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Cystoscopy

Background

Cystoscopy is endoscopy of the urinary bladder via the urethra. It may employ either a rigid or a flexible cystoscope and may be performed for either diagnostic or therapeutic purposes.

The first instrument used for visualizing the body from inside was developed by Philipp Bozzini (1773-1809), a German army surgeon, who invented the Lichtleiter (the ancestor of modern endoscopes) in 1807. Bozzini used this innovation for viewing the bullets in his patients.
The cystourethroscope has been greatly improved by the introduction of cold light, the enhancement of the optical system, and the development of videoendoscopy, flexible instruments, and virtual endoscopy.

Relevant anatomy

The adult bladder is located in the anterior pelvis and is enveloped by extraperitoneal fat and connective tissue. It is separated from the pubic symphysis by an anterior prevesical space known as the retropubic space (of Retzius). The dome of the bladder is covered by peritoneum, and the bladder neck is fixed to neighboring structures by reflections of the pelvic fascia and by true ligaments of the pelvis.

The body of the bladder receives support from the external urethral sphincter muscle and the perineal membrane inferiorly and the obturator internus muscles laterally (see the image below).

Gross anatomy of the bladder.

Gross anatomy of the bladder.

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For more information about the relevant anatomy, see Bladder Anatomy. See also Female Urethra Anatomy, Female Urinary Organ Anatomy, Male Urethra Anatomy, and Male Urinary Organ Anatomy.

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