Cystoscopy

Done by: Ms. Ahdab Faisal Eskandar

Umm Al-Qura UniversityApplied Medical Sciences CollageNursing DepartmentMedical Surgical Course II

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.

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.

Anato

my

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.

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

Cystoscopy procedure can be performed in one of two ways :

1- Pe-rcutaneously through small incisionor

2-Cystoscope inserted through urethra

Purpose of Cystoscopy

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

Purpose of Cystoscopy

2. Visualize urethra and bladder, by optical lens system that provide and magnify view.

3. High light intensity allows excellent visualization.4. Permits taken still and motion picture via digital

camera.

Purpose of Cystoscopy

5. Also, permits urologist to obtain urine specimen from each kidney to evaluate its functions.

(Cup forceps can be inserted through cyctoscope for biopsy).

6. Removing calculi from urethra, bladder and ureters using cyctoscope.

Types of cystoscopyUpper tract cystoscope

• 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.

Lower tract cystoscope• Start from urethra and

bladder• Patient usually is awake.• Lidocaine is injected several

minutes prior to study.• No more uncomfortable

than catheterization.

Renal and urethral brush 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

Nursing Role

*Pre *Intra*Post

Pre cystoscopyObtain valid consent for the procedureBlood and urine studiesx 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 .

Pre cystoscopy

Start IV accessKeep 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.

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.

Flexible cystoscopy

Rigid cystoscopy

During the procedureMaintain integrity of sterile field.Assist the urologist during procedure.Label biopsy or specimen:Date & timesite taken frompatient file numberPhysician name &Nurse initialHandel cystoscope carefully and send it to

sterilization unit.Disconnect the patient from monitor and transfer it

to the surgical ward .

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

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

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

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.

ComplicationsMost common : o burning on voidingo blood tinged urineo urinary frequencyo urinary retention

ComplicationsRarely: o profuse bleedingo Damaged of urethrao perforated bladdero urinary tract infectiono injured penisRisk 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.

Nursing management

for complication

• 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

• 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

• 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

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

Summary

ReferencesBRUNNER & SUDDARTH text book of medical & surgical nursing 10 Edition 2003Medical & Surgical Nursing critical thinking for collaborative care Volume 1By Ignatavicius and Workman- www.nursing counslt.comwww.myoclinic.comwww.bladdercancer-info.comwww.cancer.gov\cancertopic\types\bladderwww.medicinenet.comwww.en.wikipedia.org\bladder-cancerwww.surgeryencyclopedia.com/Ce-Fi/Cystoscopy.html#ixzz1DoHYvFFNwww.urologychannel.com\bladdercancer\index.shtml

Thank you