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Cystoscopy Medication

  • Author: Gamal Mostafa Ghoniem, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Jan 05, 2016
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Local Anesthetics, Amides

Class Summary

Local anesthetics block the initiation and conduction of nerve impulses. Anesthetics used for the cystoscopy include lidocaine.

Lidocaine (Xylocaine)

 

Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels. Instill local lidocaine gel into the urethra 10-15 minutes before the procedure.

Those who prefer a rigid cystoscope or are performing an office procedural cystoscopy that necessitates the use of a rigid cystoscope typically instill local lidocaine gel into the urethra 10-15 minutes before the procedure. Some studies support the use of lidocaine spray, which takes effect more quickly (within 1-5 min).[1] This option may reduce anxiety in patients waiting for the procedure, as well as save time in the setting of a busy clinic.

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Antibiotics

Class Summary

The recommended antibiotic prophylaxis includes a single dose of either a fluoroquinolone or trimethoprim-sulfamethoxazole. Alternatively, an aminoglycoside (with or without ampicillin), a first- or second-generation cephalosporin, or amoxicillin-clavulanate may be administered. Patients with negative urine cultures and those without any of these risk factors do not need antibiotic prophylaxis before cystourethroscopy.

Trimethoprim/sulfamethoxazole (Bactrim DS, Septra DS)

 

Trimethoprim blocks dihydrofolate reductase, and sulfamethoxazole inhibits bacterial synthesis of dihydrofolic acid by competing with para-aminobenzoic acid (PABA). These are 2 sequential steps in bacterial biosynthesis of nucleic acids and proteins. This agent is available in single- and double-strength form. In adults, it is most commonly taken in pill form, although a liquid suspension is available.

Levofloxacin (Levaquin)

 

A derivative of pyridine carboxylic acid with a broad-spectrum bactericidal effect, levofloxacin penetrates the prostate well and is effective against Neisseria gonorrhoeae and Chlamydia trachomatis.

Ciprofloxacin (Cipro)

 

Ciprofloxacin is a fluoroquinolone with activity against pseudomonads, streptococci, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, and most gram-negative organisms, but no activity against anaerobes. It inhibits bacterial DNA synthesis and, consequently, growth. It diffuses into prostatic fluid and is indicated for chronic prostatitis.

Ampicillin

 

Ampicillin has bactericidal activity against susceptible organisms. It is an alternative to amoxicillin when the patient is unable to take medication orally.

Amoxicillin (Moxatag)

 

Amoxicillin is an ampicillin analogue with broad-spectrum bactericidal activity against many gram-positive and gram-negative organisms.

Cefuroxime axetil (Ceftin, Zinacef)

 

Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of the first-generation cephalosporins and adds activity against Proteus mirabilis, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis. The condition of patient, the severity of the infection, and the susceptibility of the microorganism determine the proper dose and route of administration.

Cefprozil

 

Cefprozil binds to 1 or more of the penicillin-binding proteins, and this binding, in turn, inhibits cell wall synthesis and results in bactericidal activity.

Cephalexin (Keflex)

 

Cephalexin is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms. The primary activity of cephalexin is against skin flora; the drug is used for skin infections or prophylaxis in minor procedures.

Gentamicin

 

Gentamicin is an aminoglycoside antibiotic for gram-negative coverage of bacteria, including Pseudomonas species. It is synergistic with beta-lactamase against enterococci. Gentamicin interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits. Dosing regimens are numerous and are adjusted based on creatinine clearance and changes in volume of distribution, as well as the body space into which the agent needs to distribute. Monitor gentamicin by serum levels obtained before the third or fourth dose (0.5 h before dosing); the peak level may be drawn 0.5 hour after a 30-minute infusion.

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Contributor Information and Disclosures
Author

Gamal Mostafa Ghoniem, MD, FACS Professor and Vice Chair of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American Urogynecologic Society, International Continence Society, International Urogynaecology Association, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, American College of Surgeons, American Urological Association

Disclosure: Received honoraria from Astellas for speaking and teaching; Received grant/research funds from Uroplasty for none; Partner received honoraria from Allergan for speaking and teaching.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Acknowledgments

Medscape Reference thanks Michel Rivlin, MD, G Rodney Meeks, MD, Dennis G Lusaya, MD, and Edgar V Lerma, MD, for assistance with the video contribution to this article.

References
  1. Choe JH, Kwak KW, Hong JH, Lee HM. Efficacy of lidocaine spray as topical anesthesia for outpatient rigid cystoscopy in women: a prospective, randomized, double-blind trial. Urology. 2008 Apr. 71(4):561-6. [Medline].

  2. Karabacak OR, Cakmakci E, Ozturk U, Demirel F, Dilli A, Hekimoglu B, et al. Virtual cystoscopy: the evaluation of bladder lesions with computed tomographic virtual cystoscopy. Can Urol Assoc J. 2011 Feb. 5(1):34-7. [Medline]. [Full Text].

  3. Kuehhas FE, Weibl P, Tosev G, Schatzl G, Heinz-Peer G. Multidetector computed tomography virtual cystoscopy: an effective diagnostic tool in patients with hematuria. Urology. 2012 Feb. 79(2):270-6. [Medline].

  4. Dimon M, Williams C. Continuous Retroflexion Cystoscopy During Prostate Cryoablation. J Endourol. 2012 Jan 4. [Medline].

  5. Wolf JS Jr, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ. Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol. 2008 Apr. 179(4):1379-90. [Medline].

  6. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9. 116(15):1736-54. [Medline].

  7. Zhang ZS, Tang L, Wang XL, Xu CL, Sun YH. Seeing Is Believing: A Randomized Controlled Study from China of Real-Time Visualization of Flexible Cystoscopy to Improve Male Patient Comfort. J Endourol. 2011 Jul 11. [Medline].

  8. Cano-Garcia Mdel C, Casares-Perez R, Arrabal-Martin M, Merino-Salas S, Arrabal-Polo MA. Use of Lidocaine 2% Gel Does Not Reduce Pain during Flexible Cystoscopy and Is Not Cost-Effective. Urol J. 2015 Nov 14. 12 (5):2362-5. [Medline].

  9. Patel AR, Jones JS, Babineau D. Lidocaine 2% gel versus plain lubricating gel for pain reduction during flexible cystoscopy: a meta-analysis of prospective, randomized, controlled trials. J Urol. 2008 Mar. 179 (3):986-90. [Medline].

  10. Rodríguez-Rubio F, Sanz G, Garrido S, Sánchez C, Estudillo F. Patient tolerance during outpatient flexible cystoscopy--a prospective, randomized, double-blind study comparing plain lubrication and lidocaine gel. Scand J Urol Nephrol. 2004. 38(6):477-80. [Medline].

  11. Clark KR, Higgs MJ. Urinary infection following out-patient flexible cystoscopy. Br J Urol. 1990 Nov. 66(5):503-5. [Medline].

  12. Seklehner S, Remzi M, Fajkovic H, Saratlija-Novakovic Z, Skopek M, Resch I, et al. Prospective multi-institutional study analyzing pain perception of flexible and rigid cystoscopy in men. Urology. 2015 Apr. 85 (4):737-41. [Medline].

 
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Rigid cystoscope with connections to irrigation and light source.
Flexible cystoscope.
Bladder distention in patient with interstitial cystitis.
Large supratrigonal vesicovaginal fistula, showing tip of vaginal clamp.
Cystoscope assembly, part 1. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Cystoscope assembly, part 2. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Cystoscopy, part 1. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Cystoscopy, part 2. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Cystoscopy supplies. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Cystolithotripsy, part 1. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
Cystolithotripsy, part 2. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
Cystolithotripsy, part 3. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
Gross anatomy of the bladder.
 
 
 
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