Diagnostic cystourethroscopy for gynecologic conditions
- Cynthia S Fok, MD, MPH
Cynthia S Fok, MD, MPH
- Assistant Professor of Urology
- University of Minnesota
- Kimberly Kenton, MD, MS, FACOG, FACS
Kimberly Kenton, MD, MS, FACOG, FACS
- Professor, Obstetrics & Gynecology
- Chief, Female Pelvic Medicine & Reconstructive Surgery
- Northwestern University, Feinberg School of Medicine
- Chicago, IL
Cystourethroscopy is used by urologists, urogynecologists, and gynecologists. It is particularly useful in gynecologic practice for the evaluation of operative lower urinary tract injury. The use of cystourethroscopy to examine the female urethra and bladder was introduced in 1805 by Dr. Philipp Bozzini in Germany and visualization was improved in 1894 by Dr. Howard Kelly, a gynecologist in the United States [1,2]. Currently, cystourethroscopy training is provided in most, but not all, United States gynecology residency programs [3-5].
The female genital and lower urinary tracts are closely related anatomically and embryologically. Thus, many conditions or procedures affect both of these tracts. Examples of this include: urinary incontinence associated with pelvic organ prolapse, urogenital fistula, metastases of gynecologic malignancies, endometriosis, and hysterectomy or pelvic reconstructive procedures.
Cystourethroscopy is commonly referred to as cystoscopy, and this term will be used in this review.
Use of cystourethroscopy for evaluation of lower urinary tract injury for gynecologic indications is reviewed here. Prevention, evaluation, and management of lower urinary tract injury in gynecologic surgery, as well as placement or ureteral stents, are reviewed separately. (See "Urinary tract injury in gynecologic surgery: Prevention" and "Urinary tract injury in gynecologic surgery: Evaluation and management" and "Placement and management of indwelling ureteral stents".)
Gynecologic indications for cystoscopy are discussed in this section. These overlap with some, but not all, urologic indications for cystoscopy.
- Morgenstern L. The 200th anniversary of the first endoscope: Philipp Bozzini (1773-1809). Surg Innov 2005; 12:105.
- Dwyer PL. In the footsteps of Kelly and Robertson; revival of the art of cystourethroscopy in gynecology. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:713.
- CREOG's Educational Objectives. A Core Curriculum in Obstetrics and Gynecology, 9th Ed. http://www.acog.org/departments/dept_web.cfm?recno=1 (Accessed on March 17, 2011).
- Hibbert ML, Salminen ER, Dainty LA, et al. Credentialing residents for intraoperative cystoscopy. Obstet Gynecol 2000; 96:1014.
- Bowling CB, Greer WJ, Bryant SA, et al. Testing and validation of a low-cost cystoscopy teaching model: a randomized controlled trial. Obstet Gynecol 2010; 116:85.
- American College of Obstetricians and Gynecologists. ACOG Committee Opinion. Number 372. July 2007. The Role of cystourethroscopy in the generalist obstetrician-gynecologist practice. Obstet Gynecol 2007; 110:221.
- Gilmour DT, Das S, Flowerdew G. Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy. Obstet Gynecol 2006; 107:1366.
- Bai SW, Huh EH, Jung da J, et al. Urinary tract injuries during pelvic surgery: incidence rates and predisposing factors. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17:360.
- Ibeanu OA, Chesson RR, Echols KT, et al. Urinary tract injury during hysterectomy based on universal cystoscopy. Obstet Gynecol 2009; 113:6.
- Ramahi AJ, Richardson DA, Ataya KM. Urethral stones in women. A case report. J Reprod Med 1993; 38:743.
- Bootsma AM, Laguna Pes MP, Geerlings SE, Goossens A. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol 2008; 54:1270.
- DasGupta R, Sullivan R, French G, O'Brien T. Evidence-based prescription of antibiotics in urology: a 5-year review of microbiology. BJU Int 2009; 104:760.
- Wolf JS Jr, Bennett CJ, Dmochowski RR, et al. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol 2008; 179:1379.
- Goldfischer ER, Cromie WJ, Karrison TG, et al. Randomized, prospective, double-blind study of the effects on pain perception of lidocaine jelly versus plain lubricant during outpatient rigid cystoscopy. J Urol 1997; 157:90.
- Choe JH, Kwak KW, Hong JH, Lee HM. Efficacy of lidocaine spray as topical anesthesia for outpatient rigid cystoscopy in women: a prospective, randomized, double-blind trial. Urology 2008; 71:561.
- Stein M, Lubetkin D, Taub HC, et al. The effects of intraurethral lidocaine anesthetic and patient anxiety on pain perception during cystoscopy. J Urol 1994; 151:1518.
- Cundiff, GW, Bent, AE. Endoscopic evaluation of the lower urinary tract. In: Urogynecology and Reconstructive Pelvic Surgery, 3rd ed, Walters, MD, Karram, MM (Eds), Mosby Elsevier, Philadelphia 2007. p. 114.
- Graziano S, Hoyte L, Vilich F, Brubaker L. Life-threatening reaction to indigo carmine--a sulfa allergy? Int Urogynecol J Pelvic Floor Dysfunct 2005; 16:418.
- Ferro A, Byck D, Gallup D. Intraoperative and postoperative morbidity associated with cystoscopy performed in patients undergoing gynecologic surgery. Am J Obstet Gynecol 2003; 189:354.
- Almallah YZ, Rennie CD, Stone J, Lancashire MJ. Urinary tract infection and patient satisfaction after flexible cystoscopy and urodynamic evaluation. Urology 2000; 56:37.
- Clark KR, Higgs MJ. Urinary infection following out-patient flexible cystoscopy. Br J Urol 1990; 66:503.
- Turan H, Balci U, Erdinc FS, et al. Bacteriuria, pyuria and bacteremia frequency following outpatient cystoscopy. Int J Urol 2006; 13:25.
- Arpi M, Werner C, Timmermann B. Bacteremia following transurethral instrumentation. The predictive value of a serum bactericidal activity test. Scand J Urol Nephrol 1986; 20:169.
- Bavetta S, Olsha O, Fenely J. Spreading sepsis by cystoscopy. Postgrad Med J 1990; 66:734.
- Honma I, Takagi Y, Shigyo M, et al. Massive hematuria after cystoscopy in a patient with an internal iliac artery aneurysm. Int J Urol 2002; 9:407.
- Montie JE, Stewart BH. Massive bladder hemorrhage after cystoscopy in a patient with secondary systemic amyloidosis. J Urol 1973; 109:49.
- PREOPERATIVE EVALUATION AND PREPARATION
- Informed consent
- Preoperative evaluation
- Prophylactic antibiotics
- Operative setting
- Distending medium
- Inserting the cystoscope
- Examining the lower urinary tract
- - Urethra
- - Bladder
- Identifying bladder injury or erosion
- Evaluating bladder lesions
- Evaluating genitourinary fistula
- - Ureteral orifices
- Identifying ureteral injury
- When to call for consultation
- Urethral or bladder injury
- Other complications
- POSTOPERATIVE CARE
- SUMMARY AND RECOMMENDATIONS