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  • Cited by 1
  • Print publication year: 2008
  • Online publication date: December 2009

21 - ADDITIONAL PROCEDURES FOR PELVIC SURGEONS

Summary

Cystoscopy, the gold standard for diagnosis of disorders and injuries of the lower urinary tract, provides another tool for prevention and active management of urologic pathology and surgical complications by allowing the surgeon to assess the integrity and function of the urethra, bladder, and ureters. At our center, we have incidentally detected bladder endometriosis, polyps, malignant lesions, diverticula, duplicated ureter, and interstitial cystitis. One case of complete ureteral obstruction and renal necrosis due to invasive endometriosis was detected during an incidental cystoscopy. Contralateral periureteral disease was treated, resulting in successful conservation of the other kidney.

Cystoscopic technique, unfortunately, is not routinely taught during obstetrics/gynecology residency training; therefore, many gynecologists do not feel comfortable performing the procedure. This is unfortunate as gynecologists deal with urogynecologic issues daily with conditions such as urinary incontinence, pelvic organ prolapse, and severe endometriosis involving the lower urinary tract. Two large multicenter studies demonstrated that 66% to 80% of patients with chronic pelvic pain had evidence of bladder-origin pain due to bladder epithelial damage or interstitial cystitis. In the gynecologic literature, chronic pelvic pain is associated with endometriosis in 30% to 87% of cases as well. The surgical treatment of pelvic pain is the most frequent indication for operative laparoscopy, although in as many as 40% of patients, no pathology is found.