complexity of pelvic surgery, routine assessment of lower urinary tract injury becomes vital. Urinary tract injury can occur in up to 3% of all gynecologic surgeries and is associated with significant patient morbidity, medical legal risk, and increased cost of health care. This is often avoidable by intraoperative evaluation of the lower urinary tract. Despite the seriousness of undiagnosed urinary tract injury and ACOG recommendations for routine cystoscopy during gynecologic surgery, only 30% of those cases indicated actually undergo cystoscopy. In addition, office-based cystoscopy for evaluation of hematuria, incontinence, and irritative voiding symptoms is significantly underutilized. The current technique of cystoscopy is complicated, cumbersome, and cost-ineffective. CystiShore, a novel new device, enables gynecologists and other non-urologic surgeons to perform cystoscopy in a safe, simple, and standardized fashion. The disposable catheter uses a reusable mini-scope to perform dual functions. The catheter adds a fourth and critical port to the common urinary catheter to allow it to function both as a three-way catheter and as an access sheath for female cystoscopy. CystiShore combines the simplicity and familiarity of the common urinary catheter with the utility and functionality of the Sanderage cystoscope. The product has been specifically designed to optimize female cystoscopy. The length and caliber of the catheter has been optimized to provide maximum patient comfort while allowing insertion of the specially designed 2.7-millimeter, 70-degree cystoscopic telescope. It also allows multiple passes of the scope without additional trauma or infection risks to the patient. The distal end of the catheter has been designed to allow the scope tip a complete and clear view of the entire bladder lumen with a simple 360-degree rotation of the scope. When inflated, the uniquely designed pancake balloon positions the tip of the scope above the trigonal ridge in every patient, every time, making cystoscopy simple and consistent. The proximal end of the catheter was developed specifically to enable ease of use. The red-ringed balloon inflation port accepts a standard lure syringe. The blue-ringed inflation port offers a universal interface compatible with IV and cystotubing for easy connectivity during bladder fill. The yellow-ringed outflow port uses a standard configuration for attachment to a Foley drainage bag following surgery. Finally, and most importantly, the purple-ringed cystoscope port has a unique self-sealing valve set in a large funnel-shaped opening to allow easy insertion of the scope, each connection standardized, every step simple, no assembly required. With these design elements working in harmony, cystoscopy becomes as easy as one, two, three, insertion, rotation, and removal. The image is clear, complete, and consistent, allowing complete evaluation of the bladder in under one minute. Where most technology can inhibit rather than enable, CystAssure is as simple as it is functional. The procedure simplifies assembly and usage of the cystoscope, both in the OR and the office. CystAssure has the potential to enable all clinicians, including NPs and PAs, to learn, perform, and teach cystoscopy. By enabling routine cystoscopy in every patient with shorter procedural time, CystAssure can reduce costs and risk. Less instrumentation means less trauma, lower risk of infections, and less patient discomfort. Finally, routine cystoscopy in the OR and office, when indicated, improves patient access and clinical outcomes. We have performed cystoscopy using this product in over 50 patients with uniformly excellent results, and it is now our standard technique of cystoscopy in the OR and the office. It is a valuable addition to the gynecologic toolbox and has the potential to replace the current, outdated technique of rigid female cystoscopy.

lower urinary tract injury

pelvic surgery

cystoscopy challenges

CystiShore device

safer cystoscopy