The cystoscope and accessories

The cystoscope and accessories

1. The rigid Cystoscope and Accessories Mohammad ihmeidan pgy2

2. history Maximilian Carl Nitze , a German urologist, is credited with the invention of modern cystoscope , which was primarily used for inspection of the bladder. This was publicly demonstrated in 1879

3. The parts of a rigid cystoscope assembly are as follows: 1. Cystoscope sheath 2. Cystoscope obturator 3. Bridge 4. Light cable 5 . Telescope

4. The Cystoscope Sheath The cystoscope sheath is calibrated in French (Fr), this is considered to be the outer circumference of the instrument in millimeters (mm). Fr is same as Charriere (Ch). Three French is equal to one mm. It is also written as F, Fr or Ch.

5. a. Length of an adult cystoscope sheath regardless of size is 22 cm. The cross section of the sheath is not round but oval

6. Markings on the shaft: The proximal 10 centimeters from the vesical end devoid of any markings . Markings are engraved on the sheath at every 1 cm thereafter for the next 13 cm. The markings help in estimation of prostatic urethral length (In comparison, Optical Urethrotome Sheath has similar markings all along the length of the sheath).

7. Method to measure prostatic urethral length: The cystoscope is introduced along the entire length. The cystoscope is withdrawn under endoscopic vision till the bladder neck. The marking on the external meatus is noted (Point A). Thereafter, the cystoscope sheath is withdrawn till the verumontanum and a note of the marking is done (Point B). The number of markings on the sheath between point A and point B is noted, this is the length of the prostatic urethra

8. Bridges Types of Bridges (Classification) 1. Without side channel 2. With one side channel 3. With two side channel

9. Parts of Bridge Telescope channel: It accommodates the telescope. Accessories’ channel: It is meant to pass the accessories such as ureteric catheter , wires forceps, etc. It has a rubber shod which help in easy passage of the instrument.

10. Obturators They are specific for a given sheath. Once attached to the sheath it makes the tip of the sheath smooth thereby tightly fitting to it. The length of the obturator is 26 cm.

11. Parts of obturator are as follows: Vesical end knob: This helps in smooth atraumatic insertion of the cystoscope . Shaft: Connects the vesical end knob and the locking mechanism. Locking mechanism: Zero (0) should correspond to zero (0) of the sheath when locked

12. The Telescopes The telescopes are classified depending on the viewing angle. They are available as 0°, 30°, 70°, 120° and 12 ° Adult telescopes can be used with any adult sheaths. They need to be used with a bridge The light cable can be attached to the telescope directly

13. Straight forward telescopes (0°) is focused to view straight ahead, is usually used for urethroscopy . Forward oblique telescopes (30°) best affords visualization of the base and anterolateral aspect of the bladder, this is the most commonly used telescope .

14. Lateral telescope (70°) to view the bladder dome . Retrospective telescopes (120°) help to visualize the anterior bladder neck from inside.

15. The Rod-lens System The key difference in the conventional optical system and the rod-lens system is that the Hopkins rod-lens system employs special glass rods with customized finished ends. The rod-lens system reduced the air spaces between lens with long rods of glass is transported back through the telescope, it is magnified at the ocular lens . The degree of magnification is to some extent dependent on the diameter of the viewing lens.

16. Parts of Telescope Shaft : Angulation at the tip varies depending on the viewing angle. Eyepiece : It is typically black in color, the size is universal and adapts to any camera head.

17. Thank You