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, deflectability, and the size of the outer sheath and working channel have been accomplished. A superior flexible cystoscope is one with an outer sheath of 16F or less and working channel large enough to admit standard endoscopic instruments (> or = 6F). The 180 degrees two-way thumb-directed deflection and a removable light bundle are significant improvement. We present 55 patients with either urethral, bladder, or upper urinary tract lesions who were treated at the bedside using the flexible cystoscope in many settings. Local anesthesia alone was usually used. Flexible cystoscopy was also used for emergency intraoperative consultation requiring endoscopy. A treatment cart was constructed consisting of a light source, endoscopic instruments, irrigating supplies, and the endoscope. Urethral strictures, perforation, and bladder neck contractures were treated. Ureteral catheters were placed under direct vision. Removal of ureteral stents and foreign bodies, treatment of small bladder tumors with the Nd:YAG laser, and fragmentation of bladder calculi with the pulsed-dye laser were also therapeutic applications. Explanations of each treatment type and the instruments used concurrently with this endoscope are provided.