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.
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- 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