, sterile saline and a new solution. Spread the disinfection hole towel to expose the urethra. Surgical procedure: 1. The instrument is ready to take out the sterile speculum and various instruments, and wash the disinfection solution on the speculum with sterile saline. Check the eyepiece eyepiece and objective lens for clarity, adjust the height of the mirror lamp, and apply sterilized glycerin on the outside of the sheath to facilitate smoothness. Liquid paraffin will form oil beads in the salt water, making the field of vision unclear, affecting the inspection, and not being used. The ureteral catheter was inserted into the ureteral catheter for use in advance. 2. Insert the cystoscope male patient before the cystoscopy, explore whether the urethra is normal or not, and then use the speculum to slowly push along the anterior wall of the urethra to the urethral membrane. When there is resistance, wait for a while, etc. The urethral sphincter relaxation can smoothly enter the bladder. Do not use violence when inserting, so as not to damage the urethra and form a false tract. Female patients are easy to insert, but it should be noted that the speculum should not be inserted too deep to avoid damage to the bladder. If all are concave mirror sheaths, the cystoscope should be rotated 180°. 3. After the bladder and ureteral cannula were inserted into the bladder, the lens core was withdrawn and the residual urine volume was measured. If the urine is turbid (severe hematuria, pyuria or chyluria), it should be washed repeatedly until the liquid is clear, and then transferred to the inspection speculum. The saline is poured into the bladder to gradually fill it so as not to cause the patient to have a feeling of bladder swelling (generally about 300 ml). Slowly pull the speculum out and see the bladder neck. The ureteral fistula can be seen by pushing the speculum at 2 to 3 cm at the lower corners of the bladder neck. At both sides of the clock from 5 o'clock to 7 o'clock, at both ends of the ureteral fistula, both sides of the ureteral orifice can be found. If you observe carefully, you can see the phenomenon of peristaltic urination, blood discharge or milk discharge. Finally, all bladders should be examined systematically, comprehensively, and from deep to shallow to avoid omissions. Need to be ureteral intubation, should be replaced with ureteral intubation speculum, the 4 to 6 ureteral catheter into the ureteral orifice, until the renal pelvis, generally deep 25 ~ 27cm ureter should be marked at the back end to identify the left and right. If there is inflammation and congestion in the ureteral orifice that can not be distinguished, the rouge solution can be injected intravenously, and the intubation can be guided by the ureteral orifice. After cystoscopy and ureteral catheterization, the ureteral catheter was reinserted into the bladder, and then the cystoscope was withdrawn. The ureteral catheter was fixed to the vulva with a tape to prevent prolapse. The operation inside the bladder must be gentle and the inspection time should not exceed 30 minutes. 4. Urine examination Collect urine from the ureteral catheter for routine examination and, if necessary, for bacterial examination and culture. When the catheter is continuously dripped quickly, if the urine is sucked from the catheter with a syringe, and 10 to 20 ml or more can be sucked out at a time, it is suspected that there is hydronephrosis. 5. Renal function test If you do not have a rouge test in cystoscopy and need to perform a partial renal function test, you should intravenously inject phenol red or rouge according to the prescribed dose, and observe the color of urine in the renal pelvis derived from both sides. Time and concentration time. 6. Retrograde pyelography: The ureteral catheter is connected to the syringe, and the contrast agent is injected into the pyelography. The common contrast agent is 12.5% ​​sodium iodide solution, and each side is injected with 5-10 ml. The injection should be slow and not usable. When the patient has low back pain, stop immediately. And maintain pressure. Not suitable for the crowd 1. The urethra and bladder are not suitable for examination in the acute inflammatory phase, which can lead to the spread of inflammation, and the acute inflammation of the bladder is congested, and the lesion can be unclear. 2. The bladder volume is too small, below 60ml, indicating that the lesion is serious, the patient can not tolerate this test, it is also easy to cause bladder rupture. 3. Phimosis, urethral stricture, incarceration of stones in the urethra, etc., can not be inserted into the cystoscope. 4. The bone and joint deformity can not take the position of the stone. 5. Women's menstrual period or more than 3 months of pregnancy. 6. Renal function is severely degraded and there are signs of uremia, high blood pressure and poor heart function. Adverse reactions and risks Urinary tract infections, fever and low back pain may occur.

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