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Cystoscopy

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 urethra, prostate and bladder lining. No cuts are needed.

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 without a catheter.

Key points

Start with the 22 Fr sheath (default) and the 30° lens. Have the 70° lens ready in the room.
Saline, no pressure bag. Irrigation runs by gravity.
Lubricating jelly on a blue towel.
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° lens
Storz camera, GloShield, cysto pack
Saline irrigation, 3000 mL
Lubricating jelly on a blue towel
60 mL catheter-tip syringe
Surgical jumpsuit (plastic overalls)

Available in room, open only if asked

70° lens (in the room, ready to go)
Foley 18 Fr 2-way
Van Buren and Goodwin sounds
Flexible cystoscope (if supine)

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

MAC or general anesthesia.
For local cases: 2% lidocaine jelly (Urojet).
Perioperative antibiotics: cefazolin (Ancef) 2 g IV, unless contraindicated.

Positioning

Dorsal lithotomy in Yellofin stirrups.
Left arm tucked.
SCDs on.
If done supine: flexible cystoscope needed.

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

Saline.
No pressure bag.

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