I -- Diagnostic Endoscopy.- I -- Endoscopic armamentarium.- A. Endoscopes.- I. Direct vision endoscopes.- 1. Advantages.- 2. Cystoscopes.- 3. Urethroscopes.- a) Internal illumination.- b) External illumination.- IL 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. Visual lithotrites.- 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.- D. Sources of light for endoscopes.- I. Bulbs.- II. Quartz tube.- III. Batteries.- IV. Electric house current.- 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.- 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.- 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.- 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 clear 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 objective lens.- I. Orientation with different lenses (see Chap. I).- J. Routine bladder examination.- I. Blind spot.- II. Diverticular cavity.- K. Ureteral catheterization.- I. Ureteral catheters.- 1. Tips.- a) Whistle.- b) Olive.- c) Coudé.- 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.- 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. Unavoidable 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.- IV -- The normal bladder and prostatic urethra.- A. Divisions of the bladder.- B. Vascular pattern.- C. Bladder neck.- D. Trigone and ureteral orifices.- E. 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.- 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.- 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.- VI -- Abnormal appearance of mucosal blood vessels in the bladder and posterior urethra.- A. Abnormal grouping of blood vessels.- I. Acute hemorrhagic cystitis.- II. Hunner 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.- VII -- Bladder contour abnormalities associated with normal mucosa.- A. Abnormalities in bladder size and tone.- I. Contracted (usually hypertonic) bladder.- 1. Congenital.- 2. Fibrosis.- 3. Myogenic hypertonia.- 4. Neurogenic hypertonia.- II. Enlarged (usually hypotonic) bladder.- 1. Congenital.- 2. Myogenic.- 3. Neurogenic.- B. Abnormal contour of ureteral orifices (see Chap. V).- C. Abnormal orifices in the bladder wall.- I. Cellules.- II. Diverticular orifice.- Appearance of interior of diverticulum.- III. Fistulous orifice.- 1. Congenital.- 2. Intestinovesical or from abscess.- 3. Vesicodermal fistula.- 4. Vesicovaginal fistula.- IV. Herniation of the bladder.- V. Rupture through the bladder wall.- D. Depressions in the bladder wall.- I. Cystocele.- II. Following surgical removal of the rectum.- III. Sacculation.- 1. From chronic overdistention.- 2. Following surgical procedures on the bladder.- E. Elevation of the bladder floor.- I. From anteflexed or anteverted uterus.- II. From cervix.- III. From miscellaneous masses posterior to the bladder.- F. Protrusions of the fundus and dome.- I. From the uterus.- II. From extravesical masses.- G. Irregular flat or sessile protrusions.- I. Invasive malignant neoplasms.- 1. Prostatic carcinoma.- 2. Sarcomata.- 3. Squamous cell carcinoma.- II. Nonmalignant neoplasms.- 1. Myogenic and congenital.- 2. Neurofibromata.- 3. Fibromata.- III. Papular cystitis.- H. Pedunculated protuberances.- I. Fibroma and fibroadenoma.- II. Myogenic.- I. Ridges in the bladder wall.- I. Hypertrophy of the interureteric ridge.- II. Trabeculation.- Causes.- III. Undermined or floating trigone.- IV. Postoperative.- J. Septa in the bladder wall.- I. Hourglass.- II. Septate.- III. Multilocular.- 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. Eechymotic areas.- 3. Cystitis granulomatosa.- 4. Trichomonas vaginalis.- 5. Bilharziasis.- 6. Blastomycosis.- 7. Tuberculosis.- 8. Gonococcus infection of the bladder.- 9. Syphilis.- 10. Stellate areas of red discoloration.- 11. Irregular pink discoloration of the 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. Ulceration.- 1. Tubercolosis.- 2. Nontuberculous ulcerations.- 3. Actinomycosis.- IV. Invasive malignant neop]asms.- C. Blue discoloration.- Varicosities.- IX -- Abnormalities of both color and contour within the bladder.- A. Smooth, regular