The Use of Intraoperative Cystoscopy for Detection of Lower Urinary Tract Injury

Abstract

Video Objective To review the use of cystoscopy by OB/GYN generalists for detection of lower urinary tract injury during hysterectomy. This includes the basic steps to diagnostic cystoscopy, the relevant anatomy, indications and limitations. Setting Cystoscopy is routinely used in prolapse and incontinence repair procedures due to the relatively high risk of bladder or ureteral injury during these surgeries. While some recommend the routine use of intra-operative cystoscopy as a part of laparoscopic hysterectomy to detect bladder or ureteral injury, this is still not routine practice among OB/GYNs generalists. Whether this is due to decreased familiarity with the technique, or it's limitations in sensitivity for detection of ureteral injury, remains unclear. To achieve the above objectives, this video reviews the details of the equipment involved, relevant anatomy, role of the bladder survey and visualization of ureteral jetting. Tips for detecting jetting and restoring normal anatomy are discussed. A brief review of the literature is used to outline indications for cystoscopy in general gynecology as well as its limitations. Interventions NA Conclusion Intra-operative cystoscopy is a useful tool for the general gynecologist. Simple steps can be taken to make it straightforward and diagnostic. However, it's also important to realize the limitations of cystoscopy, particularly in the detection of non-obstructive ureteral injury.