filiform bougie is passed through the urethral stricture into the bladder. Sounds or
followers of desired type attached to filiform bougies are then passed into the bladder.
c. Operative Procedure for Internal Urethrotomy. The filiform bougie is
passed into the bladder; the urethrotome is connected and inserted. The Otis
urethrotome consists of a curved sound with a groove on its upper side, along which is
a triangular knife. Its sides are sharp and its apex blunt. The urethrotome is inserted,
and then the blade is released to cut the stricture. Electrosurgical cutting and
coagulating electrodes may be used.
a. General. This procedure is the visual inspection of the interior of the bladder
and examination of adjacent structures by means of an instrument (cystoscope)
introduced via the urethra into the bladder. The examination may be done as an end in
itself, or may be the first step in a series of examinations or treatments that may be
b. Patient Preparation. The patient is placed in the lithotomy position perineal,
preparation is carried out, and the patient is draped with a lithotomy fenestrated sheet
and leggings. Surgical jelly is required to lubricate instruments passed into the urethra.
A local or general anesthetic may be administered. The surgeon will require a
circulator, but probably not a scrub assistant.
c. Operative Procedure.
(1) The surgeon assembles the cystoscope, fitting the obturator into the
sheath. The light is tested, and the circulating team member adjusts the current to the
(2) The instrument is lubricated and inserted into the patient's urethra. The
obturator is removed and the telescope inserted into the sheath. The surgeon puts his
eye to the eyepiece and makes his examination. The bladder is distended with
irrigating fluid. The surgeon adjust the flow and volume with the stopcock. Then the
obturator or telescope is removed, the irrigating fluid flows out.
(3) Other procedures such as catheterization, biopsy, or stone removal are
carried out by exchanging or supplementing the cystoscope lens with the appropriate
(4) Kidney function studies, cystometry, and X-ray examinations may be
performed and various specimens of urine collected. When the examination is
concluded, the instrument is removed. A urethral catheter may be inserted as required.