During urogynecologic procedures, intra-operative cystoscopy helps identify injuries to the urethra, bladder, and ureters, and therefore may prevent complications from missing such injuries. Medical students and residents are traditionally trained in the operating room on a real patient, which could increase operative time and possibly lead to heterogenic injuries. Simulation-based training helps trainees develop their knowledge and skills while protecting patients from unnecessary risks. Currently, cystoscopy simulators are not widely available and can be costly. Previously reported cystoscopy simulators include virtual reality, animal organs, pumpkin, green pepper, glass globe, as well as costly high-fidelity models. In this video, we describe how to make a low-cost, customizable, and reusable diagnostic cystoscopy model from readily available items. Here are the needed items. An onion saver, which can be found at the local grocery store or online. A power drill. A quarter-inch metal drill bit. A plastic cup. A glass pebble. Dry eraser markers. Instant glue. Modeling clay. And a wooden board. Open the onion saver. Mark a 12 o'clock position on the outside of the model in alignment with the internal axis. Close the model, lock the two pieces together, and extend the 12 o'clock mark to both sides. This will help aligning the two pieces upon opening and closing of the model. Place the top piece on the plastic cup and drill a hole through the tip using the quarter-inch metal drill bit. This represents the urethra. Now, on the base of the model, identify the previously marked 12 o'clock position and draw the hours of the clock on the inside of the model centered around the circular structure. Apply instant glue at the 12 o'clock position and attach the glass pebble, which represents the air bubble. Now, on the top piece of the model, draw the hours of the clock on the inside of the circular structure. On the inside of the model, identify the 6 o'clock position and use it as a guide to draw two urethral orifices around 4 cm apart and 4 cm from the urethrovesical junction and draw a trigone. Now, the inside of the model is complete. Lock the two pieces together using the previous outside marking. Secure the model to the wooden board using modeling clay. Alternatively, the model could be secured to a table in a similar fashion. During a simulation session, the trainee is shown the pieces of the systoscope. The 70° systoscope, the 30° systoscope, the bridge, the systoscope sheath and the obturator. Assembly of the systoscope is then demonstrated. The bridge is fitted on the systoscope by aligning the two notches on the bridge and the zero mark on the systoscope and then locked into place. The sheath is fitted on the systoscope and the bridge by aligning the zero mark on the sheath with the zero mark on the bridge and then locked into place. The light cord is attached. The camera is attached. With this model, the systoscope is used without the sheath. To perform the cystoscopy, we teach our trainees the technique described by Cundiff using 12 sweeps along each hour of the clock from the bladder dome to the urethrovesical junction. By convention, an angled systoscope looks away from the light cord. The 70° systoscope is introduced into the bladder with the light cord up, and then the light cord is turned to the 6 o'clock position to locate the air bubble. Because of the angled lens, to look at a particular hour of the clock, the light cord needs to be 180° in the opposite direction. For example, to look at 12 o'clock, the light cord would be at 6 o'clock, and to look at 1 o'clock, the light cord would be at 7 o'clock. Multiple sweeps are made around the hours of the clock from the bladder dome to the urethrovesical junction. For each sweep, the systoscope is simply pulled out in a straight direction along its axis. Changing from one hour of the clock to the next involves simply rotating the light cord while keeping the camera buttons facing the 12 o'clock position. The orders can be visualized around 5 and 7 o'clock. After clockwise sweeps are made from 12 to 6 o'clock on the model's left side, the light cord is returned to the 6 o'clock position, and the hands are switched between the light cord and the camera. Similar sweeps are then made in a counterclockwise fashion from 12 to 6 o'clock on the right side of the model. The right urethral orifice is visualized around 7 o'clock. To visualize the contralateral urethral orifice, the interureteric ridge is followed by simply rotating the light cord. To examine the urethra, the systoscope is focused close on the bladder mucosa and then pulled gently through the urethra. Note that the 70-degree lens is not ideal for examination of the urethra. To visualize the contralateral urethral orifice, the interureteric ridge is followed by simply rotating the light cord. Note that the 70-degree lens is not ideal for examination of the urethra. Systoscopy technique with the 30-degree lens is similar. However, because of the lesser angle of the lens, the systoscope may need to be progressively angled towards the light cord with each sweep in order not to miss any parts of the bladder, especially close to the urethrovesical junction. Using modeling clay or other material, foreign bodies can be added to the model to improve its educational value. Systoscopy technique with the 30-degree lens is similar. However, because of the lesser angle of the lens, the systoscope may need to be progressively angled towards the light cord with each sweep in order to improve its educational value. Using modeling clay or other material, foreign bodies can be added to the model to improve its educational value. Using modeling clay or other material, foreign bodies can be added to the model to improve its educational value. The total cost of our model is around $30, and all the items can be obtained from the local superstore. Our model has many advantages. It is very cheap, easy to use and make, durable and reusable. It is used dry, with no need for water. It is customizable with an accessible cavity. It is anatomically somewhat similar to a human bladder, and it allows reproduction of the systoscope manipulation technique. However, it also has some disadvantages. It is rigid. It is not suitable for optive cystoscopy. It can't be used with cystoscope sheath, and it hasn't been validated. In summary, our model offers an affordable and reusable way to help medical professionals in training learn cystoscopy skills in a controlled and reproducible environment without risking patient safety.

low-cost diagnostic cystoscopy model

customizable cystoscopy model

reusable cystoscopy model

assembling a diagnostic cystoscopy model

performing cystoscopy with different angles