Cystoscope Assembly and Preparation for a Cystoscopy

Abstract

Cystoscopy is a fundamental diagnostic and therapeutic urological procedure. The patient’s safety is protected and the procedural flow is improved when the table and instrument setups are performed efficiently using sterile technique. This educational video demonstrates the preparation of the surgical field and step-by-step assembly of a standard rigid cystoscope, including the recommended workflow for sterile table arrangement, fluid management, and connection of the assembled cystoscope.

Article Overview

Cystoscopy is a minimally invasive endoscopic procedure that allows for direct visualization of the lower urinary tract, specifically the urethra and the urinary bladder.^1,2 Cystoscopy is widely used for both diagnostic investigations—including the evaluation of hematuria,³ chronic urinary tract infections,⁴ and suspected urothelial malignancies⁵—and therapeutic interventions, including biopsy collection,⁶ ureteral stent placement,⁷ and foreign body removal.^8–10 To ensure optimal outcomes and maintain strict aseptic technique, a thorough understanding of the required instrumentation and an organized approach to back table organization are very important.

In this instructional video, the surgical technologist dons a second pair of sterile gloves to provide an additional protective barrier. A second drape is placed over the back table to add an extra layer of protection between the instrumentation and the table.

To optimize efficiency, patient drapes are placed in the ring stand in reverse order of their deployment: cystoscopy drape, lithotomy leggings, a hand-drying towel, and the surgeon’s sterile gown and gloves.

Sterile normal saline irrigation fluid is poured into a sterile bowl and labeled (please check your facility's policy on labeling of medications on the field). Specimen cups are prepared for urine collection and for containment of radiopaque contrast media. Sponges are placed on the field but they do not require a formal count as they will not enter a body cavity. Finally, sterile water-soluble lubricating jelly is dispensed onto the sterile field and labeled to facilitate safe introduction of the scope into the patient's urethra.

Once the sterilization indicator within the instrument tray is verified, the cystoscope can be assembled. The camera head is securely attached to the optical lens, and its cord is passed off the sterile field to the circulating nurse. The proximal end of the fiber-optic light cable is attached to the light post of the telescope.

The protective caps are removed from the irrigation tubing, and an adapter piece is attached to the distal end. The flow-regulating clamps on the tubing are fully closed to prevent inadvertent fluid leakage.

The rigid cystoscope sheath is assembled by sliding the bridge component into the sheath housing. It should be pushed until an audible click is heard and secured by turning the locking knob. Proper attachment is confirmed with a gentle tug. Next, the obturator is inserted directly through the sheath and locked into place using its turn-knob mechanism. Verify that both fluid inflow and outflow stopcock valves are oriented in an upright position to confirm that the irrigation channels are completely closed. The fully assembled scope, along with the labeled lubricating jelly, is then ready for transfer once the patient has been draped.

Video-based instructional materials are an important educational tool in modern perioperative training. These resources are particularly important for students and clinical trainees who must master rapid, error-free instrument setups. By providing clear, reproducible visualization of procedures, such videos help bridge the gap between theoretical knowledge and practical operating room performance.

Disclosures

The author reports no conflicts of interest, financial relationships, funding, sponsorship, equipment support, or other relationships that could be perceived to influence the content of this article.