The patient should empty the bladder prior to performing a flexible cystoscopy. Preparation and local anaesthesia are performed as described above with the exception of the lithotomy position, which is not mandatory. Flat supine position in male patients is possible.
Insertion of the instrument: ™ Use excessive lubricating gel. ™ Straighten the penis with the middle and ring finger of one hand and hold the tip of the cystoscope with the thumb and index finger to guide the instrument into the external meatus.
™ Slowly pass the instrument through the urethra with continuous flow irrigation. ™ By bending the tip of the instrument, it is possible to overcome even large prostatic median lobes with the roughly 35-cm-long instrument.
™ A systematic and complete inspection of the bladder is mandatory as described above.
™ By bending the instrument more than 180°, it is possible to retrograde inspect the bladder neck.
™ Consider repeating the cystoscopy if the vision is impaired due to detritus, blood clots or active bleeding.
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