When to Consider Intraoperative Cystourethroscopy?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Summarize the procedures in which intraoperative cystourethroscopy can enhance care by early detection of injury 2. Define the benefit of intraoperative cystoscopy
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Cystourethroscopy, a diagnostic endoscopic examination of the bladder and the urethra, is a valuable procedure that can enhance surgical care
Consider intraoperative cystourethroscopy for the following
Surgery for pelvic organ prolapse such as a prolapsed bladder, or stress incontinence
The evaluation of suspected urine leak from bladder/ureteral transection
Determining suprapubic catheter placement
To prepare for diagnostic cystourethroscopy use
Sterile technique with patient in lithotomy position
Local, regional or general anesthesia
2% lidocaine jelly as lubricant and anesthetic
Historically, 5 ml of indigo carmine IV 10-15 minutes prior to cystoscopy to identify ureteral jets
If indigo carmine is unavailable, other options include
200 mg oral phenazopyridine
25 mg IV sodium fluorescein
mannitol bladder distention
normal saline bladder distention
Distend the bladder with
Sterile water or saline
If using electrocautery: Nonconducting solution such as glycine
To examine the bladder
Visualize the bladder circumferentially
Identify the trigone and both ureteral orifices
Although mainly performed by urologists, cystourethroscopy can be performed for diagnostic and occasionally operative indications by ObGyns to improve patient care. The benefit of intraoperative cystoscopyis that it allows for the verification of bilateral ureteral flow during or after obstetric, gynecologic, urologic or urogynecologic surgery and aids in the early diagnosis and treatment of cystotomy, intravesical mesh/suture placement and ureteral transection or kinking.
Nonobstructive, partially obstructive or late ureteral injuries may not be recognized or prevented
Indicated during/after placement of tension-free vaginal tape, Burch colposuspension, high uterosacral ligament vaginal vault suspension
May be indicated for McCall culdoplasty, colpocleiesis, advanced/difficult vaginal or laparoscopic hysterectomy
Cystourethroscopy adds minimal additional costs and time spent in the operating room
Granting of privileges for cystourethroscopy should be based on training, experience and demonstrated competence
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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