UROLOGIC
ENDOSCOPIC PROCEDURES
Endourology,
or urologic endoscopic procedures, can be performed in one of two ways: using a
cystoscope inserted into the urethra, or percutaneously, through a small
incision.
The
cystoscopic examination is used to directly visualize the urethra and bladder.
The cystoscope, which is inserted through the urethra into the bladder, has a
self-contained optical lens sys-tem that provides a magnified, illuminated view
of the bladder (Fig. 43-7). The use of a high-intensity light and
interchangeable lenses allows excellent visualization and permits still and
motion pictures to be taken. The cystoscope is manipulated to allow com-plete
visualization of the urethra and bladder as well as the ureteral orifices and
prostatic urethra. Small ureteral catheters can be passed through the
cystoscope, allowing assessment of the ureters and the pelvis of each kidney.
The
cystoscope also permits the urologist to obtain a urine specimen from each
kidney to evaluate its function. Cup forceps can be inserted through the
cystoscope for biopsy. Calculi may be removed from the urethra, bladder, and
ureter using cystoscopy. If a lower tract cystoscopy is performed, the patient
is usually awake and the procedure is usually no more uncomfortable than a
catheterization. To minimize post-test urethral discomfort, vis-cous lidocaine
is usually injected several minutes prior to the study. If the cystoscopy
includes examination of the upper tracts, a sedative may be administered before
the procedure. General anesthesia is usually administered to ensure that there
are no in-voluntary muscle spasms when the scope is being passed through the
ureters or kidney.
The
nurse describes the examination to the patient and fam-ily to prepare them and
to allay their fears. If an upper cystoscopy is to be performed, the patient is
usually kept NPO (nothing by mouth) for several hours beforehand, unless the
examination is being done to assess structural integrity following trauma.
Postprocedural
management is directed at relieving any dis-comfort resulting from the
examination. Some burning on void-ing, blood-tinged urine, and urinary
frequency from trauma to the mucous membrane can be expected. Moist heat to the
lower abdomen and warm sitz baths are helpful in relieving pain and re-laxing
the muscles.
After
a cystoscopic examination, the patient with obstructive pathology may
experience urine retention if the instruments used during the examination
caused edema. The nurse carefully mon-itors the patient with prostatic
hyperplasia for urine retention. Warm sitz baths and antispasmodic medication,
such as flavox-ate (Urispas), may be prescribed to relieve temporary urine
re-tention due to poor relaxation of the urinary sphincter; however,
intermittent catheterization may be necessary for a few hours after the
examination. The nurse monitors the patient for signs and symptoms of urinary
tract infection. Because edema of the ure-thra secondary to local trauma may
obstruct urine flow, the pa-tient is also monitored for signs and symptoms of
obstruction (NIDDK, 2001a).
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