27.12
Procedimiento Endoscópico Urológico: Examen Cistoscópico
Significado del Examen Cistoscópico:
La cistoscopia es una herramienta diagnóstica esencial en urología que se utiliza para evaluar la estructura y la…
Un examen cistoscópico es un procedimiento urológico que permite a los proveedores de atención médica visualizar el interior de la uretra y la vejiga mediante un cistoscopio, un tubo delgado equipado con una cámara y una luz.
Se puede realizar con un cistoscopio flexible utilizando anestesia local o con un cistoscopio rígido bajo anestesia general o raquídea.
Antes del procedimiento, la enfermera educa al paciente, obtiene el consentimiento por escrito, asegura el ayuno si es necesario y le indica que vacíe la vejiga.
Durante el procedimiento, el paciente se coloca en la posición de litotomía y el cistoscopio lubricado se inserta suavemente en la uretra y la vejiga.
A continuación, se instila solución salina estéril o agua para expandir la vejiga y mejorar la visualización.
A continuación, la cámara transmite imágenes en tiempo real de anomalías como infecciones urinarias, hematuria, cálculos vesicales, tumores, estenosis o retención urinaria. Se pueden tomar biopsias si es necesario.
Después del examen, se retira el cistoscopio.
Después del procedimiento, la enfermera monitorea los signos vitales del paciente, evalúa si hay sangrado urinario o dolor intenso, fomenta la ingesta de líquidos y brinda alivio del dolor según sea necesario.
View the full transcript and gain access to JoVE Core videos
Q1: What is a cystoscopic examination and how does it work?
A cystoscopic examination is a urologic procedure using a cystoscope—a thin tube with a camera and light—to visualize the urethra and bladder interior. The lubricated scope is gently inserted into the urethra, and sterile saline expands the bladder for clear visualization. Real-time images transmitted to a monitor allow healthcare providers to detect abnormalities such as infections, stones, tumors, strictures, and urinary retention.
Q2: What are the differences between flexible and rigid cystoscopy?
Flexible cystoscopy uses local anesthesia and is commonly performed in outpatient settings due to its less invasive nature. Rigid cystoscopy requires general or spinal anesthesia and is used for more complex procedures in outpatient and hospital settings. Both types allow direct visualization of the genitourinary system, but rigid cystoscopy accommodates therapeutic interventions like stone removal or biopsies more effectively.
Q3: What patient preparation is required before cystoscopy?
Pre-procedure preparation includes reviewing medical history for allergies and medications, obtaining written informed consent, and performing diagnostic tests like urinalysis and urine culture and sensitivity test. Patients receiving general anesthesia must fast several hours beforehand, while those undergoing local anesthesia do not. The patient should empty their bladder before the procedure begins.
Q4: How is the patient positioned during a cystoscopic examination?
The patient is placed in the lithotomy position, lying on their back with legs supported in stirrups. This positioning provides optimal access to the urethra and bladder for safe scope insertion and comprehensive visualization of the urinary tract structures during the examination.
Q5: What abnormalities can be detected during cystoscopy?
Cystoscopy detects structural abnormalities, infections, cancers, and blockages including recurrent urinary tract infections, hematuria, urinary retention, bladder stones, bladder tumors or polyps, and urethral strictures. The procedure also allows inspection of ureteral openings for obstruction signs. Biopsies may be taken if abnormalities are identified for further diagnostic evaluation.
Q6: What post-procedure care and monitoring are necessary after cystoscopy?
Post-procedure care includes monitoring vital signs for adverse reactions, assessing for infection, bleeding, or urinary retention, and managing mild discomfort or burning during urination. Encourage fluid intake to flush the bladder. Most patients resume normal activities within 1 to 4 hours, though strenuous activities should be avoided for several days, especially after biopsy.
Q7: What complications should patients report after cystoscopy?
Patients should report symptoms indicating infection or complications, such as foul-smelling urine, chills, fever, or severe pain. Mild discomfort and blood in the urine are common and typically resolve with hydration and pain management. Follow-up visits are essential, particularly if a biopsy was performed or further diagnostic evaluation is needed.