Procedure Of Cystoscopy

Take out the sterilized speculum and various instruments, and wash the disinfection solution on the speculum with sterile saline. Check whether the eyepiece and objective of the speculum are clear, adjust the height of the lamp, and apply sterilized glycerin to the outside of the lens sheath for smoothness. Liquid paraffin will form oil beads in salt water, which will make the visual field unclear and affect the examination, so it can not be used. The ureteral catheter should be inserted into the ureteral speculum in advance.
Before the cystoscope is inserted, the male patient will explore whether the urethra is normal or narrow, and then use the speculum to slowly push along the anterior wall of the urethra to the urethra membrane. When there is resistance, wait for a moment until the urethral sphincter relaxes and then smoothly enters the bladder. Do not use violence during insertion, so as not to damage the urethra and form a false path. Female patients are easy to insert, but it should be noted that the speculum should not be inserted too deeply, so as not to damage the bladder. If a concave lens sheath is used, the cystoscope should be rotated 180°.
After the speculum was inserted into the bladder, the core of the speculum was removed and the residual urine volume was measured. If the urine is cloudy (severe hematuria, pyuria or chyluria), it should be washed repeatedly until the return liquid is clear, and then replaced with an examination speculum. Saline is injected into the bladder, so that it gradually fills, so that the patient does not have a sense of bladder distension (generally about 300ml). Slowly pull the speculum out until you see the edge of the bladder neck. The interureteral ridge can be seen by pushing the speculum into 2 ~ 3cm at the two lower corners of the bladder neck margin. The ureteral orifices can be found at both ends of the interureteral cristae from 5 to 7 o 'clock of the clock. If carefully observed, it can be seen that there is peristaltic urination, blood discharge or chylous phenomenon at the mouth of the tube. Finally, the entire bladder should be systematically and comprehensively examined from deep to shallow to avoid omissions. If ureteral intubation is required, the ureteral tube speculum should be replaced, and the ureteral catheter No. 4 to 6 should be inserted into the ureteral opening until the renal pelvis, which is generally 25 to 27cm deep. The posterior end of the ureter should be marked to distinguish left from right. If the ureteral orifice has inflammation and congestion can not be identified, the indigo rouge solution can be injected intravenously, and the catheter can be guided by the ureteral orifice drainage. After cystoscopy and ureteral catheter insertion, the ureteral catheter is re-inserted into the bladder, then withdrawn from the cystoscope, and the ureteral catheter is fixed to the vulva with tape to avoid escape. The bladder operation must be gentle and the examination time should not exceed 30 minutes.
Urine extracted from the ureteral catheter is collected for routine examination and, if necessary, bacterial examination and culture. When the catheter continues to drip urine faster, such as using a syringe to aspirate urine from the catheter, more than 10 to 20ml can be aspirated at a time, hydronephrosis should be suspected.
If indigo carmine test is not performed in cystoscopy and it is necessary to perform lateral renal function test, phenol red or indigo carmine should be injected intravenously according to the prescribed dose, and the color time and concentration time in urine derived from the renal pelvis on both sides should be observed respectively.
Retrograde pyelography The ureteral catheter was connected to a syringe and the contrast agent was injected. The usual contrast agent was 12.5% sodium iodide solution, and 5 ~ 10ml was injected into each side. The injection should be slow and not forced.