27.12
Procedura Endoscopica Urologica: Cistoscopia
Significato della cistoscopia:
La cistoscopia è una tecnica diagnostica essenziale in urologia, utilizzata per valutare la struttura e la funzione del…
L'esame cistoscopico è una procedura urologica che consente agli operatori sanitari di visualizzare l'interno dell'uretra e della vescica utilizzando un cistoscopio, un tubo sottile dotato di telecamera e luce.
Può essere eseguito con un cistoscopio flessibile in anestesia locale o con un cistoscopio rigido in anestesia generale o spinale.
Prima della procedura, l'infermiere educa il paziente, ottiene il consenso scritto, assicura il digiuno se necessario e gli ordina di svuotare la vescica.
Durante la procedura, il paziente viene posizionato in posizione litotomica e il cistoscopio lubrificato viene inserito delicatamente nell'uretra e nella vescica.
Viene quindi instillata soluzione salina sterile o acqua per espandere la vescica per una migliore visualizzazione.
Successivamente, la telecamera trasmette immagini in tempo reale di anomalie come infezioni del tratto urinario, ematuria, calcoli alla vescica, tumori, stenosi o ritenzione urinaria. Se necessario, possono essere effettuate biopsie.
Dopo l'esame, il cistoscopio viene ritirato.
Dopo la procedura, l'infermiere monitora i segni vitali del paziente, valuta la presenza di sanguinamento urinario o dolore intenso, incoraggia l'assunzione di liquidi e fornisce sollievo dal dolore secondo necessità.
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.