Page 222 - Clinical Manual of Small Animal Endosurgery

210 Clinical Manual of Small Animal Endosurgery

Indications for urethrocystoscopy

Urethrocystoscopy may be employed for investigation of a wide range
of conditions affecting the lower urinary and reproductive tracts. Persist-
ent cystitis, stranguria, pollakiuria, vaginal discharge, urinary inconti-
nence, reproductive problems, trauma and neoplasia are all indications
for direct examination.

Equipment
Although flexible endoscopes are commonly used for urethrocystoscopy
in the male dog, where the length of the urethra precludes other choices,
the female urinary tract lends itself to the superior optics and versatility
of the rigid endoscope. A 2.7 mm-diameter, 18 cm endoscope with a 30°
angle of view and a matching cystoscopy sheath will be adequate for the
vast majority of bitches and may even be used in many queens. The
limiting factor in large breeds is the length of the instrument, and it may
be necessary or preferable to use a 4 mm-diameter telescope with a length
of around 33 cm and a viewing angle of 30° for these patients as the
extra length facilitates examination of the bladder. This will require a
matching cystoscopy sheath and instrumentation at additional cost.
However, even in large breeds it is often possible to carry out a full
examination with the shorter endoscope by careful external abdominal
manipulation of the bladder during the procedure. In cats and small
breeds of dogs an arthroscopy sheath may be used with the 2.7 mm
endoscope as it has a smaller cross section than the cystoscope. However
the lack of an instrument channel limits the usefulness of this approach.
Biopsies can be taken blind by pointing the instrument at the site of
interest and carefully removing the endoscope from the sheath, to allow
insertion of biopsy forceps directly down it. The endoscope is then
replaced in the arthroscope sheath and the biopsy site inspected. Smaller
endoscopes of 1.9 or 2.4 mm diameter may also be used but are usually
too short to reach the bladder except in very small kittens.
The cystoscopy sheath has two taps with Luer fitting, one on either
side, for instilling and removing fluid respectively. A further tap on the
top of the sheath controls the opening to the instrument channel that
runs along the top of the telescope and accommodates semi-flexible
biopsy forceps, grasping forceps or scissors. Other instruments such as
laser fibres or injection needles can also be passed through this channel.
Typically, this channel on the sheath of a 2.7 mm endoscope accommo-
dates 7 French (2.3 mm diameter) instruments.
A light guide cable and light source, ideally xenon or metal halide,
are also required.
Finally a camera system and monitor are essential, not only to carry
out the procedure hygienically, but also because the vastly improved
magnification and image quality will make diagnosis and treatment
much easier.