What are the precautions for bladder examination?

Cystoscopy is a method of examination in which a cystoscope is inserted from the urethra into the bladder to directly observe whether there are any lesions in the urethra and bladder. Before doing a cystoscopy, you must first be familiar with the degree of the instrument, ask the patient if he or she has any other medical history, control the amount of anesthetic and do not let it be too little, and remove the tube together with the scope.

Steps of a bladder examination

1. Be familiar with the equipment. In particular, the degree of the cystoscope, such as 70 degrees, 30 degrees or 0 degrees, different degrees of cystoscopes have their own advantages and disadvantages when observing the bladder and urethra.

2. Anesthesia must be sufficient. After the anesthetic is injected into the urethra, it should be retained for at least 5 minutes. Adequate lubrication is also important. Relieve the patient's tension, ask the patient to relax the lower abdomen, take deep breaths, and cooperate with the doctor.

3. Before the operation, the medical history should be carefully inquired. Some patients may have congenital or acquired stenosis, so you must be aware of this.

4. Grasp the direction of the mirror and gradually develop a good sense of direction during operation: always know your current position and the part you are observing. The female urethra is short and dilated, so it is easy to insert the endoscope, but be careful not to slip into the vagina. When inserting the endoscope into the posterior urethra, there is a slight downward pressure and it should be gently slid into the bladder rather than inserted. If it is difficult to insert the lens, you can look directly at it under the monitor.

5. After the endoscope is inserted into the bladder, pull out the endoscope core and measure the residual urine volume. If the urine is turbid, it should be rinsed repeatedly until it is clear, and then the examination endoscope should be replaced. Pour normal saline into the bladder and allow it to fill gradually to a level that does not cause the patient to feel bladder distension (usually about 300 ml). Slowly withdraw the endoscope until the bladder neck is visible. Push the endoscope 2 to 3 cm into the two lower corners of the bladder neck to see the interureteric ridge. The ureteral orifices on both sides can be found at the two ends of the interureteric ridge between 5 and 7 o'clock.

6. Observe one by one in the order of bladder trigone (including both ureteral orifices) - posterior wall - lateral wall - apical bulla - anterior wall... Leave no blind spots. Be familiar with various normal and pathological images.

7. When removing the tube and the endoscope, you should pay attention to the following: If it is a soft foreign body forceps (need to be inserted from the operating hole), it must be removed together with the endoscope, and pay attention to the various bends of the urethra to avoid damage. The hard one that is combined with the mirror can be taken out directly from the sheath, and then the NS in the bladder is emptied, and the obturator is inserted into the sheath to withdraw (to prevent the front end of the sheath from scratching the urethra.