Operative note 01 Core

Rigid cystoscopy

What it does: look inside the bladder with a straight scope.

Assemble the scope. White-balance the camera. Check the focus.
Never force. Always follow the lumen. Lose the view? Pull back till you find it.
Too tight? Go smaller, dilate, or do an Otis cut. (Otis = a blade that slits a tight urethra at 12.)
Left hand: penis vertical, gentle stretch. 10 mL gel. Right hand: scope vertical. Water on.
Pass under vision. Penile urethra, then bulbar. The sphincter looks like a fold-narrowing.
At the sphincter, drop your hand as you go in. The scope rides over the veru. (Veru = verumontanum, the mound at the prostate tip.)
Note the prostate lobes and the bladder neck.
In the bladder: drain and measure what comes out.
Find the trigone and both ureteric orifices first.
Survey all of the bladder. Rotate and slide. Order does not matter. Completeness does.
Press the lower abdomen to see the front wall. Use the 70 degree scope near the bladder neck and for the dome. Hold the lens still: the view turns up.
Do not over-fill. The front wall drifts away.
Pull out the way you went in. Lift hands first.

Bladder stone: Stone found: survey first, then break it. Laser: the larger fibre, 365, 500 or 550 micron. 1.5 to 2.0 J at 20 to 50 Hz. Work one edge, wall in view behind every shot. Stone punch: jaws open under vision, take an edge. Look up. Lift the stone to the middle of the bladder, clear of the wall, lens clear. Then crunch. Never close on a stone resting on the wall. Wash the pieces out. Treat the cause the same day.

From the UroRef Operative Quick Guide.