ACTIVELY DEFLECTABLE, FLEXIBLE CYSTOSCOPES - NO LONGER SOLELY A DIAGNOSTIC INSTRUMENT

The recent evolution of actively deflectable, flexible endoscopes has included the flexible cystoscope. Improvements in optics, deflectabili ty, and the size of the outer sheath and working channel have been acc omplished. A superior flexible cystoscope is one with an outer sheath of 16F or less and working channel large enough to admit standard endo scopic instruments (greater than or equal to 6F). The 180 degrees two- way thumb-directed deflection and a removable light bundle are signifi cant improvements. We present 55 patients with either urethral, bladde r, or upper urinary tract lesions who were treated at the bedside usin g the flexible cystoscope in many settings. Local anesthesia alone was usually used. Flexible cystoscopy was also used for emergency intraop erative consultation requiring endoscopy. A treatment cart was constru cted consisting of a light source, endoscopic instruments, irrigating supplies, and the endoscope. Urethral strictures, perforation, and bla dder neck contractures were treated. Ureteral catheters were placed un der direct vision. Removal of ureteral stents and foreign bodies, trea tment of small bladder tumors with the Nd:YAG laser, and fragmentation of bladder calculi with the pulsed-dye laser were also therapeutic ap plications. Explanations of each treatment type and the instruments us ed concurrently with this endoscope are provided.