ABSTRACT
Gynecologists have not been traditionally trained in performing endoscopy of the lower urinary tract. Cystourethroscopy, when compared to hysteroscopy and laparoscopy, is one of the simpler procedures to teach and to learn. Medically speaking, given the close proximity of the genital organs to the urinary tract, it is necessary for gynecologists to ensure the intactness of the urinary system after complicated pelvic procedures. Although the benefits of the routine use of cystoscopy after certain gynecologic procedures, such as a vaginal hysterectomy, have been debated, there is no question that with advances in pelvic reconstructive surgery and the use of synthetic and nonsynthetic grafts, it is incumbent on every surgeon to ensure intactness of the urinary tract. Failure to identify iatrogenic injuries intraoperatively will have life-changing and catastrophic sequelae for the patient. More complex vaginal procedures such as those for advanced pelvic organ prolapse, where the ureters are at greatest risk for injury, also dictate routine cystoscopic evaluation at the end of the procedure. The surgeon must be familiar with the different equipment and choose the best for the application, since there are multitudes of endoscopes and lenses currently available on the market. This chapter focuses on diagnostic cystoscopy only.
