Cystoscope

All there is to know about a cystoscope

A cystoscope is a unique device used during cystoscopy, a specialized diagnostic procedure usually performed after emptying the bladder. There are two main types of cystoscopes—for men and women— with their differences due to the diversity in the anatomy of the male and female urinary systems. Also, the cystoscope helps to check the condition of the urethra as well. 

Usually, this instrument looks like a fiber tube with a camera on the distal side. Still, sometimes, especially with old devices, they can look like a metal tube with a cut distal part. In most cases, they also had a special lighter near the fiber optic camera on top of the tube, illuminating the cavity of the examined organ.

A Little Bit of History of a Cystoscope

Interestingly, similar instruments were the first-ever that began the era of the endoscopy. Maximilian Carl-Friedrich Nitze, a urologist from Germany, presented the first device of that type in 1878. He created this instrument together with Joseph Leiter, a Viennese instrument creator. It was a fully operational instrument, unlike the prototype model crafted in October 1877.

The chief electrician made the next remarkable improvement of ElectroSurgical Instruments in Rochester, New York. Charles Preston decided to insert a small bulb into the standard metal cystoscope, which makes it look modern, and the whole procedure faster and cheaper, as the overall number of different complications decreases. 

After that, the next remarkable improvement was in the mid-1920s. The main idea of the brand new form of these instruments was replacing the metal parts with fiber optic. The first attempt at creating a fully operational fiber-optic cystoscope was in the 1930s in Germany. But, the fully functional device was produced only in 1960. 

Indications to use a cystoscope 

The cystoscope use is mostly for various diagnostic purposes and very rarely as a tool for treatment procedures. As mentioned above, their use is in the examination and treatment of two organs—bladder and urethra. Among the most common diseases that are discoverable during cystoscopy are:

  • Urethritis
  • Cystitis
  • Urethral cancer and other tumors
  • Microcyst
  • Bladder dilatation
  • Polyps of bladder and urethra
  • Various other types of tumors
  • Overactive bladder
  • Different types of congenital abnormalities
  • And many others

Sometimes a medical practitioner can also indirectly make guesses about the condition of a few other organs, such as the ureters and prostate glands. In the case of an enlarged prostate gland, the doctor will see it through the bladder as a protrusion on the lower surface of that organ during cystoscopy.

There is also a possibility to use a cystoscope for the treatment of small tumors. When the small part of the bladder attached to its surface tumor is resected, the operation is called the transurethral resection. Usually, the cystoscope is useful as an instrument for visualization during these procedures.

Also, sometimes, the cystoscope may be used as a visualization technique during the biopsy of the bladder, ureter, and urethra tumors. In those cases, it helps prevent significant damage to the bladder wall, allowing the medical practitioner to stop during the procedure at the right time and to avoid bladder perforation. 

According to the latest discoveries, cystoscopy use may also be during different medical treatments, like installing medicines into the cavities or intratumoral injections of medical substances or radioactive chemicals. Those methods are getting more and more popular nowadays, as everybody is trying to save human organs, without removing them.

Among the other indications to use this tool is in the treatment of the condition called urethra stricture. Usually, when the medical practitioner discovers that a patient has a restraint, he puts a specialized tube, called a stent, into the urethral canal. 

Complications of using a cystoscope

The most significant group of complications occur due to a lack of antibacterial processing of the medical equipment used during the procedures. If any instrument used during the therapeutic or diagnostic manipulation does not proceed as it should, there is a great probability of bacterial infection. It's especially essential for those types of procedures that involve the manipulations in inner organs. Cystoscopy is one of them.

The second major group of complications occurred when the perforations of the organ's cavity happened. Most often, after using the instrument, the bladder perforates, and urine begins to accumulate in the pelvis cavity, creating significant problems. But there is also a large probability of perforation of the urethra, especially when the medical practitioner is not skillful and experienced.

Another group of complications while using the cystoscope involves provoking a tremendous amount of mechanical pressure on the surface of the urethra and bladder. Usually, those may lead to different problems that look like inflammatory diseases but do not need any antibacterial therapy. Those complications often occur during a long period of continuous examinations.

General Specifications

Lots of different models of the cystoscope exist nowadays and are available on the market. Still, the main types of cystoscope are fiber and rigid. So, it is probably almost impossible to discover the specifications that will fit the various types. That's why we picked up ten specs that appeared in the technical documentation for these devices the most often. And here is what we got:

  • Angulation range - 180° up, 180° down
  • Working channel - not less than 7 Fr
  • Sheath size - not less than 16 Fr
  • Working channel port - detachable
  • Suction - included
  • Position of working channel - about 6 o'clock
  • Working length - up to 400 mm
  • Total length - up to 700 mm
  • Deflection of the distal tip - from 140° up to 210° 
  • The direction of view - straight 0°

Market Leaders

Several manufacturers of the cystoscope exist. But, unfortunately, not all make products of high quality. That is why we decided to make a list of manufacturers that create the most significant instruments. And here is what we got:

  • DmD Services
  • Cervius Medical
  • MED & IT Trading
  • VeMed GmbH
  • GP MEDICAL FRANCE
  • KOCKS S. R. L.
  • Alternup Medical
  • PRAISTON
  • Emos Technology GmbH

There are also lots of different used equipment of that type that are selling in the modern market, but, unfortunately, they are mostly pretty unreliable and can break at any time. 

Conclusions

A cystoscope is a vital instrument for use in the different areas of urology, including diagnostic and treatment procedures on urethra and bladder. Those instruments are used in a few surgical operations as well. Nowadays, the option of video recording of the whole process is also used a lot. This method probably will be developed in the future, as there are discoveries of many new pathologies and diseases of the urinary system every day. The possibility of getting a biopsy is an excellent example of the expansion of the cystoscope's functions. We should give a scientific community more resources to explore different options of those instruments and create new prototypes for various purposes.

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