Cystoscopy Training in a Female Bladder Model for Resident Education. In this video, we will review a low-cost female bladder model and demonstrate the systematic approach to aid in knowledge, skill, and understanding of standard equipment used for cystoscopy, especially learning the normal bladder landmarks and internalizing the optics of different cystoscopy lenses. The following are our disclosures. The objectives of this video include the following. There has been an increasing implementation of simulation training for resident education. However, there has been studies indicating insufficient exposure to diagnostic cystoscopy syphils during residency training. Many low-cost models have been identified as measures to help aid in training. This specific video of the female bladder model can be used as a resource to demonstrate a systematic approach for resident learning. A cystoscopy is a procedure that can be performed in office or in the operating room for a diverse spectrum of patients with urological concerns, including but not limited to the following listed conditions. This is our bladder model that we will be using to demonstrate our systematic approach for rigid cystoscopy. The bladder model mimics the female bladder with the shorter 3-4 cm urethra. Materials used to make this model include plexiglass and scrapbook store material. Alphabet letters were used to identify the right sidewall of the bladder, the right urethral orifice, the posterior bladder, the left urethral orifice, the left sidewall of the bladder, and the entire apex of the dome of the bladder, indicated by the blue, yellow, and green lines. Cystoscopes contain three main components, the sheath, bridge, and lens, also called the telescope. The sheath has a wide range of caliber, with most women able to tolerate 18-30 Fr. However, the smallest caliber for a diagnostic procedure should be used. At the proximal end of the sheath, there are two port sides where the distending medium is attached to. The bridge is then attached to the sheath. There are usually markings on the bridge that helps aid in the attachment of the sheath and lens. The bridge also has either one or two operative ports for the introduction of instruments. The lens, also called the telescope, is connected to the bridge. There are a variety of different angled lenses. The most common angled lenses used are 0°, 30°, and 70°. For each lens, the field of view reflects that of the degree angle opposite to that of the light cord attachment. The 0° lens scope is ideal for urethroscopy. The 30° lens has the best view of the posterior bladder wall. The 70° lens has the most comprehensive view of the bladder trigone and urethral orifices. Here, we will demonstrate the attachment of all parts of the cystoscope. The sheath and bridge are attached first. You can see in this view that there are small grooved markings to where the bridge connects to the sheath. The telescope or lens is then introduced. Care is always taken to place the lens parallel to the sheath as the lens can bend within the sheath, making it difficult for the introduction of operative instruments and removal of the lens. The camera is then attached to the lens. This is done by pushing on the camera's head's lever as such to open the aperture to fit the proximal end of the lens within. The camera head is often faced up with the buttons towards the ceiling and the light source attachment on the lens pointed toward the floor. The light source is then attached. This figuration aids in the sweeping motion needed in a rigid diagnostic cystoscopy with an angled lens. This is the zero-degree lens look into the female bladder model. Attention is first turned to the dome of the bladder at point D. This is the point where the air bubble will be located. Continuation of the apex of the dome was systematically brought down to the left side wall, noted by point T, then to the posterior portion of the bladder, noted by point B, followed by the right and left uretal orifices, noted by point R and point L respectively. With the zero-degree lens, ergonomics to visualize the entirety of the bladder include sweeping motion with the user turning their body. Continuation now with the right side wall of the dome and then withdrawal of the scope. Urethroscopy is best performed with this degree lens as you can fully visualize the circular urethra in its entirety. This is a 30-degree lens look into the same female bladder model. The same systematic approach is taken to visualize the bladder. The light cord is pulled with the left hand with the opposite end pointing towards 1 o'clock to view the left apex of the bladder. Due to the angle of the lens, you can note that the posterior bladder is better visualized. The same sweeping motion is used to visualize all important bladder landmarks. The same sweeping motion is used to visualize all important bladder landmarks and completed on the contralateral side. Lastly, this is a 70-degree lens. Immediately upon entry, you can visualize the dome and the apex of the bladder due to the degree of the lens. Again, the same systematic approach to assessing the bladder is used with the same sweeping technique and swivel movement of the light cord in the desired clock direction. To visualize the uretal orifices, the scope is swept upwards by raising the wrist and light cord is in the 12 o'clock position with the field of view looking at the opposite direction down to the left uretal orifice. The same is carried out on the contralateral side to visualize all other important bladder landmarks. In conclusion, simulation training for resident education significantly improves knowledge, skill, and performance. A systematic approach of the rigid systoleurotoscopy in a low-cost bladder model can be used as a teaching tool. By utilizing our female bladder model and this video, residents should be able to identify cystoscopic equipment, assemble basic cystoscopic equipment, identify different angles of lenses, and perform a full survey with improved technique to identify anatomical landmarks. Thank you for watching.

female bladder model

training residents

cystoscopy procedures

bladder landmarks

cystoscopy lenses