The cystoscope and accessories

1. THE RIGID
CYSTOSCOPE AND
ACCESSORIES
MOHAMMAD IHMEIDAN PGY2

2. HISTORY
• Maximilian Carl Nitze, a German urologist, is
credited with the invention of modern cystoscope,
which was primarily used for inspection of the
bladder. This was publicly demonstrated in 1879

3. • The parts of a rigid cystoscope assembly are as
follows: 1. Cystoscope sheath
2. Cystoscope obturator
3. Bridge
4. Light cable
5. Telescope

6. THE CYSTOSCOPE SHEATH
• The cystoscope sheath is calibrated in French (Fr),
this is considered to be the outer circumference of
the instrument in millimeters (mm). Fr is same as
Charriere (Ch).
• Three French is equal to one mm.
• It is also written as F, Fr or Ch.

8. • a. Length of an adult cystoscope sheath regardless
of size is 22 cm.
• The cross section of the sheath is not round but
oval

9. • Markings on the shaft: The proximal 10 centimeters
from the vesical end devoid of any markings.
• Markings are engraved on the sheath at every 1
cm thereafter for the next 13 cm.
• The markings help in estimation of prostatic urethral
length (In comparison, Optical Urethrotome Sheath
has similar markings all along the length of the
sheath).

10. METHOD TO MEASURE
PROSTATIC URETHRAL
LENGTH:
• The cystoscope is introduced along the entire length.
The cystoscope is withdrawn under endoscopic vision till
the bladder neck. The marking on the external meatus is
noted (Point A). Thereafter, the cystoscope sheath is
withdrawn till the verumontanum and a note of the
marking is done (Point B).
• The number of markings on the sheath between point A
and point B is noted, this is the length of the prostatic
urethra

11. BRIDGES
• Types of Bridges (Classification)
• 1. Without side channel
• 2. With one side channel
• 3. With two side channel

12. PARTS OF BRIDGE
• Telescope channel: It accommodates the telescope.
• Accessories’ channel: It is meant to pass the
accessories such as ureteric catheter, wires
forceps, etc. It has a rubber shod which help in
easy passage of the instrument.

14. OBTURATORS
• They are specific for a given sheath.
• Once attached to the sheath it makes the tip of the
sheath smooth thereby tightly fitting to it.
• The length of the obturator is 26 cm.

15. PARTS OF OBTURATOR ARE AS
FOLLOWS:
• Vesical end knob: This helps in smooth atraumatic
insertion of the cystoscope.
• Shaft: Connects the vesical end knob and the locking
mechanism.
• Locking mechanism: Zero (0) should correspond to
zero (0) of the sheath when locked

18. THE TELESCOPES
• The telescopes are classified depending on the viewing
angle.
• They are available as 0°, 30°, 70°, 120° and 12°
• Adult telescopes can be used with any adult sheaths.
• They need to be used with a bridge
• The light cable can be attached to the telescope directly

19. • Straight forward telescopes (0°) is focused to view
straight ahead, is usually used for urethroscopy.
• Forward oblique telescopes (30°) best affords
visualization of the base and anterolateral aspect of
the bladder, this is the most commonly used
telescope.

20. • Lateral telescope (70°) to view the bladder dome.
• Retrospective telescopes (120°) help to visualize
the anterior bladder neck from inside.

21. THE ROD-LENS SYSTEM
• The key difference in the conventional optical system and the rod-
lens system is that the Hopkins rod-lens system employs special
glass rods with customized finished ends.
• The rod-lens system reduced the air spaces between lens with
long rods of glass is transported back through the telescope, it is
magnified at the ocular lens.
• The degree of magnification is to some extent dependent on the
diameter of the viewing lens.

24. PARTS OF TELESCOPE
• Shaft: Angulation at the tip varies depending on the
viewing angle.
• Eyepiece: It is typically black in color, the size is
universal and adapts to any camera head.

25. Thank You