What is a urethroscope?

What is a Urethroscope?

A urethroscope is an endoscopic instrument designed to visualize the interior of the urethra, allowing direct inspection of the urethral lumen, identification of strictures, and evaluation of urethral pathology. 1

Instrument Types and Characteristics

Urethroscopy can be performed using different endoscopic platforms:

• Rigid ureteroscopes have a tip diameter of less than 8 F and can access the entire ureter, though flexible ureteroscopy is increasingly favored due to technical advances 1
• Flexible ureteroscopes are passively deflectable fiberoptic instruments that must be stabilized with a cystoscope, flexible introducer sheath, or guide wire for placement through the urethra and bladder into the ureter 2
• Pediatric cystoscopes (20F or smaller caliber) can be used for urethroscopy, particularly in women after urethral dilation to 32F 3
• Modern ureteroscopes incorporate improved optics, increased durability, and enhanced capabilities compared to earlier models 4, 5

Clinical Applications

Diagnostic Uses

Urethroscopy serves multiple diagnostic purposes:

• Identifies and localizes urethral strictures and allows evaluation of the distal caliber, though the length of the stricture and the urethra proximal to the stricture cannot be assessed in most cases 1
• Preferred over retrograde urethrography for penile injuries, as recommended by the American Urological Association 6
• Provides additional diagnostic information in uncertain cases of urethral trauma when distinguishing between complete and incomplete lesions is challenging 7
• Facilitates safe catheter placement under direct vision in patients with failed catheterization attempts 8

Therapeutic Applications

The urethroscope enables various therapeutic interventions:

• Endoscopic management of urethral strictures through urethral dilation or direct visual internal urethrotomy (DVIU) 1
• Biopsy and resection of lesions within the distal ureter, particularly in women with transitional cell carcinoma involving the ureteral orifice or intramural ureter 3
• Stone visualization and treatment throughout the upper urinary tract when combined with lithotripsy techniques 4

Technical Considerations

Procedure Requirements

• Irrigation through the instrument is beneficial for clearing the visual field and distending the lumen 2
• Anesthesia is typically required for urethroscopy procedures 3
• Most ureteroscopic procedures can be performed on an outpatient basis, with only 6.8% requiring hospitalization for procedure-related complications 9

Limitations

• Cannot assess stricture length or the proximal urethra in most cases, making retrograde urethrography (RUG) with or without voiding cystourethrography (VCUG) the study of choice for delineating stricture length, location, and severity 1
• Diagnostic value is limited to selected clinical situations when using flexible instruments 2

Critical Safety Points

Contraindications to Blind Procedures

• Never perform blind basketing (stone extraction without endoscopic visualization) as this risks urethral injury 6
• Avoid blind catheterization in suspected urethral trauma cases 6, 7
• Avoid fluoroscopic imaging of stones alone without direct urethroscopic vision during procedures 6

Trauma Evaluation

• Blood at the urethral meatus requires immediate retrograde urethrography before any catheterization attempt 6, 8
• Flexible cystoscopy/urethroscopy can visualize urethral obstruction and facilitate safe catheter placement when catheterization has failed 8
• In pelvic fractures with blood at the meatus, always evaluate for urethral injury before bladder catheterization 6