Hematuria is one of the main clinical manifestations of many genitourinary diseases. A significant portion of hematuria is due to curable malignant tumors, and the key is early detection, diagnosis, and timely treatment. Cystoscopy is important for diagnosing hematuria.
It can identify the source of blood in the urine. By directly observing the bladder, it can be determined whether the bleeding is from a lesion in the bladder or from the upper urinary tract. The latter can be determined by observing the color change of urine expelled from the ureteral opening.
It can determine the cause of hematuria. If the bleeding is from the bladder, not only can the bleeding site be visualized, but also the cause of the bleeding can often be determined. Even if the hematuria originates from the upper urinary tract, objective data can be provided for clinical diagnosis through pyelonephritis urine tests and retrograde pyelography.
For patients with urinary tract infections (including specific and non-specific infections) who are ineffective after anti-infective treatment, or who have recurrent infections even after being cured, a full cystoscope bridge examination is necessary.
For adult or pediatric patients with persistent urinary urgency, frequency, pain or other urinary abnormalities, especially in cases where drug treatment is ineffective, cystoscope bridge is particularly important. Valuable clues for diagnosis can be provided by combining the results of cystoscopy imaging (such as inflammation, ulcers, stones, foreign bodies, deformities, etc.) and retrograde pyelography (changes in morphology or appearance of destructive lesions).
In the treatment of bladder system diseases such as bleeding spots or papillomas in the bladder, electrocauterization can be performed through cystoscope bridge; bladder stones can be crushed and flushed out with a lithotripter; small foreign bodies and lesion tissues in the bladder can be removed with foreign body or biopsy forceps; and ureteral stenosis can be cut open with a resectoscope (or expanded with a dilator) through cystoscope bridge.
Take out the sterilized endoscope and various instruments, rinse the disinfectant solution on the endoscope with sterile saline solution. Check whether the eyepiece and objective lens of the endoscope are clear, adjust the height of the mirror light, and apply sterilized glycerin outside the sheath for lubrication. Liquid paraffin will form oil droplets in saline solution, which will affect the view and inspection, and should not be used. Prepare the ureteral catheter in advance and insert it into the ureteral catheter endoscope for backup.
Insert the cystoscope
For male patients, before inserting the cystoscope, check whether the urethra is normal or stenotic, and then slowly push the endoscope along the anterior wall of the urethra to the membranous part of the urethra. If there is resistance, wait for the urethral sphincter to relax and enter the bladder smoothly. Avoid using violence during insertion to prevent urethral injury and false tract formation. Female patients are easy to insert, but attention should be paid not to insert the endoscope too deep to prevent bladder injury. If a concave sheath is used, the cystoscope needs to be rotated 180°.
Check the bladder and insert the ureteral catheter
After the endoscope is inserted into the bladder, the core should be removed to measure the residual urine volume. If the urine is turbid (severe hematuria, pyuria, or chyluria), it should be washed repeatedly until the return liquid is clear before changing to the examination endoscope. Physiological saline is injected into the bladder to gradually fill it, without causing bladder distension in patients (generally about 300ml). Slowly withdraw the endoscope until the bladder neck is seen. After the cystoscope examination and ureteral catheter insertion, insert the ureteral catheter into the bladder again and then withdraw the cystoscope. Use tape to fix the ureteral catheter to the perineum to prevent it from falling out. The operation in the bladder must be gentle and the examination time should not exceed 30 minutes.
Collect the urine discharged from the ureteral catheter for routine examination, and if necessary, perform bacterial examination and culture. If the catheter continues to drip urine quickly and more than 10-20ml can be extracted at a time with a syringe, renal pelvic dilatation should be suspected.
Renal function test
If indigo carmine test is not performed during cystoscopy examination but a side-by-side renal function test is required, phenol red or indigo carmine should be intravenously injected at the prescribed dose, and the appearance and concentration time of urine discharged from the two sides of the renal pelvis should be observed.
Connect the ureteral catheter to the syringe and inject the contrast agent for pyelography. 12.5% sodium iodide solution is commonly used, and 5-10ml is injected on each side. The injection should be slow and not forceful. When the patient has back pain, the pressure should be maintained immediately.