Cystoscopy and ureteroscopy

Cystoscopy and ureteroscopy are performed to diagnose and treat lesions of the lower (urethra, prostate, and bladder) and upper (ureter and kidney) urinary tracts.

1. Warmed irrigation fluids are used to improve visualization and to remove blood, tissue, and stone fragments.
   1. Electrolyte solutions (normal saline and lactated Ringer's) are isotonic and do not cause hemolysis upon intravascular absorption. Because of ionization, they cannot safely be used for procedures involving monopolar electrocautery. However, these solutions can be used with newer, bipolar electrocautery.
   2. Sterile water has optimal visibility and is nonconductive. However, intravascular absorption can cause hemolysis and hyponatremia/hyposmolality.
   3. Nonelectrolyte solutions of glycine, sorbitol, and mannitol have good visibility and are nonconductive. Near isotonicity minimizes hemolysis, although large volume absorption may cause hyponatremia.
2. Anesthesia
   1. Depending on the patient and procedure, anesthesia for cystoscopy/ureteroscopy can range from topical lubrication alone to monitored anesthesia care, regional, and/or general anesthesia (GA). Placement of a rigid cystoscope (particularly in males) and distention of the bladder and ureters can be quite stimulating. Postoperative pain is minimal.
   2. If regional anesthesia is used, a T6 level is required for upper tract instrumentation, whereas a T10 level is adequate for lower tract surgery.
   3. GA can be effective with short-acting intravenous (IV) and inhaled anesthetics. Transient muscle relaxation may be required.
   4. Lithotomy position is most common.