Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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 Posted: Sun May 06, 2007 1:26 pm Post subject: |
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You can really go off a person..........!
Indications - haematuria, macroscopic or microscopic if over 40?, symptoms suggestive of voiding dysfunction - hesitance, terminal dribbling, double-voiding, retention, abnormality on USS, dysuria in abscence of infection, pain after urination, chronic pelvic pain with bladder associations suspicious of interstitial cystitis. Any older patient with OAB failed on treatment. Post TVT/TOT to check for bladder perforation. Urine in vagina!
How?
Most use rigid cystoscopes in gynae therefore give general anaesthesia once checking general health. Check indication and recent MSU result to exclude infection. Urinalysis prior to surgery. Most can be day surgery.
Consent for biopsy and bladder perf risk.
Lithotomy, clean and drape, check camera if used and equipment.
Insert sheath with lubricating gel and remove inner to drain bladder ino bowel. Insert camera and lock into place. Fill bladder slowly with saline if not using diathermy under no pressure (gravity only) stop and check after 300mls or so. Check bladder mucosa in systematic sweeping fashion - check bubble to ensure orientation and perform 360 degree circling. Check both ureteric orifices and spill from ureters. Look for tumours, polyps, vasculature, plaques, trabeculation and note bladder capacity - DO NOT OVERFILL.
Pictures if needed.
Biopsy if suspicious and ensure bleeding settles. If bleeds/ perforation consider foley catheter post op and admission.
Empty bladder at end.
When to call urologist?
ureteric damage. bladder tumour requiring biopsy/ resection or near to ureters. massive bleeding from perforation or biopsy. |
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