80: Intraoperative suprapubic cystoscopy

Abstract

Cystourethroscopy is a common tool used in obstetrics, benign, and subspecialty gynecology for both diagnostic and therapeutic purposes. Conventionally, the cystoscope is inserted trans-urethrally where the entirety of the bladder can be observed through various angled rigid scopes or flexible scopes. However, less conventional and alternative techniques may be warranted depending on the clinical scenario or when pathologic conditions may limit conventional cystourethroscopy. In this video, we demonstrate a safe and useful alternative to investigate the bladder using suprapubic cystoscopy in a patient in which there was strong suspicion for trophoblastic invasion of the bladder tissues. We performed a review of the use for suprapubic cystoscopy as it is currently used in obstetrics and gynecology and urology. We demonstrate the steps and technique to perform suprapubic cystoscopy in a patient with invasive placentation in whom bladder involvement was strongly suspected. The technique and steps to perform suprapubic cystoscopy was demonstrated intraoperatively. Adequate bladder survey was able to be performed safely without the need for prolonged catheterization, antibiotic prophylaxis, or need for post-operative imaging without post-operative genitourinary complication. Suprapubic cystoscopy can be a useful tool for the obstetrician gynecologist in cases where trans-urethral cystoscopy is limited by pathology or alternative views for diagnostic purposes are warranted such as this case where there was great concern for trophoblastic invasion of the bladder. This technique can be performed safely and is a low risk procedure.