CYSTOSCOPY AND BIOPSY.pptx

cystoscopy and biopsy procedure

1. DISCRIBE THE PROCEDURE FOR CYSTOSCOPY AND BIOPSY. DR USMAN HARUNA KAMBA SURGERY/UROLOGY UDUTH SOKOTO 19/08/2023.

2. Introduction Definition Classification Indictions / CONTRAINDICATIONS Therapeutic Diagnostic Procedure Pre op Intra op Post op Compliactions FOLLOWUP Conclusion References.

3. Cystoscopy is an endoscopic visualization of bladder, urethra and ureteric orifices via either flexible or rigid cystoscope. It may involve taking tissue for histology, instillation of therapeutic agents, placement or removal of stents It may also be a component of other treatment modalities such as ureteroscopy and lithotripsy.

4. Components of cystoscopy Cystoscopy procedure – bladder only Cystoscopy and biopsy Cystoscopy and stent removal.

5. Classification. Flexible cystoscopy has revolutionised outpatient assessment of the lower urinary tract under local anaesthesia. Flexible cystoscopes can be classified as fibrescopes because they contain fibre ‐optic bundles within a flexible shaft that illuminate the viewing area and transmit images to the eye piece. In these cystoscopes tip deflection is up to 210º.

6. Digital flexible cystoscopes uses a video chip instead of fibres . Focusing is not necessary as video chip delivers a uniform‐focused picture with a high optical resolution. The tip of these is only 9.8 F and hence easier to insert. Rigid Diagnostic Cystoscopy Photodynamic diagnostic cystoscopy (PDD) involves administration of 5‐aminolevulinic acid (5‐ALA), which bypasses the rate limiting step in the biosynthesis of heme. It induces high levels of proto‐porphyrin IX ( PpIX ) in mitochondria of neoplastic or highly proliferating cells.

7. Indications include: Hematuria, gross or microscopic. Surveillance/evaluation of malignancy (bladder, urethra, upper tract UCC, abnormal cytology) Lower urinary tract symptoms (LUTS): The irritative voiding symptoms, obstructive voiding symptoms, Urinary incontinence, Chronic pelvic pain syndrome, Recurrent UTIs.

8. Stent removal Instillation of therapeutic agents – BCG, chemotherapeutic agents TURBT Lithotripsy Evaluation of urologic fistulas, urethral or bladder diverticulum Bladder neck procedures Treatment of incomplete urethral strictures. Contraindicated in: Urosepsis Coagulopathy.

9. Purpose for cystoscopy Assist in obtaining biopsies Targetting of suspicious areas Guidance for systematic biopsies Collect urine sample from bladder Removal of previously inserted stent Treat certain bladder conditions.

10. Cystoscopy procedure Pre – operative preparation History – medications aspirin and other anticoagulants allergy to local anaesthetic agents, latex or iodine, Examination – palor , hypotention , signs of urosepsis, CKD Investigations – FBC, Urinalysis, urine mcs , clotting profile, CXR/ ECG, urine cytology. Written informed Consent taken It is an office procedure.

11. Intraoperative. Anaesthesia: Local/ GA, prophylactic antibiotics. Analgesics. Position : Lithotomy Endoscopic tower and monitor Irrigation fluid – normal saline Cystoscopes , biopsy forceps, xylocaine jelly , urethral catheter, light source and camera, sample bottle all are set Pt is cleaned and drapped Xylocaine jelly instilled into the urethra for L.A Well lubricated Cystoscope gently introduced into the urethra under vision on the monitor Urethra and the entire bladder visualized, biopsies taken Proceeds depends on the indication for cystoscopy.

12. Post op Empty the bladder Pass urethral catheter Antibiotics/ analgesics Send labelled sample for laboratory examination

13. Complications. Intraop Mild abd . Discomfort Strong urge to void Bleeding may obsecure visual field Post op Haematuria Painful/ frequent micturition Infection Urine retention

14. References.

15. Thank you