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Cystoscopy - Indications and Complications

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This is part of the Gynsurgery guidelines used in an educational setting for residents in Ob-Gyn.

Indications for Cystoscopy

  1. As a routine procedure after Burch retropubic urethropexy, abdominal or vaginal paravaginal repair, uterosacral colpopexy, or culdoplasty
  2. To check for suspected/possible ureter injury (obstruction, interruption)
  3. To check for bladder injury (cystotomy, sutures in bladder, erosion of mesh)
  4. To verify suprapubic catheter placement
  5. To place ureteral stents
  6. To stage gyn malignancy
  7. To evaluate a vesicovaginal fistula
  8. To evaluate hematuria if cystitis, glomerulonephritis and renal stones have been ruled out

Complications of Cystoscopy

  1. minor urethral pain
  2. postoperative urinary tract infection (1-5%)
  3. urethra, bladder or ureteral injury/perforation
  4. risk of missing pathology

Prevention of Cystoscopy Complications

  1. minor urethral pain
    1. lubricate cystoscope trochar
    2. use smallest caliber cystoscope available for diagnostic purposes
  2. postoperative urinary tract infection
    1. no benefit from prophylactic antibiotics
    2. maintain sterile field for introduction of cystoscope
  3. urethra, bladder or ureteral injury/perforation
    1. visualize urethra and bladder immediately upon introduction of cystoscope
    2. avoid excessive introduction pressure of cystoscope
  4. risk of missing pathology
    1. use different degree scopes from 0 degrees to 30 to 70 degrees to visualize entire urethra, bladder trigone and walls and ureteral openings

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