Technique

Patient preparation:

• Flexible cystoscopy—usually performed following intra-urethral instillation of 10 ml of 1% lidocaine-containing gel

• Rigid cystoscopy—requires either regional (e.g., spinal) or general anesthesia

• Due to the risk of UTI (up to 46%) and sepsis, high-risk patients (e.g., resection, presence of stone or urinary catheter, upper tract manipulation) must receive a single dose of prophylactic antibiotics (usually gentamicin or a quinolone)

Irrigation

The irrigation fluid may be—

• Conductive (contains electrolytes)—normal saline and Ringer's lactate solution

• Non-conductive—glycine and water allow electrocoagulation

In certain situations (e.g., visualization of the dome of bladder if view using irrigation fluid is suboptimal), an air cystoscopy may be useful.

TABLE 6.6. Features of rigid and flexible cystoscopes

Rigid Flexible

TABLE 6.6. Features of rigid and flexible cystoscopes

Rigid Flexible

Components

Sheath Obturator Bridge Telescopes

Working elements—(deflecting mechanism, biopsy forceps, etc.)

Fiber-optic light bearing bundle Fiber-optic image bearing bundle A single irrigation-working channel

Size

8-32F (8-12F for pediatric use)

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