Cystoscopy refers to the direct visualization of the anterior and posterior urethra, bladder neck, and bladder mucosa using an endoscope. This procedure is performed both to evaluate the lower urinary tract and to establish access to the upper urinary tract (see Plate 10-33). Common indications include microscopic or gross hematuria, obstructive voiding symptoms, surveillance of a known urinary tract malignancy, inability to urinate following surgery for incontinence, and removal of a foreign body.
Cystoscopes are available in a variety of sizes and may be either rigid or ﬂexible in design. The size (outer diameter) of a cystoscope is given in the French scale. Rigid Cystoscopes. A rigid cystoscope has a long metal sheath, bridge, and rod-lens system. The sheath is the outer cover through which the rod-lens system is inserted. It remains within the bladder when the rod-lens system must be removed or exchanged. It also contains the port for infusion of irrigant ﬂuid, which helps maintain continuous visualization. The sheath is inserted into the bladder with an obturator in its lumen, which has an atraumatic tip to ensure safe passage through the urethra. “Visual” obturators contain a lumen for the lens, which permits direct visualization of the insertion process, whereas “nonvisual” obturators lack such a lumen.