Cystoscopy Pathology (On-Demand)-Cystoscopy Pathology

Cystoscopy Pathology - Handout

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Intraoperative cystoscopy is an important tool in gynecologic procedures to identify urinary tract injuries and other common bladder findings. It helps differentiate between benign and malignant lesions in the bladder and can prompt immediate referral and repair of urinary tract injuries. While it may not identify all urinary tract injuries, it can significantly reduce the need for reoperation and litigation.<br /><br />During cystoscopy, a flexible or rigid scope is used to visualize the bladder. The scope has different lenses and working adaptors for additional instruments. It is important to perform a complete systematic evaluation of the bladder, including the trigone, ureteral orifices, lateral walls, and dome. The bladder is inspected for various findings such as squamous metaplasia, trabeculations, diverticulum, inflammation, and benign lesions like cystitis cystica and polyps.<br /><br />The decision to perform intraoperative cystoscopy should be based on the surgical procedure and the surgeon's clinical judgment. While some studies support routine cystoscopy during laparoscopic hysterectomy and high-risk procedures, others argue for selective use based on suspicion of injury.<br /><br />There are various methods to assess ureteral patency, including the use of urinary tract dyes like methylene blue or indigo carmine. These dyes help visualize the ureteral efflux during cystoscopy.<br /><br />The debate on routine cystoscopy continues in the medical community, with considerations of cost-effectiveness, training, and potential risks. However, it is generally agreed upon that cystoscopy can aid in the timely detection and management of urinary tract injuries, leading to improved patient outcomes.<br /><br />In conclusion, intraoperative cystoscopy is an important tool in gynecologic procedures for identifying urinary tract injuries and other bladder findings. Its use should be based on clinical judgment and the specific surgical procedure. While further research is needed to establish definitive guidelines, current evidence supports its selective use in high-risk cases and laparoscopic hysterectomy.

Keywords

intraoperative cystoscopy

urinary tract injuries

bladder findings

benign lesions

malignant lesions

reoperation

flexible scope

laparoscopic hysterectomy

ureteral patency

improved patient outcomes