Cystoscopy female is an endoscopic procedure for examining the bladder mucosa with a cystoscope (rigid or flexible). After preliminary antiseptic treatment, the instrument is inserted through the urethra into the bladder. The image is transmitted to the monitor screen. Manipulation is performed under local or general anesthesia. Cystoscopy female is performed in a urological chair and allows you to identify polyps, mucosal erosion, neoplasms, the presence of concretions in the bladder cavity. During the procedure, inflammatory processes and infections of the lower urinary tract, structural abnormalities, damage to the walls of the organ are diagnosed. Manipulation allows you to stop bleeding, perform a polypectomy and biopsy, and administer medications. Requires minimal preparation.
Attempts to visually inspect hollow organs have been made since the beginning of the XIX century, but the date of birth of endoscopy, of which modern cystoscopy female is a part, is usually considered to be 1877, when the first rigid cystoscope was invented – a prototype of a modern instrument. The modern cystoscope has a complex structure. It consists of a fiber-optic system and a large number of lenses through which the image of the organ under study is transmitted to the screen. The instrument is adapted for visual observation, catheterization, therapeutic manipulations and drug administration. There are several tracts inside the urological endoscope (cystoscope). Some allow you to deliver special urological instruments into the bladder cavity: a polypectomy loop, biopsy forceps, with the help of others, various drugs are injected. In modern urology, there are also children’s cystoscopes. They are most often flexible and have a small diameter. During cystoscopy female, a rigid version of the equipment is usually used.
Cystoscopy female helps the doctor to study in detail the mucous membrane of the bladder that is inaccessible for external examination. Manipulation is used as an additional diagnostic method when non-invasive techniques (for example, ultrasound scanning) cannot detect neoplasms, ulcers or polyps, as well as differentiate the detected pathology. Often, cystoscopy female is combined with chromocystoscopy. The cystoscopy procedure has both advantages and disadvantages. On the one hand, this is the most informative method of examination of the lower urinary tract. On the other hand, it causes pain, therefore, despite its apparent simplicity, it requires anesthesia. In addition, due to the invasiveness of cystoscopy, injury to the urinary tract and infection may occur. The procedure is possible if the urethra is passable for a cystoscope, and the bladder holds about 100 ml of clear liquid.
Indications and contraindications
Cystoscopy female is used for the diagnosis and differential diagnosis of recurrent interstitial cystitis, is used to determine the causes of hematuria of unclear genesis (even with a small number of red blood cells), is performed with enuresis, atypical cells in the urine. Cystoscopy is appropriate in women with urination disorders of unclear etiology, pain syndrome localized in the pelvic region. Manipulation is carried out with urolithiasis, diverticula, strictures, fistulas of the urethra and bladder to clarify the results of ultrasound and CT. Cystoscopy female for therapeutic purposes is carried out for lithotripsy, removal of tumors and papillomas, bougie and cauterization of erosions.
It is contraindicated to perform cystoscopy female with acute inflammation of the organs of the female genital sphere and lower urinary tract, with lesions that significantly complicate visual examination (abundant hematuria and pyuria), ruptures of the urethra. Cystoscopy female should not be performed if there are problems with blood clotting.
Preparation for cystoscopy female
It is believed that cystoscopy female is simpler and less painful than in men. In fact, this is so because of the short (3-5 cm) and wide (1-1.5 cm) female urethra. However, this is an invasive procedure, accompanied by discomfort and certain risks. Therefore, cystoscopy female is preceded by a doctor’s conversation with the patient, in which the smallest details of the upcoming intervention are discussed. Before the procedure, the patient must undergo a special clinical and laboratory examination, including UAC, OAM, coagulogram, ultrasound of the pelvic organs and a gynecologist’s examination.
Methodology of conducting
Cystoscopy female is performed on an empty stomach. To prevent postmanipulation infection, doctors disinfect equipment, patients take a shower. Before starting a cystoscopy female, it is necessary to delay urination for an hour so that the urine straightens the walls of the bladder. If there is not enough urine, sterile fluid is additionally injected through a catheter, after which a diagnosis is performed. Cystoscopy female is performed in a hospital (urological, nephrological department) or a day hospital by an endoscopist-urologist. Since this is an invasive examination method, the patient signs a voluntary informed consent to the procedure with a warning about all possible complications. The manipulation lasts from 5 to 45 minutes.
Cystoscopy female is performed on a manipulation table with leg holders, in a supine position. Pathology of the pelvic bones involves manipulation on the side. 10 ml of a 2% solution of warm lidocaine (novocaine) is injected into the urethra for anesthesia. For more effective anesthesia, analgesics are added parenterally. With a high threshold of pain sensitivity, under the age of 12 years or the patient’s desire, manipulation under general anesthesia is allowed. At the beginning of the next stage, the cystoscope is carefully inserted into the urethra, having previously treated it with an antiseptic (sterile glycerin), which does not change the transparency of the optical medium. Then the rest of the urine is released from the bladder and its walls are washed with warm furacilin in a dilution of 1:5000.
At the next stage of cystoscopy female, the bladder is filled with the same furacilin until the patient feels the urge to urinate. The amount of the injected solution corresponds to the capacity of the organ. For cystoscopy female, 200 ml of liquid is enough. The front wall of the bladder is examined first, gradually moving to the left and right side surfaces. The cystoscope is rotated clockwise. The triangle between the inner opening of the urethra and the entrances to the ureters is examined in particular detail. It is in this area (the Lieto triangle) that pathological changes are most often localized.
The detection of hematuria or pyuria is an excuse for washing the bladder with distilled water. Pus is washed well, the release of the bladder from blood can be accompanied by the development of hemolysis, therefore it should be carried out with caution. If cystoscopy female involves taking a biopsy or therapeutic measures, its duration increases. If the material was taken from the pathological focus, at the end of cystoscopy female, the tissue is sent for histology.
After cystoscopy female
After the manipulation, it is recommended to drink plenty of water to minimize the feeling of itching, burning and soreness when urinating. Impurities of red blood cells in the urine disappear after a few days. The course of cystoscopy female is recorded in detail in the protocol of the patient’s medical history, an extract from which is given to her hands. The protocol records the condition of the bladder and ureters, detected neoplasms, concretions, erosions, diverticula, strictures, foreign bodies and inflammation. The complications that have arisen are described.
Cystoscopy female may be complicated by rupture of the urethra as a result of a violation of the manipulation technique (due to an attempt to insert a cystoscope into the urethra with effort through its narrow opening). If a rupture has occurred, then subsequent scarring of the injury site is considered a complication of the procedure, as is the formation of a fistula requiring emergency surgical intervention with the imposition of a cystostomy. In addition, complications of cystoscopy female are urethrorrhagia (bleeding), resorptive fever, inflammation and genitourinary infections arising from violations of the rules of asepsis during the preparation and conduct of the examination. If, after a cystoscopy, pain during urination, pain in the lumbar region, hematuria, chills persist for a week, this is a reason to consult a doctor.