UrethrocystoscopyDisusun oleh : Eko
SubektiUrethrocystoscopyEndoscopic examinations are one of the most
important tasks in urological diagnostics and therapies. Especially
the endoscopy of the urethra and the bladder are regarded as
standard diagnostic procedures in urology. Indications for
Urethrocystoscopy Gross hematuria. Persistent hematuria. Suspicion
of bladder carcinoma, tumour infiltration from outside or
metastases. Follow-up in superficial bladder cancer. For patients
with upper tract transitional cell carcinoma to rule out coexistent
bladder tumours. nspection of orifices in !esicoureteral"renal
reflux or ureterocele. #ecurrent urinary tract infection $%&'.
(iagnosis of interstitial cystitis. Hohenfeller, (2005) Manual
Endourology-raining for !esidents "" #$-25(iagnosis of female
urethral di!erticula. Suspicion of !esico!aginal or !esicoenteric
fistula. Suspicion of infra!esical obstruction $bladder outlet
obstruction'. (etection of urethral or !esical foreign bodies.
%rethral inspection under suspicion of stricture, tumour,
di!erticulum or fistula. Hohenfeller, (2005) Manual
Endourology-raining for !esidents "" #$-25)cute urethritis, acute
prostatitis, acute epididymitis. Febrile urinary tract
infection.Strong coagulopathy. Hohenfeller, (2005) Manual
Endourology-raining for !esidents ""
#$-25CystourethroscopyCystourethroscopy#igid cystoscopeFlexible
scope&elescope.* %rethroscopy is best accomplished + ,-degree
or -.-degree lens pro!iding a straight-ahead !iew.* n the bladder,
a /,-degree lens is commonly used and pro!ides excellent
!isuali0ation of the trigone, dome, and posterior and lateral
walls.* 1,-degree lens pro!ide better !isuali0ation of the anterior
wall, dome, and inferior lateral walls. &elescopes with a
-.,-degree lens are utili0ed for inspection of the bladder neck.
2arger working channel for auxiliary e3uipment2arger irrigation
channel and therefore impro!ed !ision, impro!ed e!acuation of blood
clots and detritus.Facilitated manipulation and easy orientation
during inspection. Flexible instruments are a!ailable with a
diameter of -4 Fr or less with bending of the instruments up to
.-,5 upwards and -.,5 downwards, allowing inspection of the total
bladder. 6on!enient for patient, nearly pain free, well tolerated.
&otal inspection of bladder with one optical instrument.
Special indication in continent urinary di!ersion $i.e. ileal
neobladder'. Special indication of endoscopy of ileal conduit.
Special indication for patients who cannot be positioned for rigid
endoscopy due to contractures of the lower extremities or cox
arthrosis. Special indication for patients with fro0en pel!is.
Positioning#igid cystoscopy+ lithotomy position. Flexible
cystoscopy+ supine or lithotomy position.&he genital area
should be prepared and disinfected. %naesthesia Generally well
tolerated with local anaesthesia in adultsn children general
anaesthesia nserting the instrument+ Straighten the penis. %se
excessi!e lubricating gel. ntroduce the sheath, closed with the
obturator. n the bulbar part, the urethra turns from an almost
hori0ontal direction to a steep rise behind the symphysis towards
the bladder neck. &he cur!ature at the bulb is easily to
o!ercome by lowering the instrument. nserting the instrument+
#emo!e the obturator and use the telescope. 7ith continuous flow
irrigation and straightened urethra, gently mo!e towards the
bladder. &n urethros'o"y: nspect all parts of the urethra
$penile, bulbar, membranous and prostatic'. )ssess luminal si0e
$strictures, di!erticula, fistulas' E!aluate mucosa $lesions,
tumours'.External striated sphincter $pass with gentle
pressure'.Prostatic urethra +8 9erumontanum.8 kissing lobes.8
Estimate length of prostatic urethra. 8 nspect the bladder neck
opening. &n 'ystos'o"y: Start inspection with the /,5
telescope, sup- plement with different telescopes $i.e. 1,5' if
necessary to inspect all areas of the bladder $i.e. roof, bladder
neck'. Start with inspection of the trigone $ureteral orifices +
position, number and form. colour of urine :et'. Systematic
e!aluation of the base, lateral walls, posterior wall and roof of
the bladder and bladder outlet.2aporan operasi+Posisi litotomi
stadium anestesi asepsis antisepsis medan operasi dengan betadine,
tutup duk steril.;asukkan :elli -, 66 ke urethra.;asukkan sheath no
-> .. buah '(i!ertikel $)da"tidak,>>.. =uah, lokasi, leher
sempit"tidak, batu.., massa..'&umor $)da"tidak, bentuk,
2etak.., :umlah.., ukuran..#apuh"tidak, =atu $)da"tidak, >buah,
7arna ';uara ureter kanan dan kiri $&ak"tidak tampak,
tertutup.., bentuk..=ladder neck $&inggi"tidak'Protrusi lobus
medius $)da"tidak'?issing lobe $)da, >>.
cm"tidak'9erumontanum $@ormal"tidak'Perkiraan 9olume kandung
kencing(o))on (o)"li'ations pain, dysuria. #arely bleeding or
transient gross hematuria. traumatic lesion of the urethra with
perforation. !ery rarely perforation of the bladder,urethral
strictures due to mucosal lesions. TERIMA KASIH
