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Practical cystoscopy: care of the instruments and preparation for a cystoscopic examination.

Periodically, a look at the past helps health care professionals see how much practice has changed as well as how some concepts and practices remain similar to the original rationales and techniques. Two chapters from a 1911 textbook on cystoscopy have been reprinted that describe catheter and instrument care and preprocedure requirements for cystoscopy performed in the hospital, office, or home. Sterilization methods and instruments for cystoscopy have improved in the century since this book was written but the rationale for the procedure and concepts guiding the instrumentation have some similarity with the practices performed nearly 100 years ago. Some comments also provide a bit of comic relief. One example, "this undoubtedly shortens the life of the catheter, but it lengthens the life of the patient" appears in the discussion about catheter cleaning after use in a pus case.

Cystoscopes↗

Bladder perforation of the tension-free vaginal tape detected with a flexible cystoscope.

A 67-year-old woman who presented with stress urinary incontinence underwent a tension-free vaginal tape (TVT) operation. Postoperatively, she complained of urgency, gross hematuria and dysuria, which persisted for one week. Cystoscopy with a flexible cytoscope revealed penetration of the bladder wall by the tape, which had been missed during the TVT procedure by rigid cystoscopy. After the penetrating portion of the tape was excised, her symptoms were resolved and continence was preserved. This case suggests that employment of a flexible cytoscope is useful to detect the placement of tape in the bladder wall, which may be missed with a rigid cytoscope.

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