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).