الفهرس 
UROLOGIC ENDOSCOPIC PHOTOGRAPHYOnly 14 pages are availabe for public view
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Abstract
SUJ.\-IMARY
During embryonic development, there is a close
association between the urinary and genital system,
especially in the early stages. This close relationship
accounts for the high incidence of associated pathology and
anomalies in the two systems and makes one organ system
responsive to both benign and malignant alterations in the
other. This concept provides the clinician with the
rationale for investigating the urinary system when defects
are present in the genital system.
The disease processes that cause urinary symptoms can
arise at any site in the genital tract; ovary, parovarium,
fallopian tube, uterine corpus, cervix or vagina.
The physician in gynecologic practice often encounters
conditions that cause functional and anatomic changes in the
urinary tract. Many urinary tract injuries occur in the
performance of gynecologic surgery than during any other
type of surgery. The major problems are usually encountered
in radical pelvic surgeries, as well as the anatomic
physiologic alterations of the urinary tract resulting from
common malignant and inflammatory gynecologic conditions.Many problems involving the urinary tract that
previously could be diagnosed only at the time of surgery
are now routinely evaluated through the use of endoscopy.
Direct visualization of the urethra, bladder neck and the
bladder is accomplished by urethrocystoscopy which is
primarily indicated for diagnosis of lower urinary tract
disease. Access to the upper urinary tract is also now
feasible by ureteroscopy and through the cystoscopic
guidance: ureteral catheterization, bougynage and retrograde
contrast urography is of utmost importance. Major examples
of the value of urethrocystoscopy in gynecology is the
evaluation of cervical cancer and for investigation of
urinary symptoms including hematuria, and incontinence or
fistulae, evaluation of voiding symptoms (obstructive and
irritative), and finally other traumatic lesions.
Provisionally, the aim of the work was to document
fifty cases presenting to Ain Shams University Maternity
Hospital with a variety of gynecologic condition with
expectation of endoscopic findings. Reversely the underlying
gynecologic lesions were evaluated and categorized as far as
the degree and the extent, on basis of the endoscopic
features. A main part of the work was to acquaint the
gynecologits with both the uroendoscopic armementarium and
principles of uroscopic handicraft.
·---------------Summary (129) ---
Patients were clinically evaluated with scoring of
history and feature points as far as gyne is concerned.
Certain investigations like radiography, pelvic
ultrasonography and laboratory tests were done whenever
needed.
All cases were submitted to careful examination under
anesthesia with snap documentation of clinical
manifestations whenever possible. Meanwhile,
urethrocystoscopy and occasional ureteroscopy with ureteral
gouging and catheterization were done in all cases.
Evaulation of the data by endoscopy against the scored
clinical features has cleared up a new concept of
dimensional assessment of the cases:
Primarily, the results urge to proceed with further
research and investigations in some cases.
- Secondly, the major points revealed are the following:
. First: an additional modality to categorize staging
of cancer cervix; sometimes showing evidence of
lymphatic involvement of the periurethral, bladder neck
and trigonal area.
Second: both structural and dynamic evaluation of
cases of stress incontinence: holding, voiding and
retaining mechanism of the bladder and its outlet.Third: defining whether vesical, bladder neck or
urethral prolapse as the underlying cause for
incontinence and clear definition for preserved or lost
ureterovesical angle, which in turn is an important
prerequisite for the choice of the type of surgery and
the way of access.
Fourth: clear evaluation of iatrogenic lesions
particularly urinary fistulae communications (vesicovaginal,
urethro-vaginal, uretero-vaginal or combined
lesions) .
. Fifth: two interesting subclinical fistulae formation
were revealed and prevented by endoscopic manoeuvering
with temporary ureteric stenting after dilatation of
entangled ureters following pelvic surgeries to be
fully reconnected at a later stage.
Finally, a variety of interesting cases were diagnosed
and documented endoscopically.
A review of the principle of art of uroendoscopy and a
description of the basic armementarium were included.