ENCYCLOPEDIA OF UROLOGY

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HANDBUCH DER UROLOGIE 
ENCYCLOPEDIA OF UROLOGY 
ENCYCLOPEDIE D'UROLOGIE 
HERAUSGEGEBEN VON· EDITED BY 
PUBLIEE SOUS LA DIRECTION DE 
C. E. ALKEN V. W. DIX H. M. WEYRAUCH 
HOMBURG (SAAR) LONDON SAN FRANCISCO 
E. WILDBOLZ 
BERN 
VI 
SPRINGER-VERLAG· BERLIN· GOITINGEN· HEIDELBERG· 1959 
ENDOSCOPY 
BY 
ROGER W. BARNES 
R. THEODORE BERGMAN· HENRY L.HADLEY 
LOS ANGELES 
WITH 184 FIGURES 
SPRINGER-VERLAG· BERLIN· GOTTINGEN· HEIDELBERG· 1959 
ISBN-13: 978-3-642-86573-2 e-ISBN-13: 978-3-642-86571-8 
DOT: 10.1007/978-3-642-86571-8 
Alle Rechte, insbesondere das der tlbersetzung in fremde Sprachen, vorbehalten 
Ohne ansdriickliche Genehmignng des Verlages ist es auch nicht gestattet, dieses 
Buch oder Teile daraus auf photomechanischem Wege (Photokopie, Mikrokopie 
zu vervielfiiltigen 
© by Springer-Verlag OHG. Berlin· G6ttingen· Heidelberg 1959 
Softcover reprint of the hardcover I st edition 1959 
Die Wiedergabe von Gebrauchsnamen, Handelsnamen, Warenbezeichnungen usw. in 
diesem Werk berechtigt auch ohne besondere Kennzeichnung nicht zu der Aunahme, 
dall solche Namen im Siun der Warenzeichen- und J\farkenschutz-Gesetzgebung 
als frei zu betrachteu waren und daher von jedermaun benutzt werden diirHen 
This volume is dedicated to the Urologists of India 
who are struggling for recognition of the speciality of Urology 
Contents 
Part I - Diagnostic Endoscopy 
Chapter I - Endoscopic armamentarium 
A. Endoscopes ... 
I. Direct vision endoscopes 
1. Advantages 
2. Cystoscopes 
3. Urethroscopes . 
a) Internal illumination 
b) External illumination 
II. Lens endoscopes 
1. Advantages .. . . . 
2. Optical systems used in endoscopes 
a) Right angle . . . 
b) Obliquely forward 
c) Retrograde 
d) Directly forward 
e) Adjustable 
3. Telescopes . . . . 
a) Wiring circuit . . . . . . . 
b) Catheter guides and deflectors 
c) Protection of catheters . . 
d) Carriage for telescopes 
III. Endoscope sheaths ..... . 
1. Illumination. Types of sheaths 
2. Beaks and fenestrae of sheaths 
3. Light posts. 
4. Stopcocks . . . 
5. Obturators . . . 
6. Locks ..... 
IV. Sizes of endoscopes 
V. Instruments designed for endoscopic surgery 
1. Stern McCarthy visual prostatic electrotome 
2. Resectoscope made by Wolf (Germany) . 
3. Modifications of the McCarthy electrotome 
4. Visuallithotrites . . . . . . . . . 
Telescope ........... . 
B. Instruments used through endoscopes 
I. Electrodes . . . . . . . . . 
II. Forceps, rongeurs, and scissors 
III. Infiltration needles 
IV. Ureteral catheters (Chap. II) 
V. Special ureteral catheters 
VI. Ureteral instruments 
1. Bougies ...... . 
2. Calculus dislodgers . . 
a) Wire basket ..... 
b) Looped ureteral catheter 
c) Forceps ..... 
3. Transilluminator . . 
C. Cystoscopic attachments 
I. Cystoscope holders 
II. Teaching attachment 
III. Photographic attachments 
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D. Sources of light for endoscopes 
I. Bulbs ...... . 
II. Quartz tube 
III. Batteries . . . . . . 
IV. Electric house current 
Contents 
E. Care and maintenance of endoscopes 
I. Routine care . . . . . . . . . . . . 
1. Basic precautions to prevent breakage 
2. Disinfection . . . . . . . 
II. Minor repairs and adjustments 
1. Light failure . . . . . . . 
a) Light bulb ..... . 
b) Contact rings of lamp post ..... 
c) Contacts between cord and lamp post. 
d) Light cord. . . . . . . . . . . . . 
e) Connection of cord to battery terminals 
f) Rheostat . . . . . . . . . . . . 
g) Connections inside battery container 
h) Batteries . . . . . . . . 
2. Blurred vision . . . . . . . . . . . 
F. The cystoscopic room (theatre) 
I. Aseptic technique, cleanliness and decorum 
II. Floor ...... . 
III. Electric switches . . . . 
IV. Darkened room ...... . 
V. Anesthetic equipment . . . . 
G. Cystoscopic room equipment 
I. Cystoscopic table 
II. Cystoscopic stools . . . 
III. Irrigating fluid supply . 
1. Flask system . . . . 
2. Sterilizer near ceiling . . 
3. Pressurized from container on floor 
4. Water sterilizer-pitcher-jar 
5. Control of water by foot switch. . 
H. Endoscopic armamentarium in the armed forces 
Chapter II - The cystoscopic procedure 
A. Value of properly performed cystoscopy 
The cystoscopist . 
1. Training . . . . . . . . . . . 
2. Dexterity . . . . . . . . . . 
B. Indications and contraindications for cystoscopy 
I. Indications . . . . . . . . . . 
II. Contraindications . . . . . . . 
C. Routine supplies for cystoscopy 
I. Sterile set-up . . . . . . . 
II. Lubrication . . . . . . . . 
III. Drapes . . . . . . . . . . 
IV. Media for distending bladder 
1. Water 
2. Urine 
3. Oil . 
4. Air. 
D. Preparation of the patient 
I. Prophylactic antibiosis 
II. Bowel preparation . . 
III. Analgesia. . . . . . 
VII 
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VIII 
IV. General or spinal anesthesia 
V. Local anesthesia 
1. Anesthetic agents . 
2. Application 
3. Untoward reactions 
E. Position of the patient 
F. Checking of equipment 
I. Instruments 
II. Light bulbs 
Contents 
G. Introduction of the cystoscope. 
I. Information gained from passing the cystoscope 
1. Stricture. . . . . . . . . 
2. Elevated posterior lip . . . 
3. Elongated prostatic urethra 
4. Residual urine . . . . . . 
II. The causes of difficulties encountered during passage of the cystoscope 
H. Procedures for obtaining cl ear visualization . . . . . . 
I. Adequate intensity of illumination of the interior of the bladder 
II. Distention of the bladder . . . . . . . . . . . . . 
III. Washing debris from the bladder . . . . . . . . . 
IV. Manipulation of the inflow of fluid through the sheath 
V. Proper manipulation of the objcctive lens 
I. Orientation with different lenses (see Chap. I) 
J. Routine bladder examination 
I. Blind spot 
II. Diverticular cavity 
K. Ureteral ca theteriza tion 
I. Ureteral catheters 
1. Tips. . . 
a) Whistle. 
b) Olive .. 
c) Coude 
d) Filiform. 
e) Conical or Garceau and Braasch bulb 
2. Size ... 
3. Flexibility . . . . . 
4. Opacity ..... . 
5. Graduation markings 
II. Technique of ureteral catheterization 
III. Manipulations to facilitate ureteral catheterization 
L. Differential renal function 
I. Chromocystoscopy 
1. Indigocarmine 
2. Trypan red. . 
3. Neoprontosil . 
II. Phenolsulphonaphthalein (P. S. P.) 
III. Urea clearance . . . . . . . . . 
M. Kidney study (retrograde cystoscopy) . 
N. Removal of the cystoscope 
O. Cystoscopy hipogastrica . 
P. Experimental and practice cystoscopy 
I. Female dogs 
II. Phantom bladder . . . . 
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Contents 
Chapter III - Postendoscopic care, reactions and complications 
A. Postendoscopic care 
B. Reactions and complications 
C. Prophylaxis of complications 
I. Gentleness 
II. Alertness . . . 
III. Carefulness . . 
IV. Good judgment 
V. Avoidance of overeagerness 
VI. Definite prophylaxis. . . 
D. Una void a ble reactions and complications 
I. Sensitivity to drugs . . . . . . . . . . . 
II. Presence of disease.. . . . . . . . . . . 
E. Diagnosis and treatment of reactions and complications 
I. Fever, spasm and pain 
II. Sensitivity to the local anesthetic 
III. Urethral bleeding 
IV. Perforation . . 
V. Extravasation. 
VI. Anuria. 
Chapter IV - The normal bladder and prostatic urethra 
A. Divisions of the bladder 
B. Vascular pattern .. 
C. Bladder neck ..... . 
D. Trigone and ureteral orifices 
Eo Distending the bladder 
F. Bladder tone . . . . . . 
G. Capacity ....... . 
H. Variations of the normal bladder 
I. During pregnancy . . 
II. In the aged 
I. The prostatic urethra 
Chapter V - Abnormal ureteral orifices 
A. Congenital anomalies 
I. Agenesis . . 
1. Unilateral 
2. Bilateral . 
II. Imperforate. 
III. Ectopic location 
1. Below normal 
2. Above normal 
IV. Duplication. . . 
1. Unilateral . . 
2. Bilateral and multiple 
V. Abnormal shape and size 
1. Atresic 
2. Constricted. . 
3. Dilated 
4. Unusual shape 
B. Acquired abnormalities of size, shape and position 
I. Dilated ...... . 
1. Golf hole ......... . 
2. Impacted calculus. . . . . . . 
3. Incompetent ureterovesical valve 
IX 
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x Contents 
II. Position higher than normal 
1. Retracted . . . . . . . 
2. Surgical reimplantation . . 
3. Following ureteral meatotomy . . . 
4. Following resection of bladder tumors 
III. Constricted . . . . . 
1. Following surgery . 
2. Following infection 
C. Edema ..... . 
I. Calculus . . . 
II. Catheterization 
III. Tumor ... . 
IV. Infection .. . 
D. Protrusion of the ureteral meatus 
I. Calculus . 
II. Ureterocele 
III. Tumor .. 
E. Ulceration 
I. Tuberculous . 
II. Nontuberculous 
F. Projections from the ureteral orifice 
I. Blood clot 
II. Calculus 
III. Pus ... 
IV. Tumor .. 
V. Prolapse of ureteral mucosa 
G. Propulsions through the ureteral orifice 
I. Bloody jet 
II. Pus 
III. Dye ... 
Chapter VI - Abnormal appearance of mucosal blood vessels in the bladder 
and posterior urethra 
A. Abnormal grouping of blood vessels 
I. Acute hemorrhagic cystitis 
II. Runner ulcer • . . . . . . . . . . 
III. Scars ............. . 
B. Decrease in number and size of blood vessels 
I. Chronic cystitis . . . 
1. Herpes vetularum 
2. Fibrosis . . . . . 
II. Anemia ..... . 
C. Increase in number and size of blood vessels 
I. Subacute cystitis . . . . . . . . . . 
1. Infection, trauma, chemical irritation 
2. Allergy ..... . 
3. Endocrine imbalance 
II. Bladder tumor 
III. Prostatic adenoma 
D. Prominent blood vessels 
I. Bladder neoplasm . . . 
II. Large prostatic adenoma 
III. Recurrent prostatic adenoma 
IV. Sclerosis of blood vessels of the bladder mucosa 
V. Varicosities of the bladder . . . . . . . . . 
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Contents XI 
Chapter VII - Bladder contour abnormalities associated with normal mucosa Page 
A. Abnormalities in bladder size and tone 72 
I. Contracted (usually hypertonic) bladder 72 
1. Congenital . . . . . . 72 
2. Fibrosis . . . . . . . . . 72 
3. Myogenic hypertonia 72 
4. Neurogenic hypertonia. . . 72 
II. Enlarged (usually hypotonic) bladder 72 
1. Congenital . 72 
2. Myogenic .. . . . . . . . . . 72 
3. Neurogenic. . . . . . . . . . . 73 
B. Abnormal contour of ureteral orifices (see Chap. V) 73 
C. Abnormal orifices in the bladder wall 73 
I. Cellules ............. 73 
II. Diverticular orifice ........ 73 
Appearance of interior of diverticulum 73 
III. Fistulous orifice . . . . . . . . . 74 
1. Congenital . . . . . . . . . . 74 
2. Intestinovesical or from abscess. 74 
3. Vesicodermal fistula. . . . . 75 
4. Vesicovaginal fistula 76 
IV. Herniation of the bladder 76 
V. Rupture through the bladder wall 76 
D. Depressions in the bladder wall 77 
I. Cystocele . . . . . . . . . . . . . . 77 
II. Following surgical removal of the rectum 77 
III. Sacculation. . . . . . . . . . . . . 77 
1. From chronic overdistention . . .. . 77 
2. Following surgical procedures on the bladder 77 
E. Elevation of the bladder floor . . . 77 
I. From anteflexed or anteverted uteruR 77 
II. From cervix . . . . . . . . . . . .. . 78 
III. From miscellaneous masses posterior to the bladder 78 
F. Protrusions of the fundus and dome 78 
I. From the uterus ......... 78 
II. From extravesical masses ..... 79 
G. Irregular flat or sessile protrusions 80 
I. Invasive malignant neoplasms 80 
1. Prostatic carcinoma . . . 80 
2. Sarcomata . . . . . . . 80 
3. Squamous cell carcinoma 81 
II. Nonmalignant neoplasms. . 81 
1. Myogenic and congenital . 81 
2. Neurofibromata. . 82 
3. Fibromata . . . . . . . 82 
III. Papular cystitis . . . . . . 82 
H. Pedunculated protuberances 82 
I. Fibroma and fibroadenoma . 82 
II. Myogenic. . . . . . . . . 82 
I. Ridges in the bladder wall 82 
I. Hypertrophy of the interureteric ridge 82 
II. Trabeculation . . . . . . . . 83 
~ Causes . . . . . . . . . . . 83 
III. Undermined or floating trigone 83 
IV. Postoperative . . . . . . 84 
J. Septa in the bladder wall 85 
I. Hourglass . 85 
II. Septate r. . 85 
III. Multilocular. 85 
XII Contents 
Chapter VIII - Color abnormalities of the bladder mucosa without change of contour 
A. Red and pink discoloration (predominating) . 
I. Generalized red discoloration . . . . . . 
Acute cystitis . . . . . . . . . . . . . 
II. Patchy areas of red and pink discoloration 
1. Acute cystitis . . . . 
2. Ecchymotic areas 
3. Cystitis granulomatosa 
4. Trichomonas vaginalis 
5. Bilharziitsis . 
6. Blastomycosis . . . . 
7. Tuberculosis. . . . . 
8. Gonococcus infection of the bladder 
9. Syphilis ........... . 
10. Stellate areas of red discoloration 
ll. Irregular pink discoloration of thc trigone 
12. Red area in dome . . . . . . . . 
B. Red, White, light grey and light pink discoloration 
I. White irregular areas 
1. Alkaline incrusted cystitis 
2. Irradiation reaction' 
3. Leukoplakia . . 
4. Thrush infection 
II. Sloughing tissue 
1. Severe infection 
2. Gangrenous cystitis 
3. Trauma .. 
III. illceration . . . . . 
1. Tubercolosis . . . 
2. Nontuberculous ulcerations. 
3. Actinomycosis . . . . . . 
IV. Invasive malignant neoplasms 
C. Blue discoloration 
Varicosities . . . . . . . . . . . 
Chapter IX - Abnormalities of both color and contour within the bladder 
A. Smooth, regular red protrusions 
I. Benign bladder tumors. . . . . 
1. Arising from the bladder wall . 
2. Arising from embryonic rests . 
II. Granulomatous tissue . . . . . 
III. Malignant invasive tumors of the bladder 
1. Sarcoma and mixed sarcomatous tumors 
2. Squamous cell carcinoma 
3. Teratoma . . . . . . . . . . . . . 
IV. Malignant extravesical tumors ..... 
B. Smooth red multilo bulated protrusions 
I. Edema ......... . 
1. Diffuse edema . . . . . 
2. Localized areas of edema. 
3. Bullous edema 
a) Allergy ...... . 
b) Amebiasis . . . . . . 
c) Intestinovesical fistula 
d) Indwclling urethral catheter 
e) Invading neoplasm 
II. Neoplasms . . . . . . 
1. Benign ..... . 
a) Chronic cystitis 
b) Cystitis glandularis 
2. Malignant ..... 
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Contents XIII 
Page 
C. Irregular red intravesical protrusions 97 
I. Neoplasms . . . . . 97 
1. Carcinoma . . . . 97 
2. Osteogenic sarcoma 98 
3. Amyloidosis 98 
II. Granulation tissue 98 
1. Nonspecific infections .. ...... 99 
2. Subacute and chronic specific infections, stones, foreign bodies, neoplasms 
and trauma ... . . . . . . . 99 
D. Irregular red and white protrusions 
I. Material causing white discoloration . 
1. Calcareous deposit; sloughing tissue 
2. Mucopurulent and epithelial exudate 
3. Miscellaneous. . . . . . . . 
a) Combination of substances 
b) Gauze sponge . . . . . . 
c) Fragment of bone 
II. Lesions causing red and white protrusions 
1. Neoplasm .......... . 
2. Severe chronic infections. . . . . 
E. Red and pink papillary projections 
I. Bullous edema 
II. Papillary tumors 
1. Papillomata 
2. Aniline tumors 
3. Leukoplakia; bilharzia 
4. Colloid urachal tumors . 
5. Hamartoma . . . . . 
F. Discolored cystic, vesicular and polypoid elevations 
I. Entamoeba histolytica . . . 
II. Cystitis cystica . . . . . . 
III. Cystitis emphysematosa 
IV. Dermoid cvsts and teratoma 
V. Echinococcus disease 
VI. Endometriosis. . . . . . . 
VII. Gonococcal infection, healed 
VIII. Hemangioma . . . . . 
IX. Herpes zoster . . . . . 
G. Yellow or greyish yellow elevations of the bladder mucosa. 
I. Cystitis follicularis 
II. Lipomata. . 
III. Leiomyomata 
IV. Malakoplakia 
V. Osteoma .. 
VI. Tubercles. . 
H. Blue elevations 
I. Varicose veins 
II. Endometriosis . 
III. Metastatic melano-epithelioma 
I. Reddish brown elevations. 
Lichen planus. . . . . 
J. Discolored depressions ... 
I. Lacerations and rupture 
II. Following electrosurgical procedures 
III. lnceration 
1. Chronic infections . 
a) Tuberculosis . . 
b) Nontuberculous 
c) Actinomycosis 
2. Neoplastic . . . . 
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XIV Contents 
K. Lesions showing all types of color and contour abnormalities 
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I. Vesical bilharziasis 
l. Hemorrhagic areas . . 
2. Edema ...... . 
3. Discolored white areas . 
4. Ulcerations. 
5. Tubercles 
6. Protrusions 
a) Nodules. 
b) Cystic .. 
c) Papillomata . 
7. Complicating lesions. 
8. Diagnosis . . . . . 
II. Carcinoma of the bladder . 
1. Variable appearance . 
2. Differential diagnosis 
III. Gangrenous cystitis 
IV. Syphili~ ..... 
V. Pemphigus vulgaris 
VI. Vesical tuberculosis 
Chapter X - Abnol'mal bladder contents 
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III 
III 
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I. Blood clots . . 112 
1. Location . . 112 
2. Identification 112 
3. Evacuation . 112 
II. Calculi . . . . . 114 
1. Identification 114 
2. Location . 114 
a) Floor 114 
b) Fundus 114 
c) Dome . . . 114 
3. Number and size . 114 
a) Estimation of size 115 
4. Shape and color . . 115 
a) Composition in general. 115 
b) Light colored phosphatic 115 
c) Faceted phosphatic . . . . . . . 115 
d) Brown spiculed ("mulberry") oxalate 115 
e) Dark ("Jackstone") oxalate 115 
f) Pale yellow to deep brown mixed 116 
g) Characteristic color 116 
III. Foreign hodies 116 
1. Inserted by patients 116 
2. Incrustation . . . 116 
3. Bone fragments 116 
4. Floating objects . 117 
a) Debris and oil . 117 
b) Paraffin . . . 117 
cJ Wood . . .. ... ll8 
5. Following medical or surgical procedures U8 
a) Gauze sponge . . . . . . . . . ll8 
b) Nonabsorbable suture material ll8 
c) Urological equipment . . . . . U8 
IV. Shreds of mucus, pus and epithelial cells ll9 
V. Sloughing tissue .......... 119 
Chapter XI - Abnormalities 01 the bladder neck and posterior urethl'a in the male 
I. Contracture of the vesical orifice ....... 119 
1. Appearance at the margin of the vesical neck 119 
2. Appearance from within the bladder . . . . 120 
3. Appearance from the prostatic urethra . . . 121 
Contents 
II. Intrusion into the bladder neck and prostatic urethra 
1. Median bar ......... . 
2. Median lobe prostatic hypertrophy 
3. Lateral lobe prostatic hypertrophy 
4. Ventral lobe prostatic hypertrophy 
5. Prostatic abscess ...... . 
6. Carcinoma of the prostate 
7. Carcinoma primary in the mucosa 
8. Polypi and cysts . . . . . . . . 
III. Rigidity of the prostatic urethra and bladder neck 
IV. Abnormal dilatation of the vesical orifice ... 
1. Congenital defects and neurogenic lesions . . 
2. Urinarv obstruction . . . . . . . . . . . 
3. Prostatic adenoma; postoperative . . . . . 
V. Post inflammatory fibrosis of the prostatic urethra 
VI. Dilatation of prostatic duct orifices 
Orifice of prostatic diverticulum or abscess . 
VII. Abnormalities of the verumontanum 
1. Congestion and infection . . . . . . . 
a) Granulation tissue. . . . . . . . . 
2. Enlargement .................... . 
VIII. Abnormal red discoloration of the mucosa of the prostatic urethra 
IX. Calculi and foreign bodies in the prostatic urethra 
X. Posterior urethral valves . . . . . . . . . . . 
XI. Interpretation of findings in the prostatic urethra 
1. Close view . . . . . . . . . . . . . . 
2. Distortion due to passage of the endoscope 
XII. Cystoscopy for diagnosis of prostatism . . . . 
Chapter XIT - Abnormalities of the bladder neck and urethra in the female 
I. Contracture of the vesical orifice 
II. Dilatation of the vesical orifice 
III. Increased curvature of the urethra 
IV. Normal urethral mucosa ..... 
V. Fibrosis and stricture of the urethra 
VI. Increased redness of the urethral mucosa 
VII. Irregularities at the bladder neck 
1. Edema ..... 
2. Granulations . . . . . 
3. Neoplasm . . . . . . . 
4. Polypoid growths 
VIII. Irregularities in the urethra 
1. Granulations 
2. Neoplasm. . . . 
3. Polypoid growths 
4. Sacculation . . . 
IX. Diverticular orifice ... 
1. Calculus in diverticulum 
2. Neoplasm in diverticulum 
X. Periurethral ducts 
XI. Urethral meatus. . . . . . 
Chapter XID - Urethroscopy and miscellaneous endoscopic procedures 
I. Urethroscopy . . . . . . . . 
1. Urethroscopes . . . . . . 
2. Technique of urethroscopy 
3. Normal urethra 
f a) Prostatic . . 
b) Membranous 
c) Bulbous . 
d) Penile ... 
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XVI Contents 
Page 
4. Abnormal urethral contour . . . . . 
a) Constriction . . . . . . . . . . 
b) Depression, sacculation and dilatation 
c) Intrusions . . . . . . . . . . . 
5. Abnormal color of the urethral mucosa 
a) Increased redness . . . . . 
b) White or light colored areas 
6. Orifices . . . . . . . . . 
a) Urethral diverticulae. . . . 
b) Periurethral gland duct 
c) Ectopic ureteral orifice. . . 
II. :Miscellaneous diagnostic endoscopy 
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1. Endoscopy of the intestinal bladder 
2. Endoscopy of the kidney . . . . . 
3. Endoscopy of the vagina . . . . . 
4. Intraperitoneal and gastric endoscopy 
Part II - Endoscopic Surgery 
Chapter XIV - Miscellaneous endoscopic surgical procedures and treatments 
I. Endoscopic ureteral treatment ....... 139 
1. Ureteral dilation . . . . . . . . . . . . . . . . 139 
2. Renal pelvic drainage by ureteral catheter 139II. Endoscopic manipulations for removal of ureteral calculi 139 
1. Ureteral dilatation 140 
a) Catheters. . . . . . . . . . . 140 
b) Bag distention . . . . . . . . 140 
2. Injection into ureter . . . . . . . 140 
3. Instruments for extraction of calculi 140 
a) Filiform and dental floss 141 
b) Looped catheter. . 141 
c) Corkscrew catheter 141 
d) Wire basket 141 
4. Reactions and care 141 
III. Ureteral Meatotomy . 141 
1. For calculus. . . 141 
2. For stricture 141 
IV. Endoscopic renal treatment 142 
1. Through nephrostomy opening 142 
a) Renal calculi . . . . . . . 142 
b) Foreign body . . . . . . . 142 
V. Ejaculatory duct catheterization 142 
VI. Application and injection of medicaments 143 
VII. Application of radium or its elements to bladder tumors 143 
1. Radiation element . . 143 
2. Radon emanation seeds 143 
VIII. Biopsy of bladder lesions 143 
1. Indications . . . . . 143 
2. Armamentarium and technique 143 
3. Biopsy of intraureteral tumors 144 
IX. Electrocoagulation. . . . . . . . 144 
1. Indications . . . . . . . . . 144 
2. Armamentarium and technique 144 
X. Removal of foreign bodies from the bladder 145 
1. Forceps or cystoscopic rongeurs through the cystoscope 145 
2. Manipulation through the vagina 146 
3. Floating foreign bodies 146 
Paraffin ........... 146 
XI. Litholapaxy ........... 146 
1. Advantages, indications and contraindications 146 
2. Visual versus blind lithotrites . . . . 146 
t r a) Litholapaxy performed under vision 146 
b) Blind litholapaxy. . . 147 
3. Evacuation of fragments . . . . . . 147 
Contents 
XII. Extracystoscopic endoscopic pocedures 
1. Through the urethra . . . . . . 
2. Through a suprapubic cystostomy 
XIII. Endoscopic treatment of urethral strictures 
1. Dilatation. . . . . . . . . . . . . 
2. Incision and resection 
XIV. Intraperitoneal and gastric endoscopic treatment 
Chapter XV - Endoscopic surgery - a specialty within a specialty 
I. Advantages and disadvantages of endoscopic surgcry 
1. Advantages ...... . 
a) Better tolerated. . . . 
b) Less postoperative pain 
c) Shorter hospitalization . 
d) No external wound 
e) More accurate and more adequate removal of tissue 
f) Shorter operative time for removal of small lesions 
2. Disadvantages. . . . . . . . . . . . . . . . . 
a) Long apprenticeship and technical difficulty 
b) Requires large calibre urethra. . . . . . . . . 
c) Longer operative time for removal of large lesions 
d) Multiple stage operation 
II. Training the endoscopic surgeon 
1. Difficulties and importance 
2. Preliminary endoscopic training 
3. Instruction . . . . . . . . . 
4. Who should be trained . . . .. ... 
a) All trainees in preparation for the specialty of urology 
b) Trainees possessing abundant manual dexterity . . 
c) Some urologists . . . . . . . . . . . . . . . . 
d) Not the occasional endoscopic operator. . . . . . 
e) Not general practitioners or most general surgeons. 
5. Preliminary practice 
a) Beef heart . . . . . 
b) Clay model . . . . . 
III. Armamentarium and supplies 
1. Resectoscopes or electrotomes 
a) Stern-McCarthy electrotome 
b) Modifications of the McCarthy electrotome 
e) One hand operated resectoscopes 
d) Control of the cutting loop . . . 
e) Rotating modifications. . . . . 
f) Loop electrodes . . . . . . . . 
g) Resectoscopes for bladder tumors 
2. Electrosurgical units . . 
3. Table and stool 
4. Attachments to the table 
5. Irrigating fluid 
a) Sterile water . . . . 
b) Isotonic and nonhemolytic fluids 
c) Satisfactory irrigating fluids 
d) Glucose 
e) Glycene . . . . . . . . 
f) Sorbitol, Mannitol . . . . 
6. Miscellaneous armamentarium 
a) Aspiration apparatus 
b) Alligator forceps 
c) Drapes ........ . 
7. Lithotrites and lithotriptoscopes 
XVII 
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XVIII Contents 
Chapter XVI - Electrosurgical units 
I. Development of electrosurgical currents 
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165 
II. Characteristics of electrosurgical currents 
a) Requirements for surgery 
b) Cutting current . . . . . . 
c) Coagulating current . . . . 
b) Combination currents . . . 
e) Modern electrosurgical units 
III. Effect of currents on tissue 
a) Electrodes . . 
b) Tissue change 
c) Faradism. . . 
IV. Checking machine failures 
V. Care of the machine . . . 
Chapter XVII - Indications for endoscopic surgery 
I. Training, ability and experience of the surgeon 165 
II. Differential diagnosis 166 
1. Indefinite symptoms . . 166 
2. Residual urine 166 
3. Bladder tone .. . . . 167 
4. Cystoscopic examination 167 
5. Cystogram . . . . . . 167 
III. Size of the lesion . . . . . 167 
1. Duration of the operation . . .. . 167 
2. Estimate of size and consistency of the prostate 168 
a) Digital palpation through rectum . . . . . 168 
b) Cystograms and urethrogramsJ. . . . . . . 169 
c) Cystoscopic examination . . . . . . . . . . . . . . . . . .. . 170 
Endoscope used p. 170. - Lateral lobes p. 170. - Length of prostatic 
urethra p. 170. - Intravesical protrusion p. 171. 
d) Correlation of all examinations. . . . . . . 172 
3. Corrclation of size with amount of tissue removed 172 
4. Estimate of size of vesical tumors and stones 173 
;'a) Cystoscopic examination . . . . 173 
b) X.rayexamination . . . . . . 173 
Stone p. 173. - Tumor p. 173. 
5. Indications based on size . . . . . 173 
a) Stone . . . . . . . . . . . . 173 
b) Tumor. . . . . . . . . . . . . 173 
IV. Invasion and malignancy of bladder tumors 174 
1. Invasion 174 
2. Malignancy . . . 174 
V. Position of the lesion . 174 
1. Bladder tumors 174 
a) In the dome 174 
b) On the floor 174 
c) In the fundus 174 
2. In a diverticulum 175 
3. Beneath an overhanging prostate 175 
VI. Prostatic carcinoma . . . . . . . . 175 
1. Use hormone therapy first 175 
2. Occult carcinoma . . . . . . . . 175 
VII. Bladder neck contracture and median bar 175 
1. Suitable for endoscopic surgery . 175 
2. Difficult to evaluate . . . . . . . 176 
3. Contracture in women . . . . . . 176 
4. Contraindications . . . . . . . . 176 
VIII. Chronic prostatitis and prostatic calculi 176 
1. Intractable prostatitis 176 
2. Prostatic abscess 176 
3. Tuberculous prostatitis 176 
4. Prostatic calculi . . . 176 
IX. Neurogenic bladder dysfunction 
1. Difference of opinion . . 
2. Positive indications 
3. Acute neurological lesions 
X. Multiple lesions . . . . . . 
1. Obstruction and stone . 
2. Obstruction and tumor . 
3. Obstruction and diverticulum 
XI. Multiple stage operations 
Contents 
XII. Surgical risk . . . . . . . . . . 
1. Tolerance to endoscopic surgery 
2. Evaluation of surgical risk 
3. Improving the risk 
4. Poor renal function 
5. Poor risks 
Chapter xvrn - Examination, preoperative care and selection of the anesthetic 
I. Preoperative examination 
II. Preoperative care 
1. Bladder drainage 
2. Poor surgical risk . . . 
3. Decompression of the bladder 
4. Suprapubic cystostomy . . 
a) Trocar cystostomy ... 
b) Permanent cystostomy . 
c) Resection mortality . . 
5. Bed rest . . . . . . ... .. . 
a) Cardiac decompensation and extreme hypertension 
b) Avoid bed rest whenever possible 
6. Cardiac care ..... . 
7. Infection . . . . . . . . 
a) Chemotherapy 
b) Ureteral catheterization 
8. Vasligation . . . . . . . 
9. Dilatation of urethral stricture 
10. Fluids ...... . 
III. Selection of the anesthetic 
1. General considerations 
2. Intraprostatic. . . . 
3. Intradural spinal 
4. Miscellaneous . . . . 
5. Preoperative sedation 
Chapter XIX - Technique with the Stern-lUcCaI"thy electrotome 
I. Difficulties in mastering the technique . . . 
II. Importance and checking of armamentarium 
1. Loop electrode 
2. Illumination. . . . 
3. Electrosurgical unit 
4. Indifferent electrode 
III. Position of the patient . 
IV. Position of the operator . 
V. Introducing the resectoscope 
1. Preliminary dilatation. .. 
2. Hinged obturator to follow urethral roof 
3. Bypassing a false passage . . . . . . . 
4. Perineal urethrotomy ....... . 
5. Internal urethrotomy ........... . 
VI. Observation of the bladder neck and posterior urethra 
1. Use of different optical systems 
2. Composite view . . . . . . . . . . . . . . . 
XIX 
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xx Contents 
VII. Holding the resectoscope . 
VIII. Starting the resection 
1. Removal of first pieces 
2. Avoidance of the trigone 
IX. Orientation . . . . . 
X. Method and rhythm . . . . 
1. Planned approach 
a) Superficial to deep 
b) 6 to 12 o'clock positions 
c) Removal by sections. . . . 
d) Advantages of starting the resection at the 6 o'clock position 
2. Coordination of movements . . . . . . . . . . . . . 
a) Foot and eye ................. . 
b) Fenestra alternately against and removed from tissue 
c) Manipulation of water inflow . 
d) Logical sequence of procedure. 
e) Sequence for bladder tumors 
XI. Visualization . . . . . . . . . . . 
1. Importance of clear visualization 
2. Causes and correction of poor visualization 
a) Water or debris on ocular lens 
b) Poor illumination . . . . . . . . . . 
c) Debris and air bubbles covering the objective lens 
d) Pieces of tissue . . . . . . . . . 
e) Debris clinging to loop . . . . . . 
f) Inadequate inflow of irrigating fluid 
g) Objective lens too far from tissue 
h) Objective lens against tissue 
i) Excessive bleeding ..... . 
j) Clots covering the field of vision . 
XII. Identification of tissue . . . . . 
1. Importance . . . . . . . . 
2. Objective lens close to tissue 
3. Prostatic tissue 
4. Highly malignant tissue 
5. Bladder neck fibers 
6. False or surgical capsule 
7. True capsule 
8. Bladder muscle 
9. Near perforation 
10. Complete perforation 
Peri capsular fat 
ll. Openings which are not perforations 
a ) Venous spaces ...... . 
b) Ejaculatory ducts ..... . 
12. Survey at conclusion of operation 
XIII. Manipulation of the resectoscope 
1. Swinging against and away from nonresected tissue 
2. Removal of intravesical middle lobe 
3. Tissue located ventrally 
a) Ventral lobe ..... . 
b) Tags located ventrally . . 
c) Tumors located ventrally. 
4. Undermining the trigone 
5. Resecting tissue about the verumontanum 
6. Evacuation of tissue and clots ..... 
a) By manipulation of the sheath 
b) By suction, pressure or alligator forceps 
c) Technique for use of suction 
XIV. Locating and controlling bleeding 
1. Pinpoint electrocoagulation 
2. Lens close to tissue 
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Contents 
3. Systematic search for bleeders 
4. Pressure of the shearth against a bleeder 
5. Rebound bleeding . . . . . 
6, Bleeding under clots . . . . . . 
7. Bleeding behind tags of tissue 
8. Vessel spurting into lens 
9. Bleeding behind the bladder neck 
10. Venous bleeding . . . . . . 
11. Injection of vasoconstrictors 
XV. Concluding the operation .... 
1. Selection of pieces for microscopic examination 
2. Examination at the end of operation . . . . 
a) Prostatic urethra . . . . . . . . . . . 
b) The inside of the bladder. . . . . . . . 
3. What constitutes adequate removal of tissue 
a) Prostate . . . . . . . . . . . . . . 
b) Bladder tumors . . . . . . . . . . . . 
XVI. Incision of the dorsal bladder neck and trigone 
1. Combined hypertrophy of the trigone and elevated bladder neck 
2. Elevation of bladder neck only 
3. Exposure of sub trigonal adenoma 
XVII. Transurethral diverticulotomy 
XVIII. Insertion of the catheter . . . . . . 
1. HemostatiC' bag catheter . . . . . 
2. Catheter passed through the resectoscope sheath 
3. Immediate bladder irrigation . . . . . . . . 
XIX. Rapid resection of large prostates and bladder tumors 
1. Swift technique . . . . . . 
2. Rapid identification of tissue 
3. Powerful electrosurgical unit 
4. Control of bleeding . 
5. Large pieces of tissue 
Chapter XX - Variations in technique of endoscopic prostatic resection 
I. Rectal palpation and counterpressure 
1. Purpose ........ . 
2. Technique. . . . . . . . 
II. Encirclement of prostatic tissue 
1. Technique. . . . . . . . 
2. Advantages . . . . . . . 
3. Disadvantages ..... . 
a) Landmarks on the floor . 
b) Obstructing masses of tissue 
c) Early perforation 
III. Punch prostatectomy . . . . . . 
1. Technique. . . . . . . . . . . 
a) Manipulation of the instrument 
b) Control of bleeding 
c) Method of resection . . . 
d) Adequacy of the resection 
2. Advantages . . . . . . . 
a) Little trauma . . . . . 
b) Volume of water inflow 
c) Tactile evaluatiou . 
d) Direct vision . . . 
3. Disadvantages . . . . 
a) Increased bleeding. 
b) Difficult excavation 
c) No magnification 
d) Direct vision . . 
e) Bladder tumors . 
XXI 
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XXII Contents 
Chapter XXI - Endoscopic resection of the bladder neck in the female Page 
I. Indications . . . . . . . . . . . . . . . . 223 
1. Urinary obstruction . . . . . . . . . . 223 
2. Chronic inflammation of the bladder neck 223 
3. Hyperplasia of the periurethral glands . . 224 
4. Neurogenic vesical dysfunction .. . . . . .. ......... 224 
5. Collar contracture of the bladder neck and elevation of the posterior lip 224 
II. Preliminary conservative care ...... 224 
III. Cystoscopic appearance of collar contracture 224 
1. Right angle lens 224 
2. Foroblique lens 225 
3. Retrograde lens 225 
IV. In children and infants 226 
V. Surgical technique 226 
1. Technique in general . . . 226 
2. Adequate removal of tissue . 226 
3. Incision of the interureteric ridge 227 
4. Bladder neck resection in children 227 
5. Postoperative catheterization 227 
VI. Postoperative care 227 
VII. Results. . . . . . . . . . . . 228 
Chapter XXII - Immediate complications 
I. Frequency . . . . . . . . . . 
II. Injury to the urethra and bladder 
1. Pendulous urethra . . . . . 
2. Prostatic perforation . . . . 
3. Bladder wall perforation 
4. Resection of the trigone 
5. Ventral bladder wall resection ..... 
6. Perforation at the prostaticovesical junction 
III. Recognition of perforation and extravasation 
1. Importance of recognition ..... . 
2. Suprapubic or perineal pain and rigidity. 
3. Cystourethrograms ......... . 
4. Appearance of the area of perforation 
IV. Treatment of perforation and extravasation 
V. Undermining the trigone1. Method of avoiding 
2. Treatment 
VI. Injury to the external sphincter 
VII. Excessive blood loss 
1. Detection . 
2. Treatment 
3. Fibrinolysis 
VIII. Absorption of irrigating fluid 
Chapter XXIII - Postoperative care 
I. Importance . . . 
II. Catheter drainage 
1. Aseptic closed system .. 
2. Maintenance of free drainage 
a) Without irrigation. . . . 
b) With irrigation . . . . . . . . 
c) To prevent bladder overdistention .. .. 
d) Change of catheter and use of evacuating tube 
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Contents 
III. Control of bleeding 
1. Medication 
2. Electrocoagulation 
3. Blood transfusion 
4. Delayed secondary hemorrhage 
IV. Postoperative extravasation 
V. Fluid intake 
VI. Ambulation . 
VII. Bowel care 
VIII. Sedatives . . 
IX. Hiccoughs 
X. Postoperative catheter management 
1. Removal of the catheter 
2. Replacement of the catheter 
3. Persistent residual urine 
4. Obstruction to passage of the catheter 
XI. Infection and fever 
XII. Hospitalization . . . . 
XIII. Dilatation of the urethra 
1. Sounds ..... . 
2. Kollmann dilator 
XIV. Routine postoperative oders 
Routine postoperative orders for prostatic resection cases 
Chapter XXIV - Results and sequelae 
XXIII 
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I. General discussion 241 
II. Statistical reports . . . . . 241 
III. Functional results . . . . . 243 
IV. Incomplete removal of tissue 243 
1. Symptoms and findings 243 
2. Repeat resection 243 
a) Earlyobstruction . . 243 
b) Recurrence of the growth 244 
V. Urethral stenosis 244 
1. Meatal stenosis 244 
2. Bladder neck stenosis 244 
a) Causes . . . . 244 
b) Diagnosis. . . 244 
c) Treatment . . 245 
VI. Urinary incontinence 246 
1. Temporary 246 
2. Permanent 246 
VII. Sexual changes 247 
1. Libido . . 247 
2. Ejaculation 247 
VIII. Vesical hypotonia 247 
1. Cause. . . . 247 
2. Management . 247 
a) Catheterization and irrigation 247 
b) Plastic procedure .... , 247 
c) Diagnosis of possible causes, 247 
IX. Fibrosis of ureteral orifices 248 
X. Persistent infection . , , 248 
XI. Recurrence of malignancies 248 
1. Prostate . 248 
2. Bladder tumors . . . 248 
References . . . . . . . . . . . 249 
Grundlegende Anderungen der Pflege urologischer Instrumente. Reinigen und Sterilisieren 
im Urologischen Krankenhaus Miinchen. Von Chefarzt Professor Dr. Ferdinand MAY. 263 
Author Index . 269 
Subject Index 276 
Contributors to volume VI 
ROGER W. BARNES, M. S., M. D., D. Sc. (Med.), F. A. C. S., F. 1. C. S. Professor 
of Surgery (Urology) and Chairman of the Division of Surgery, School of 
Medicine, College of Medical Evangelists; Chief of Urology Service, Los Angeles 
County Hospital; Senior Attending Surgeon, White Memorial Hospital; Attend-
ing Staff, Glendale Sanitarium and Hospital and Good Samaritan Hospital. 
Consultant in Urology to Christian Medical College, Vellore, South India, 1956 
to 1957 and 
R. THEODORE BERGMAN, B. Sc., IV!. D., D. N. B., F. A. C. S., F. I. C. S. Clinical 
Professor of Surgery (Urology~, School of Medicine, College of Medical Evan-
gelists; Chief of Urology Service, White Memorial Hospital; Senior Attending 
Surgeon, Los Angeles County Hospital; Attending Staff, Glendale Sanitarium 
and Hospital and Good Samaritan Hospital and 
HENRY L. HADLEY, B. A., M. D., D. N. B., F. A. C. S. Assistant Professor of 
Surgery (Urology), School of Medicine, College of Medical Evangelists; Attending 
Staff, White Memorial Hospital, Los Angeles County Hospital, Glendale 
Sanitarium and Hospital, Good Samaritan Hospital. Consultant, Southern 
Pacific Company 
Part I. Diagnostic Endoscopy 
Ohapter 1 
Endoscopic armamentarium 
Endoscopy has elevated the modern urologist from the status of a venereal 
disease doctor to that of a highly trained and skillful specialist (MCCARTHY 1951). 
It has put the urinary bladder and urethra on the outside of the body, as it were, 
for those who are experienced in the use of the endoscopic armamentarium. 
Intricate diagnostic and surgical procedures which would otherwise be impossible, 
are made available by means of endoscopy. 
A. Endoscopes 
Endoscopes, the instruments with which visual examination of the urinary 
bladder and urethra is accomplished, are many and varied. There are two general 
types - direct vision, and indirect vision utilizing a lens system. 
The indicated size of endoscopes used in this text is the French Charriere 
scale which is the diameter in one-third millimeters; for example, a No. 15 Fr. 
is 5 mm in diameter. In Europe the same scale is sometimes indicated by the 
abbreviation Chan. 
I. Direct vision endoscopes 
1. Advantages 
There are some advantages of direct vision endoscopes for cystoscopic and 
urethroscopic examination (RIDLEY). The view obtained through them i~ the 
actual picture of the area under observation; there is no distortion by magni-
fication nor by diminution. A lesion can sometimes be more accurately identified 
than through a lens. Rigid instruments for manipulation within the bladder and 
urethra can more easily be used through the direct vision endoscope, although 
rigid catheters are not necessary as the catheter guides are small tubes which 
may be placed directly in front of the ureteral orifice. Catheters passed through 
them cannot loop or buckle. There is no friction to their passing and an extremely 
delicate sense of touch and feel is attained. It is therefore sometimes possible 
to catheterize ureters which are difficult to catheterize tl1l'ough a lens instrument. 
Bleeding points in the bladder are more easily identified because there is less 
clouding of the distention medium when air is used to distend the bladder; when 
water is used, the direct view penetrates the cloudiness better than does the view 
through a lens. 
2. Cystoscopes 
The Braasch is the most commonly used direct vision instrument. Modifications 
by BUMPUS, THOMPSON, and others have improved the original. The model 
(Fig. 1) which is most widely used at the present time is size 24 Fr.; size 28 Fr. 
is sometimes used. The beak is convex and the fenestra circular and located at 
the distal end of the cystoscope sheath. The light bulb is in the beak and the 
Handbuch der Urologie, Ed. VI I 
2 
Name 
Alcock 
Lithotrite 
Endoscopic armamentarium 
Table 1. Summary of available endoscopes 
(Some available endoscopes are not included in this list) 
Use and special 
features 
Visual litho-
tripsy in adults 
Optical system and telescope 
standard 
equipment 
Right angle 
carries light 
others 
available 
None 
Sheath size, catheter 
capacity, type, 
attachments 
Motive power; rack 
and pinion on a 
wheel. Large stop-
cocks. Jaws open 
parallel to shaft 
Manufacturer 1 
and/or 
distributor 
(see p. 10 
for list of 
manufacturers) 
A.C.M.I. 
-~--~~ -------1-------- -------~ ----------I----~-----
Ballenger 
Urethroscope 
Posterior urethro- Single magnifying 
scopy. Direct view lens mounted on 
light on carrier light carrier 
Kone 24 Fr. open tube. A.C.M.I. 
Convex beak 
-------1--------1------- ~ ~~ -----I-------~ -~--
Beer Infant 
Cystoscope 
Cystoscopy and 
catheterization 
of one ureter in 
infants 
Rt. angle size 10 Ii 
Fr. Used for ex-
amination only 
without a sheath. 
Detachable from 
catheterizing 
sheath 
None 15 Fr. with cathe-
terizing sheath 
which is detachable 
from telescope. 
1-4 Fr. Concave 
beak 
A.C.M.I. 
--------1---------1--------1------11--------1-------
Braasch-BumpusCystoscope 
Braasch-
Bumpus-
Thompson 
Resectoscope 
Brown -Buerger 
Cystoscopes 
(Any combina-
tion of telescopes 
and sheaths is 
available) 
Routine cysto-
scopy and urethro-
scopy. Direct vi-
sion and water 
distention 
Endoscopic pro-
static surgery. 
Direct vision 
water distention 
Complete for 
adult routine 
cystoscopy 
Magnifying 
lens in viewing 
window 
Right angle 24 Fr.: 
3 -No. 6 Fr. 
I-No. 10 Fr. 
28 Fr.: 
2 -No. 6 Fr. 
i 1 - No. 14 Fr. 
Light in beak. 
Electro-
Surg. 
I
, Convex beak. 
-------1--------1---
Magnifying II' 
lens in viewing 
window 
Right angle ex-
amining, 
operating, double 
catheterizing 
Right angle 
I 
I 
Obliquely 
forward for 
convex 
sheath. Re-
I 
trograde 
convertible 
(both operat-
ing & cath-
eterizing) 
28 Fr. Cold punch. 
Fulgurating elec- I 
trode. Large stop-
cock 
16Fr.:2-No.5Fr. 
21Fr.:2-No.5Fr. 
I-No.7Fr. 
24Fr.:2-No.7Fr. 
I-No.9Fr. 
Convex and 
concave beak 
Br. cvsto. 
Electro-
Surg. End. 
lnst. G.U. 
Mfg. 
A.C.M.I. 
Br. Cysto. 
lnst. 
End. lnst. 
GT. Mfg. 
--------I--------II------~--- ----- ------ ----
Brown -Buerger 
Female Conver-
tible 
Shorter and larger 
for universal use 
in women 
---------1-------
Buerger Cysto-
Urethroscope 
Routine cysto-
scopy and po-
sterior urethro-
scopy in adults 
Rt. angle. Ex-
amining. Conver- : 
tible (both operat- : 
ing and : 
catheterizing) I 
Rt. angle. Exa-
mining. Conver-
tible (both ope-
rating and cathe-
terizing) 
None 
None 
28 Fr. Short 
2 -No. 8 Fr. 
I-No. 10 Fr. 
Concave beak. Light 
in beak 
21Fr.: 2-No6 Fr. 
I-No.7 Fr. 
24Fr.: 2-No.7Fr. 
I-No.9Fr. 
A.C.lV!.I. 
Br. Cysto 
A.C.M.I. 
1 Some endoscopes might be available from other manufacturers or distributors than those listed. 
Cystoscopes 3 
Table 1. (Continued) 
Optical system and telescope :iHanufacturer 
Sheath size, catheter and/or 
Nanle Use and special 
I 
.--~ 
capacity, type, distributor features standard others attachments (see p. 10 
equipment avaiable for list of 
manufacturers) 
Buerger Uni- Examining blad- Direct vision. None 25 Fr. Window for A.C.M.I. 
'ersal Urethro- der and posterior Catheter channel. water distention 
scope and anterior Light carrier without telescope. 
urethra separate. May Large stopcock. AI-
also be used so used as open tu-
without. Water be. Obturator has 
or air distension flexible beak 
-~.-
Butterfield Examining blad- Rt. angle. Double None 15 Fr. 2 -No.4 Fr. A.C.M.I. 
louble Catheter- der and urethra catheterizing Convex beak. Small 
ing Children's and double stopcock. Light in 
Cysto-urethro- catheterizing in beak 
scope children 
, 
".--
I Butterfield Examining, Foroblique1 None 18 Fr. Oval. Short. A.C.M.I. 
emale Urethro- operating and 
I 
2-No.4Fr. 
;cope and In- catheterizing in (through one 
fant Vagino- women. Urethro- channel) 
scope scopy in women. I-No. 6 Fr. 
Vaginoscopy in Catheter channel on 
infants sheath 
- ~~~~----l------~·------- --·····-···~~~-l-~·-~·· -.-.-
Campbell 
)ilating Cysto-
urethroscope 
Examining, oper-
ating, catheter-
izing and urethro-
scopy in adults 
Foroblique 
interchangeable 
between 17 Fr. 
and 21 Fr. sheaths 
None 17 Fr. 21 Fr. 1 -
No. 10 Fr. Catheter 
channel on sheath. 
Open end. Concave 
beak 
A.C.l\U. 
~~~.-~ ----~~~~--i-~~~~~- -,·--~~~~I-~~~~~~~-I-~---~~ 
ampbell Minia-
cure Operating I 
and Double 
Catheterizing 
Operating and 
catheterizing in 
infants 
Rt. angle 
examining 
None 13t Fr. Operating. 
1 - No.4 Fr. 15 Fr'l 
Double catheter-
izing. 2 - No. 3t Fr. 
Concave beak. 
Light in beak. Ope-
rating and catheter 
channel on separa-
te sheaths. Fixed 
inclined plane 
catheter deflector 
-··~-·-I-~~~~~~-I-· i --~~~--
:;ampbell Uni-
versal Infant 
Cystoscope 
leming Bladder 
rumor Forceps 
Examining and 
double catheter-
izing in infants 
Rt. angle; light 
carried separately. 
Light and tele- ! 
scope project into I 
bladder . 
.-~~--- .. - -~~~~~~~ 
Removing biopsy 
specimens from 
bladder in adults 
Rt. angle 
Carries light 
Foroblique. 
Direct 
vision 
9t Fr. Examining 
only 15 Fr. Double 
catheterizing. 2 -
No.4 Fr. Catheter 
channel on sheath. 
Straight. Open end 
-_ ... - ~- ---~~~~---~-
None 21 Fr. Jaws activa-
ted by forceps hand-
le and motion paral-
lel to shaft. 
-~~~~~-I-~~~~~---·· -... ~--
Gentile endo-
scopes 
Complete assortment of endoscopes for diagnosis and surgery, 
including bright light source through quartz tube which can be 
used for photography 
A.C.M.I. 
A.C.M.I. 
A.C.M.I. 
Gentile 
1 Foroblique is the American Cystoscope Makers Inc. registered trade mark to designate 
their obliquely forward vision telescope. 
1* 
4 Endoscopic armamentarium 
Table 1. (Continued) 
Optical system and telescope Manufacturer and/or 
Use and special Sheath Size, catheter distributor Name capacity, type, features standard others attachments (see p.lO 
equipment available for list of manufacturers) 
Hendrickson Visual lithotripsy Foroblique None Forceps grip moti- A.C.M.I. 
Lithotrite in adult vation of jaws 
which open parallel 
to shaft. Large lu-
men stopcock 
J. E. Semple Endoscopic sur- Foroblique 26 Fr. Bakelite. End.lnst. 
Rotatable gery one hand Sheath telescope 
Resectoscope operation. and cutting loop 
Scissor type grip 
for index and se-
rotate 
cond fingers 
Kelly Cysto- Air distention None Various sizes. 
scope open tube for External light re-
women flected by head 
mirror 
-
Kirwin Routine cysto- Rt. angle. Ex- None 15, 20 & 24 Fr. A.C.M.I. 
Cystoscope scopy. Double amining. Conver- Carries light. Fen-
fenestra and tibIe. (Both estra on each side 
flexible beak operating and of sheath. Flexible 
catheterizing) jointed beak. Large 
stopcock 
--~~~ 
--
Kirwin Visual litho- Rt. angle (Young) A.C.M.I. Forceps grip moti- A.C.M.I. 
Lithotrite tripsy in adults Carries light vation of jaws 
which open at right 
angle to shaft 
- ~~ ~~----
Kirwin Visual removal of Same as above except jaws are smooth and keen A.C.M.I. 
Rongeur biopsy specimens edged 
~~--
Kirwin Rotary Endoscopic sur- Foroblique i Right angle 28 Fr. Metal cover- A.C.M.I. 
Resector gery. Rotating Retrograde ed. Short straight 
loop electrode Direct beak obliquely open 
makes transverse end. Hinged obtur-
cut. Motivated by ator 
gears and wheel 
---~ ~--- ~---- ~- --~ --- -
Laidley 16 Fr. Examining and Right angle. Ex- None 16Fr.:2-No.5Fr. A.C.M.I. 
Double Cath- double catheteriz- al!lining. Double Concave and con-
eterizing ing in children catheterizing i vex beaks. Light in Children's ! beaks 
~~1;oscope I 
~~ 
----
Lowsley Visual removal of Foroblique i None 22 Fr. : Forceps grip A.C.l\U. 
Grasping biopsy specimens I motivates jaws. Br. Cysto. Forceps and foreign 
I 
Lower jaw hinged End.lnstr. 
bodies and serrated. Open 
parallel to shaft. 
~---
Stopcock 
~ ~ 
Lowsley- Anterior and Direct vision. i None 24Fr.:2-No.4Fr. A.C.lVLI. 
Peterson posterior urethro- Separate light. Partial oblique 
Universal scopy. Ejacula- Carrier and two fenestra. Straight 
Endoscope tory duct and catheter channels end. Hinged obtu-
ureteral cath- rator 
eterization. Ful-
I 
guration in blad-
der 
~ame 
Lowsley 
Urethroscope 
HcCarthy Con-
vertible Close 
Vision Cysto-
urethroscope 
McCarthy De-
[lecting Forob-
. que Panendo-
scope 
icCarthy Ejacu-
1tory Duct Cath-
eterizing 
Instrument 
McCarthy 
Foroblique 
Panendoscope 
YlcCarthy 
Infant 
Cystoscope 
Use and special 
features 
Cystoscopes 
Table 1. (Continued) 
Optical system andtelescope 
standard 
equipment 
others 
available 
Sheath size, catheter 
capacity, type, 
attachments 
I 
Anterior and pos- Foroblique. Sepa- i 
terior urethrosco- rate light carrier 
py and operating and catheter guide 
None 24, 26, 28 Fr. Par-
tial oblique fene-
stra. Straight end. 
Hinged obturator in adult 
Routine cystosco-
pic and posterior 
urethroscopic 
operating and 
catheterizing 
Obliquely forward None 21Fr_ 2-No.5Fr. 
special close vi- 24 Fr. 2-No.7Fr. 
sion objective I-No.9Fr. 
lens. Catheter 27 Fr. 
guides and deflee- 2 - No.8 Fr. 
tor on telescope 1 - No. 10 Fr. 
convertible Carries light. Fe-
(both operating nestra on side. 
and catheterizing) , Slight convex beak 
5 
Manufacturer 
and/or 
distributor 
(see p.lO 
for list of 
manufacturers) 
A.C.M.1. . 
A.C.l\U. 
Br. Cysto. 
End. Instr. 
----____ ~ ----___ -_-1----___ ~ _ _1 _____ _ 
Routine cysto-
scopic and 
posterior 
urethroscopic 
operating and 
catheterizing 
Special foroblique 
Carries light. 
Catheter guides 
and deflector on 
telescope. 
Convertible 
None 24 Fr. 
2-No. 7 Fr . 
I-No. 10 Fr. 
Obliquely open 
straight end 
- ---~ .. ----I-------·------I-~ 
Catheterizing 
ejaculatory ducts 
Foroblique. Cath-
eter tunnels and 
roller deflecting I' 
mechanism 
None 24 Fr. 2-No4Fr. 
Ejaculatory duct 
catheters. Obli-
quely open straight 
end 
A.C.M.I. 
A.C.1VI.1. 
-~ _·-----1---------- ~---'-----
I 
Routine cystosco-
py and posterior 
urethroscopy. 
Catheterizing 
and operating. 
First instrument 
to use 
McCarthy forob-
lique optical 
system 
Foroblique. De-
tachable catheter 
guides. Inter-
changeable cath-
eter washers and 
rigid deflectors 
Foroblique 
examining 
(larger field 
of vision) 
Rt. angle 
Retrograde 
Even numbers 16 
Fr. to 30 Fr. All 
use same telescope 
and bridge as-
sembly 
16Fr. 2-No.4Fr. 
I-No.6Fr. 
30Fr.: 
2-No. 9 Fr. 
I-No. 14 Fr. 
Straight obliquely 
open end. Also 
available: Extra 
long sheath. Con-
vex open end beak· 
ed sheath. Light 
carrier to usesheath 
as open tube 
urethroscope.1Vlul-
tiple catheter 
adapters 
------~.- - .- - ~ -------1---------
Examination, 
single catheteriz-
ing and posterior 
urethroscopy in 
infants 
Foroblique. Single 
catheter guide or 
deflector 
None 10 Fr. Oval. 
I-No. 3t Fr. 
Convex beak. 
Obliquely open end 
A.C.M.1. 
Br. Cysto. 
G.U. Mfg. 
A.C.1VLI. 
G.U. Mfg. 
6 Endoscopic armamentarium 
Tahle1. (Continued) 
Optical system and telescope 
Use and special Sheath size, catheter Name features 
I 
capacity, type, 
standard others attachments 
equipment available 
McCarthy Examining, Foroblique None 11 Fr. Examining 
Miniature catheterizing and only. 
Cystoscope posterior urethro- 12Fr. I-No.4Fr. 
scopy in infants 14 Fr. Slightly 
beaked 
2-No.4Fr. 
Catheter channel 
in sheath. Inclined 
plane deflector 
McCarthy Examining and "Periscopic" for- None 24 Fr. I-No.8Fr. 
Periscopic single catheteriz- oblique with pi- Straight obliquely 
Cystoscope ing or operating voted movable open end 
mirror giving 1700 
field 
--
McCarthy Routine examin- Foroblique. Three Rt. angle Even numbers 18 
Routine ing, catheterizing, catheter guides. Retrograde to 28 Fr. 
Cystoscope operating and Convertible 18Fr. 2-No.5Fr. 
posterior urethro- (operating and I-No.6Fr. 
scopy in adults catheterizing) . 28 Fr. 
Rigid deflectors 2-No.8Fr. 
I-No. 13 Fr. 
Obliquely open end 
convex beak 
- ---
McCarthy Elec- Endoscopy sur- Foroblique re- Rt. angle 24,26,28 Fr. Bake-
trotome (Resec- gery. Most widely movable from Retrograde lite, metal covered 
toscope) (Stern- used resectosco- working element Direct or plastic. Straight 
McCarthy visual pe. Loop controll- obliquely open end. 
Prostatic Elec- ed by rack and Long or short 
trotome) pinion attached straight beak. 
to handle. Cutt- Straight or hinged 
ing loop activat- (Timberlake) 
ed by damped obturator 
current 
----- -
Modifications of McCarthy Electrotome (A.C.M.I.) 
BAUllRUCHER: One hand operation. Forefinger pulls loop against spring. 
CREEVY: One hand operation. Two finger grips push loop against spring. 
Manufacturer 
and/or 
distributor 
(see p.lO 
for list of 
manufacturers) 
A,C.M.I. 
A.C.M.I. 
----
A.C.M.I. 
A.C.M.I. 
Endo. Inst. 
G.V. Mfg. 
Foley Rotatable: One hand operation. Thumb pushes loop against spring, with a disc surrounding 
telescope. Supply lines remain stationary while remainder of resectoscope rotates. 
GIBSON: One hand operation. Forefinger pulls loop against spring. Pistol grip. 
IGLESIAS: One hand operation. Thumb pushes loop against leaf type spring. Two finger rests on sheath. 
McCarthy Convertible: Adjustment to make telescope move with loop. 
McCarthy Infant: No. 12 Fr. and short. Rotating water inlet. Rack and pinion attached to knob. 
McCarthy Remote Control: Switch for current to loop is on a knob handle which moves loop. 
McCarthy of Smaller Calibre: No. 16 and 20 Fr. Standard length. Rotating water inlet. Rack and 
pinion attached to knob. 
MiLLER: One hand operation. Thumb on a ring surrounding telescope pushes loop against spring. 
NESBIT: Original one hand operation modification. Thumb in thumb rest pushes loop against spring 
which returns loop to original position. All sizes corresponding to McCarthy except the 12 Fr. infant. 
Nesbit Perineal: One hand operation 33 Fr. and short (6t"). 
SCOTT: One hand operation. Finger pulls loop agamst spring. Pistol grip. Sheath telescope and loop 
rotate within housing for supply lines and handle. 
Name 
McCarthy 
Urethroscope 
_ILLIN'g Cysto-
opes and Re-
sectoscope 
"rcCrea Infant 
Cystoscope 
Otis-Brown 
Cystoscope 
-------
.avich Conver-
ble Cystoscope 
----
.avich Litho-
triptoscope 
Ravich 
Urethroscope 
----
Squire 
Urethroscope 
I 
I 
Use and special 
features 
Anterior and 
posterior 
urethroscopy in 
adults 
Cystoscopes 
Table 1. (Continued) 
Optical system and telescope 
standard 
equipment 
Magnifying lens I 
mounted ~:Jll light 
carner I 
I 
others 
available 
None 
Sheath size, catheter 
capacity, type, 
attachments 
Even numbers 22 
to 28 Fr. Straight 
and beaked open 
tube. Separate 
light carrier to 
distalendl 
For routine diagnostic and surgical endoscopy 
Examining, single 
catheterizing and 
operating in 
infants 
Right angle 
examining 
None I Oval 13 Fr.: I-No.4 Fr. 
Catheter guides on 
sheath. Inclined 
plane deflector. 
Slightly convex 
beak. Light in 
beak 
7 
Mannfacturer 
and/or 
distributor 
(see p. 10 
for list of 
mannfacturers) 
A.C.M.I. 
G.U. Mfg .. 
Br. Cysto. 
A.C.lVLI. 
-------1------------- - ---------1-------
Examination on-
ly in adults and 
children. First 
electrically 
lighted cystosco-
pe made in U.S.A. 
-- ---------
Routine examin-
ing, catheterizing 
and operating in 
adults 
----- ---
Visual lithotripsy 
in adults 
Posterior urethro-
scopy in adults 
--
--
Anterior and 
posterior urethro-
scopy in adults 
Right angle 
examining 
---
Right angle 
examining. 
Convertible 
-------
Foroblique 
Magnifying lens 
mounted on 
sheath 
---
Magnifying lens 
mounted on 
sheath 
I 
I 
I 
I 
I 
i 
I 
I 
I 
None 
--------
None 
None 
None 
None 
13, 15, 18, 20 Fr. 
Convex and conca-
ve beaks. Light in 
beak 
---------
21 Fr.:2-No.6Fr. 
I-No.8Fr. 
Slight convex beak. 
Light in beak 
------
27 Fr. Forceps grip 
motivation of jaws 
open parallel to 
shaft stopcock 
22 Fr. Open tube 
Fenestra in end 
Convex beak carrieslight 
Anterior tube 22, 
24,26 and 28 Fr. 
Straight open end. 
Posterior tube 24, 
26, 28 Fr. Convex 
beak oblique fenes-
tra in end. Light 
mounted externally 
A.C.M.I. 
A.C.lVLI. 
---
-,---
A.C.lVLI. 
A.C.M.I. 
-----------
A.C.lVLI. 
Stern-McCarthy visual prostatic electrome - same as McCarthy electrotome 
Swift Joly 
Aero-urethro-
cope (Harkness) 
Anterior urethro-
scopy in adults 
Magnifying lens Closed tube for air 
distension. Light 
source incorporat-
ed in ocular end 
Br. Cysto. 
G.U.Mfg. 
8 
Nalne 
Swift Joly's 
Cystoscope 
Vest Dilating 
Cystoscope 
Wilhelm Insu-
lated Urethro-
scope 
Use and special 
features 
Routine cysto-
scopy and posteri-
or urethroscopy in 
adults and older 
children. Diather-
my attachment 
For large size ope-
rating and dilating 
instruments 
Anterior and 
posterior urethro· 
scopy in men and 
women. Especially 
for fulguration 
Endoscopic armamentarium 
Table1. (Continued) 
Optical system and telescope 
standard 
equipment 
Right angle 
Foroblique. One 
catheter guide 
Magnifying lens 
mounted on 
sheath 
others 
available 
None 
Sheath size, catheter 
capacity, type, 
attachments 
15 Fr. to 24 Fr. 
Double 
Catheterizing 
28 Fr.: 
I-No.17 Fr. 
Straight, obliquely 
open end 
Anterior 21, 24, 
28 Fr. Posterior 
24 Fr. Female 24, 
28 Fr. Bakelite 
open tube. Light 
mounted externally 
:Manufacturer 
and/or 
distribntor 
(see p. 10 
for list of 
manufacturers) 
Br. Cysto. 
End. Inst. 
G.U. :Mig. 
A.C.M.L 
A.C.l\'LL 
-------I~--------I-- ---------
Wolf adult cysto· 
scopes (any com-
bination of tele-
scopes and 
sheaths avail-
able) 
Wolf Infant 
and Children's 
Cystoscope 
Complete for adult 
cystoscopy and 
urethroscopy 
Examination, ca-
theterizing and 
operating 
Rt. angle 900• 
Obliquely for-
ward 1350 • Obli-
quely backward 
600 • 2 slightly ob-
liquely forward 
1000, 1100 • Tele-
scope removable 
from catheter 
guides single and 
double 
12 Fr. (Charr.) ex-
amining 
15Fr.: I-No.5Fr. 
17Fr.:2-No.5Fr. 
Various sizes up to 
No. 24 Fr. which 
takes 1 - No. 10 
Fr. or 2-No. 7 Fr. 
conCaVe}Fenestra 
Convex on 
Straight side 
Light on sheath. 
Operating sheath 
Richard Wolf 
G.m.b.H. 
(Germany) 
I
, contains guide 
Rt. angle. 7 Fr. ~ ~-O-b-li-qu-~ly -I-I-O-F-r-.--e-x-a-m-in---I Richard Wolf 
telescope curved forward ing G.m.b.H. 
beak-without 12Fr.:l-No.5Fr. (Germany) 
sheath 13Fr.: 2-No.4Fr. 
Concave beak. Light 
-----�- - ~ - -----~ I 
in beak 
Rt. angle. Direct -O-b-l-iq-u-e-I-y-I-2-7- Fr. S--l-ig-I-lt-Iy-c-on-- I-R-i-c-h-a-rd-Vi--To-lf Wolf 
Resectoscope 
Endoscopic pro-
static surgery. 
Rack and pinion 
motivation 
(almost) retrograde vex beak. Fenestra G.m.b.H. 
on side of sheath (Germany) 
of loop 
-------I-----~---~I----------
--1--------------------
Wolf Resecto-
scope Small 
Rt. angle. Obli-
quely forward 
16, 20 Fr. Straight 
bealL Fenestra in 
side 
Richard Wolf 
G.m.b.H. 
(Germany) 
Endoscopic sur-
gery. Trigger ma-
nipulation of 
loop 
-------I------=----I------~~--~ - -----I------~--- -------
Wolf-Hosel 
Resectoscope 
Endoscopic pro- Obliquely for-
static surgery. ward 
Pistol grip and 
trigger manipula-
tion of loop. 
24, 27 Fr. Oblique-
ly open end. Handle 
and connections 
rotate around 
sheath, loop and 
Richard W oli 
G.m.b.H. 
(Germany) 
telescope 
-------1---------1----------------I-----~--- - -~- ---
Wolf 
Lithotriptor 
Visual lithotripsy Rt. angle. Moves None Jaws move parallel 
in adults with jaws. Carries to shaft. Rock and 
light pinion on a wheel 
Richard Wolf 
G.m.b.H. 
(Germany) 
Name Use and special features 
Vo1£ Stone and Visual lithotripsy, 
Foreign Body foreign body and 
Forceps biopsy in adults 
Young Adult Routine examin-
Cystoscope ing, operating, ca-
theterizing and 
posterior urethro-
scopy in adults 
----~ 
x oung Cysto- Foreign bodies 
copic Ronguer and biopsy 
specimens in 
adults 
x oung Cysto- Foreign bodies 
copic Ronguer and biopsy 
Improved specimens 
in adults 
x oung Infant Examining and 
Cystoscope catheterizing in 
infants 
Young Anterior and 
Urethroscope posterior urethro-
scopy in adults 
Cystoscopes 
Table 1. (Continued) 
Optical system and telescope 
.tandard others 
eqnipment available 
Rt. angle. None 
CaITies light 
Rt. angle. Ex- Retrograde 
amining. Conver- Obliquely 
tible. Protecting Forward 
disc 
Sheath size, catheter 
capacity, type, 
attachments 
Interchangeable 
serrated and sharp 
jaws 
24Fr. :2-No. 7Fr. 
1-No.9Fr. 
Convex and conca-
ve. Light in beak. 
Rotating large stop-
cocks 
9 
Mannfacturer 
and/or 
distributor 
(see p. 10 
for list of 
mannfacturers) 
Richard Wolf 
G.m.b.H.' 
(Germany) 
A.C.M.I. 
-~ ~- --,- I-----I------~ ---- ----
Rt. angle None 
carries light 
---~ 
Rt. angle None 
caITies light 
Rt. angle None 
carries light 
------
Magnifying lens None 
mounted on 
sheath 
! 
Transverse forceps 
handle motivation 
of sharp jaws which 
open at right 
angles to shaft 
-I--~------I--
A.C.lIU. 
G.U. Mfg. 
Forceps handles in A.C.lVLI. 
plane of shaft 
9t Fr. Examining. 
12 Fr. Double 
catheterizing. 
2 - No.3 Fr. In-
clined plane deflec-
tor. Convex beak 
A.C.lVLI. 
----I--------~- --- ----
Anterior 22, 24, 
26, 28 Fr. Straight 
open tube. Poste-
rior 24, 26, 28 Fr. 
Convex open tube. 
Light mounted 
externally 
A.C.M.I. 
------ ---- ~~--~---~- --- ---~--------I------"---I---- ---
May (Ferd.) 
Strahl-Cysto-
cope (no beak) 
Routine cysto-
scopy and posterior 
urethroscopy, 
while washing the 
field of vision 
System 
Zeiss-Kollmorgen -Heynemann 
boilable, I Panor 
1350 forward (panorama, 
:prograde and 
No. 21 or 16 Fr. 
boilable 
Heynemann 
-------1--------- ________ -':_r~~rograde) ____ _ ~ __ 
May (Ferd.) 
Strahl-Cysto-
cope (no beak) 
Routine cysto-
scopy and posterior 
urethroscopy, 
while washing the 
field of vision, 
fixed catheter 
deflector, 
examining and 
System 
Zeiss-Kollmorgen -Heynemann 
boilable, I Panor 
1350 forward (panorama, 
prograde and 
I retrograde) 
No. 22 or 17 Fr. Heynemann 
boilable 
1- No.5 Fr. 
single catheterizing i 
------ ----~~-------- -----~-----1---------1------
May (Ferd.) 
Strahl-Cysto-
cope (no beak) 
Routine cysto-
scopy and posterior 
urethroscopy, 
while washing the 
field of vision, 
fixed catheter 
deflector, examin-
ing and double 
catheterizing 
System 
Zeiss-Kollmorgen -Heynemann 
boilable, I Panor 
1350 forward (panorama, 
'prograde and 
retrograde) 
No.23,50r20Fr. 
boilable 
2-No.5Fr. 
Heynemann 
10 
Name 
May (Ferd.) 
Strahl-
Cystoscope 
(no beak) 
May (Ferd.) 
Strahl-
Cystoscope 
(no beak) 
May (Ferd.) 
Strahl-
Cystoscope 
Fischer 
(Karl S.) 
Urethroscope 
with May 
Haywalt 
dilators 
Endoscopic armamentarium 
Table 1. (Continued) 
Use and special 
features 
Routine cystoscopy and 
posterior urethroscopy, while 
washing the field of vision, 
fixed catheter deflector, ex-
amining, single catheterizing 
and operating 
Childrens' cystoscopy and 
posterior urethroscopy, while 
washing the field of vision, 
fixed catheter deflector, ex-
amining, single catheterizing 
Optical system and telescope 
standard 
equipment 
others 
available 
System 
Zeiss-Kollmorgen-Heynemann 
boilable, I Panor (panorama, 
1350 forward prograde and I retrograde) 
System 
Zeiss-Kollmorgen-Heynemann 
1350 forward 
boilable, I None 
, 
Sheath size,catheter capacity, 
type, attachments 
Manu-
facturer 
and/or 
distribu-
tor· 
No. 24 or 20 Fr. Heyne-
boilable mann 
I-No. 8 Fr. 
No. 15 Fr. boil- Heyne-
able mann 
I-No. 5 Fr. 
and operating 
---------------1--------1----
Infants' cystoscopy while System 
washing the field of vision, Zeiss-Kollmorgen-Heynemann 
fixed catheter deflector, ex- 1350 forward I None 
amining, single catheterizing 
No. 11 Fr. Heyne-
1 - No.4 Fr. mann 
and operating 
-----1---------------1---- ------. 
Anterior and posterior urethro- System 
scopy, cystoscopy of small Zeiss-Kollmorgen-Heynemann 
bladders, single catheterizing boilable, I None 
and operating in urethra and 1720 forward ~ 
bladder, especially narrow 
strictures, combined with 
Heywalt-May dilators No.9, 
28.5 Fr. 
No. 19,5 or 22 Fr. Heyne-
I-No.5 Fr. mann 
2-No.5Fr. 
I 
-----1-------- -----1------'---
Mauermayer 
Resector 
Endoscopic surgery of all tu- System 
mors (prostate and bladder), Zeiss-Kollmorgen-Heynemann 
double illumination system: boilable, 1350 forward 
1 lamp fixed on sheath, 1 lamp 1720 forward Panor (panorama, 
movable with loop, one hand prograde and 
operation, the cutting force is retrograde) 
executed by the spring; 
thumb controls irrigation 
even while forefinger assists 
in rectum; one two-ways-
stopcock 
No. 27 Fr. 
(metal sheath) 
Heyne-
mann 
* See below for list of manufacturers. 
Availability of endoscopes 
The endoscopes listed in this table are available from the following companies 
Abbreviation 
A.C.M.1. .. 
Br. Cysto .. 
Electro-surg. 
End. Inst. 
G.U.Mfg. 
Gentile . 
Greenwald 
Heynemann 
Takei ... 
Nat. Elect .. 
Wolf 
Manufacturing or Distributing Company 
American Cystoscope Makers, Inc., 1241 Lafayette Ave., New York, 59, New York 
British Cystoscope Company, 44 Clerkenwell Road, E.C. 1, London 
Electro Surgical Instrument Company, Rochester, New York, U.S.A. 
Endoscopic Instrument Company, Ltd., 52 Shirland Road, London W. 9 
Genito-urinary Manufacturing Company, Ltd., 28a, 33 and 32 Devenshire Street, 
London W.I 
P. Gentile and Cie, Societe it Responsabilite Limitee au Capital de 18,000,000 de Fr., 
49, rue Saint-Andre des Arts, Paris, VI 
Greenwald Company, 2688 Dekalb Street, Gary, Indiana, U.S.A. 
C. G. Heynemann, Miinchen 8, Germany 
Takei Company, Tokyo, Japan 
National Electric Instrument Company, Elmhurst, New Hampshire, U.S.A. 
Richard Wolf Instrument Company, Germany 
Cystoscopes 11 
ocular end is covered by a window which may be either plain glass or a magnifying 
lens. Catheter guides are inserted through the sheath and direct the catheters 
Fig. 1. Braasch direct vision cystoscope 
straight forward within the bladder. A single, larger catheter guide is used when 
larger instruments are passed. A right angle lens system is available to pass 
through the sheath for examination purposes. 
Fig. 2. Cystoscopy with Kelly cystoscope showing reflected light from head mirror and variollS positions of in-
strument which permit visualization of most of interior of bladder (adapted from KELLY and BURNHAM) 
One of the disadvantages of the direct vision cystoscope is that a smaller 
than 24 Fr. size does not provide adequate vision. 
12 Endoscopic armamentarium 
The Kelly cystoscope (Fig. 2) is used in women. The patient is placed in the 
knee chest position. Negative intraabdominal pressure in this position allows the 
bladder to become distended with air which enters through the open tube cysto-
scope. Most of the interior of the bladder can be surveyed by manipulating the 
instrument into different positions. Illumination is reflected from a head mirror. 
Ureteral catheterization is accomplished by inserting a fine wire stilette through 
the catheter to stiffen it. After the tip enters the ureteral orifice, the wire is 
withdrawn about 2 cm.; thus the flexible tip can more easily follow the ureteral 
curves as the catheter is passed upward. 
An improved air cystoscope has recently been developed in France (GODDARD). 
The ocular end is funnel shaped, providing for better controlled vision and facil-
itating the passing of instruments through it. There is a handle attached near 
the ocular end which makes it easier to manipulate. 
Some gynecologists who also practice female urology find the Kelly cysto-
scope to have some advantages over others. This instrument, however, permits 
of only a small and usually dark field of vision. Debris and clots cannot be easily 
evacuated and the visual field cannot be kept clear by irrigating fluid during 
cystoscopy. Physicians using the Kelly cystoscope routinely claim good visu-
alization. 
3. Urethroscopes 
Open tube urethroscopes are useful because they give direct access to the 
urethral mucosa. Silver nitrate stick or solutions on an applicator can be applied 
directly to lesions in the anterior or posterior urethra. The field of vision through 
an open tube urethroscope is nearly as large as that obtained through a lens 
urethroscope because the area being examined is always very close to the ob-
jective end of the instrument; it is only by moving the lens away from the object 
that a larger field of vision is obtained. Therefore, there is very little advantage 
to the lens urethroscope compared to the open tube one when the size of the 
field of vision is considered. The lens urethroscope provides the advantage of 
slight magnification. 
a) Internal illumination. Open tube urethroscopes in which the source ot 
light is inside at the objective end give better illumination of the field of vision 
than do the ones which have the light outside the tube. A lamp mounted on a light 
carrier which brings the light to the distal end of the tube is used in the Ballenger, 
the Young, the Wolf (Germany), and other urethroscopes. A similar light-
carrying attachment may be used through the McCarthy panendoscope sheath, 
thus converting it into an open tube urethroscope. The Ravich open tube urethro-
scope has the light mounted in the convex beak. 
b) External illumination. The light ,gOUTCe is outside the tube in the Squier, 
the Young and the Wilhelm open tube urethroscopes. A strong light is mounted 
on the flange at the ocular end of the tube and is focused into the tube. A small 
magnifying lens is fitted to the light carrier and can be swung into position for 
better visualization of the field. 
Urethroscopes which are intended for use in the prostatic urethra only have 
a short curved beak, the fenestra being on the convex side of the curve. The 
Ballenger and the Ravich urethroscopes are designed for this purpose. Some 
instruments such as the Squier and Young have both the straight and the curved 
tubes. The straight tube of the Wilhelm instrument is made of nonconducting 
bakelite which facilitates the use of electrodes through it. Some urethroscope tubes 
are supplied in several sizes, usually from 22 Fr. to 28 Fr. A short tube for use 
in the female urethra is supplied with the Wilhelm instrument. 
Optical systems used in endoscopes 
II. Lens endoscopes 
1. Advantages 
13 
Cystoscopes with lens systems are much more widely used and have numerous 
advantages over the open tube instrument. A larger and brighter field of vision 
is obtained. The bladder can be more thoroughly examined; all of its interior 
can be surveyed clearly when the different optical systems - forward vision, 
obliquely forward, right angle, and retrograde - are used. When the inner lens 
is close to the tissue being viewed, there is magnification. The field of vision 
can be kept clear by allowing fluid to flow in through the instrument during the 
examination. Blood clots and debris can be evacuated through the sheath. 
Lens urethroscopes provide a slightly larger field of vision than open tube 
instruments, but have the disadvantage