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Cystoscopy and Bladder Biopsy / Fulguration

Dr. Stephen Lukasewycz

What is this procedure?Tap to read

Cystoscopy: a camera (cystoscope) goes through the urethra into the bladder so the surgeon can look at the bladder lining.

Biopsy and fulguration: small pieces of any abnormal area are taken with biopsy forceps and sent to pathology. The spots are then sealed with a cautery tip (Bugbee) to stop bleeding or treat small spots.

Retrograde pyelogram (RPG): sometimes added. A thin tube is passed up into the ureter and dye is injected while X-ray pictures are taken, to outline the ureter and kidney.

Afterward: most patients go home the same day.

Key points

Several specimens. Label each one separately as the surgeon calls it.
Warm sterile water for irrigation, not saline. Glycine if no water is available.
Bugbee: coag 25, cut 0. Grounding pad on.
22 Fr sheath (default); open both the 30° and 70° lenses.
If retrogrades are booked: C-arm in the room and set up before the patient comes in. See the retrograde section below.

Supplies

Open

Cysto set
22 Fr sheath (default)
30° and 70° lenses
Storz camera, GloShield, cysto pack
Bugbee 5 Fr with cord
Grounding pad
Rigid cold cup biopsy forceps
Warm sterile water irrigation
Specimen cups with formalin, one per site
Lubricating jelly on a blue towel
Surgical jumpsuit (plastic overalls)

Available in room, open only if asked

60 mL catheter-tip syringe
Foley 18 Fr 2-way
Glycine 1.5% (if no water)

If retrograde pyelogram

Open

C-arm (set up before the patient comes in), C-arm drape
Contrast: Omnipaque 300 mgI/mL, 30 mL, diluted 50/50
Ureteral catheter: 6 Fr open-ended (white)

Available in room, open only if asked

Sensor wire
Rigid ureteroscope

If sending urine for cytology or culture

Whistle-tip ureteral catheter, a separate one for each kidney.
Sterile specimen cups, labeled right or left.
Cytology and culture each go with their own slip.

Gloves

7.5.
Surgical jumpsuit (plastic overalls).

Anesthesia

Often MAC; general if needed.
Perioperative antibiotics: cefazolin (Ancef) 2 g IV, unless contraindicated.
B&O suppository 60 mg after the prep is fine.

Positioning

Dorsal lithotomy in Yellofin stirrups.
Left arm tucked.
SCDs on.

Prep and drape

Povidone-iodine (Betadine) scrub and paint: pubis, perineum, upper third of thighs, and genitals. For female patients, paint only in the vagina.
After the prep, dry the perineum and place the lithotomy drape.
Do not place towels under the drape. Towels let the drape slip and fall, which contaminates the field.
Please continue draping after the prep; no need to wait for the surgeon.

Irrigation

Warm sterile water.
Glycine 1.5% if no water is available.
No pressure bag.

Cautery

Bugbee: coag 25, cut 0.
Grounding pad on.

Specimens

Expect several. Each site in its own formalin cup, labeled as the surgeon calls it.

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