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Cystoscopy Useful in Diagnosis, Evaluation. (Microscopic Hematuria, Recurrent UTI).

ASHEVILLE, N.C. -- Cystoscopy is indicated for a number of conditions seen in a general ob.gyn. practice, and it can be particularly useful for pinning down a diagnosis in conditions that have a number of potential causes, Dr. AnnaMarie Connolly said at the annual Southern Obstetric and Gynecologic Seminar.

Performing cystoscopy in a patient presenting with unexplained microscopic hematuria, for example, would allow visualization of cancer, foreign bodies, inflammation, interstitial cystitis, or traumatic injury, all of which could be the culprit, said Dr. Connolly of the University of North Carolina, Chapel Hill.

Similarly, cystoscopy can be useful for evaluating recurrent urinary tract infections and is completely acceptable in patients who present with three or more UTIs within a 6-month period. This approach can help rule out stones, masses, and other foreign bodies.

Dr. Connolly described one.patient with recurrent UTIs and irritative symptoms who was found during cystoscopy to have three errant sutures in the bladder wall from a previous surgical procedure. The sutures were resected and the patient recovered.

Other roles for cystoscopy include the evaluation of urethral diverticula, which are usually found along the posterior urethra, and the evaluation of urinary incontinence. Cystoscopy for urethral diverticula may be a useful starting place, but because it has only a 60% diagnostic sensitivity, it is not the preferred method of diagnosis. For urinary incontinence, cystoscopy is most useful for gathering information in patients thought to have intrinsic sphincter deficiency, Dr. Connolly said, noting that it can also be useful for identifying masses, stones, or sutures, which could be causing symptoms of stress incontinence.

Cystoscopy also can be used intraoperatively; it is particularly useful when there is concern about potential bladder injury and when collagen is being injected for the treatment of intrinsic sphincter deficiency.

As for equipment, a variety of lenses can be used with the cystoscope; the 12-degree, 30-degree, and 70-degree lenses are most helpful, in Dr. Connolly's experience. This is particularly true when it comes to imaging the ureterovesical junction and looking for normal coaptation, she said.

Filling the bladder with 250-300 cc of fluid will help iron out the mucosal folds and minimize the chance that small lesions or stones are missed, Dr. Connolly said. She added that complications with cystoscopy are generally mild and occur only rarely but can include dysuria, irritative voiding symptoms, infection, and bladder spasms. Pushing fluids for 24 hours following the procedure is helpful for preventing many of these problems.
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Author:Worcester, Sharon
Publication:OB GYN News
Date:Oct 15, 2001
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