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Virtual cystoscopy: reality in imaging of bladder tuberculosis.

We present a case of urinary tuberculosis investigated initially by ultrasound and multidetector computed tomography (MDCT). The MDCT-derived volumetric data were used to generate virtual cystoscopy (VC) images, which revealed a bladder ulcer. The presence of this ulcer was confirmed by conventional cystoscopy-guided biopsy and there was good agreement regarding various features of the ulcer, such as the site, size and shape, as detected by virtual and conventional cystoscopies. VC, a result of simple postprocessing of preacquired MDCT data, proved valuable in the characterization of the bladder lesion in conjunction with CT and ultrasound images. Although a larger study is warranted, in our case these en face VC representations of the ulcer served as useful precursors to conventional cystoscopic biopsy.

Adult↗

[Cystoscopy and endovesical biopsy in renal tuberculosis].

Cystoscopy and endovesical biopsy of the bladder wall were performed at early stages of investigation prior to the onset of tuberculostatic treatment in 77 patients with destructive renal tuberculosis, verified both bacteriologically and histologically. Cystoscopy proved to be valuable in 83.2% of the cases, particularly so where the destruction focus communicated with the renal calyx-pelvis system. Cystoscopic symptoms of renal tuberculosis occurred at the following rates: tubercles in 6.5%, focal hyperemia, in 18.2%, erosion and ulcer, in 9.1%, bullous edema of the ureteral opening, in 11.6%, all kinds of changes of ureteral opening, in 37.6%. There were no visible changes of vesical mucosa in 16.8%. The pattern of mucosal changes correlated with the markedness of X-ray morphological changes in the kidney. Endovesical biopsy was positive in 52%, its results, being significant in cases of open destructive developments and ureteral affection. The value of endovesical biopsy increased where it was performed at the peak of clinical and cystoscopic symptoms, at early stages of disease, before the onset of tuberculostatic treatment. False-negative results of endovesical biopsy do not exclude renal tuberculosis. High value of cystoscopy and endovesical biopsy makes them up-to-date diagnostic tests for renal tuberculosis.

Adult↗

[Detection of precancerous lesions of the bladder by contact-micro-cystoscopy].

Contact-micro-cystoscopy is a new method to examine the bladder epithelium by micro-endoscope after staining. According to this method, normal epithelium was stained slightly and showed smooth surface and small, sparse nuclei. Neoplastic lesions were stained deeply and showed irregular surface and large, dense nuclei. One hundred and sixty nine biopsy specimens of cystoscopically normal bladder mucosa were analyzed. The diagnostic accuracy of neoplastic lesions by this method was 75.9%. In vivo mapping of the bladder epithelium was also possible using this method in association with random biopsy. Contact-micro-cystoscopy was thought to be useful to detect precancerous lesions or flat carcinoma of the bladder which was difficult to be detected by conventional cystoscopy.

Carcinoma in Situ↗

Office flexible cystoscopy.

Since the development of the first purpose-built flexible cystoscope in 1984, flexible cystoscopy has become an accepted diagnostic and therapeutic modality. Indeed, it is estimated that more than 10 per cent of practicing urologists are already familiar with this technology. The flexible cystoscope has markedly extended the urologist's ability to examine the bladder, and it has become a valuable adjunct to the rigid cystoscope. Although the operation of this instrument is vastly different from that of its rigid counterpart, with practice, the technique can be learned. After experience is obtained with diagnostic flexible cystoscopy, the urologist will likely prefer this new instrument for bladder inspection, as it provides for a more thorough yet less morbid and less expensive examination. In the future, the development of improved and smaller instrumentation will further extend the therapeutic indications for flexible cystoscopy. Indeed, advances in laser technology are already providing the urologist with 300- to 600-micron (0.9 to 1.8F) flexible probes capable of incision (KTP laser), fulguration (Nd:YAG laser), and stone disintegration (tunable dye laser). Lastly, the skills obtained in using the flexible cystoscope are all readily applicable to the development of dexterity with the already available flexible nephroscope and the more recently developed flexible ureteroscope.

Ambulatory Care↗

Flexible cystoscopy.

Flexible cystoscopy allows examination of the bladder under local or general anaesthesia. This article describes the technique and the situations in which it is used, as well as its advantages and deficiencies. As the range of therapeutic applications of flexible cystoscopy increases, the need for rigid cystoscopy may disappear completely.

Costs and Cost Analysis↗

Evaluation of importance of cystoscopy in staging carcinoma of the uterine cervix.

Four hundred cases with carcinoma of the uterine cervix were evaluated by cystoscopy regarding involvement of urinary bladder. In stages I and II there was not a single case of bladder involvement; in stage III, 3 out of 39 cases and in stage IV, 2 out of 10 patients were found to have bladder involvement. Thus cystoscopy resulted in elevating the clinical stage in 3 of these patients but was unchanged in 2 cases. These findings indicate that cystoscopy is mandatory only for clinical stages III and IV.

Biopsy↗

The effect of digital rectal examination, flexible cystoscopy and prostatic biopsy on free and total prostate specific antigen, and the free-to-total prostate specific antigen ratio in clinical practice.

PURPOSE: We evaluated the effects of common urological maneuvers on serum free prostate specific antigen (PSA) and established guidelines for clinical practice. MATERIALS AND METHODS: Total and free PSA, and free-to-total PSA ratio were determined in 82 men with lower urinary tract symptoms before and 30 minutes after 3 different prostatic manipulations: 1) digital rectal examination (36 cases), 2) flexible cystoscopy (26) and 3) transrectal ultrasound guided prostatic biopsy (20). PSA forms were measured with Hybritech Tandem-R assays. RESULTS: Cystoscopy had no effect on total PSA, while digital rectal examination had a slight, statistically significantly positive effect and biopsy uniformly increased total PSA (geometric mean ratio 2.43, t = 5.08, p <0.001). Free PSA was increased by digital rectal examination (geometric mean ratio 1.67, t = 4.25, p <0.001), prostatic biopsy (geometric mean ratio 4.80, t = 7.48, p <0.001) and cystoscopy (geometric mean ratio 1.21, t = 2.51, p = 0.019). There was a significant increase in free-to-total PSA ratio after each maneuver. The rate of change in free PSA and free-to-total PSA ratio after biopsy differed between patients with benign and malignant histological findings. CONCLUSIONS: Free PSA and free-to-total PSA ratios are altered by all forms of prostatic manipulation. The PSA response to manipulation may be different in patients with prostatic malignancy. Phlebotomy must precede digital rectal examination in the clinical and research setting to avoid misleading results.

Adult↗

[Infectious risks of outpatient cystoscopy in men with sterile urine].

OBJECTIVE: To prospectively assess the inherent risk of infection associated with outpatient cystoscopy performed in men with sterile urine without antibiotic prophylaxis. MATERIAL AND METHODS: 298 cystoscopies were performed in men corresponding to these criteria, with the exclusion of patients at risk of bacterial endocarditis. The equipment consisted of three cystoscopes prepared according to the recommendations of the Société Française d'Hygiène Hospitalière. The disease justifying the examination was specified for each patient. The sterility of the urine was verified during the week preceding the examination and 48 hours later by urine culture. RESULTS: Out of 281 evaluable patients, an infection was observed in 22 cases (7.8%), and was symptomatic in only one case. Escherichia coli was the organism most frequently isolated (50%) and no multiresistant bacteria were detected. A particularly high infection rate was observed in enterocystoplasty patients (21.7%). CONCLUSION: The infectious risk of cystoscopy in the presence of sterile urine, performed according to recommendations, appears to be higher than previously reported. This risk appears to be significantly higher in the case of enterocystoplasty than for other diseases.

Ambulatory Care↗

Seed loss through the urinary tract after prostate brachytherapy: examining the role of cystoscopy and urine straining post implant.

This study describes one institution's experience with seed retrieval through the urinary tract and makes recommendations for cystoscopy and urine straining post prostate brachytherapy (PB). 1794 patients from two separate cohorts covering different time periods (early versus late) were analyzed. All patients were preplanned with a modified peripheral loading technique and implanted with preloaded needles (125I or 103Pd) under ultrasound guidance. A catheter was used to delineate the urethra during the volume study but was not used during the implant. All patients underwent post implant cystoscopy. All patients were instructed to strain their urine for seven days post implant and return any seeds to our center. In our experience, seed loss through the urinary tract is a common event after PB, occurring in 29.7% of patients and was more common in patients from the early cohort, those implanted with 125I seeds or those patients with prior transurethral resection of the prostate. Average seed loss per case, however, represents only 0.58% of total activity. We continue to recommend routine post implant cystoscopy for seed retrieval and periprocedural management. We no longer recommend that patients strain their urine at home after documenting a low rate of seed loss after discharge.

Brachytherapy↗

Clinically occult bladder cancer diagnosis. Trial using ultraviolet cystoscopy.

Ultraviolet cystoscopy was used to demonstrate flat cancerous and precancerous bladder lesions by two techniques based on different principles: the loss of epithelium blood group antigenic expression using immunofluorescence reaction, and submucosa neoangiogenesis after fluorescein intravenous injection. The results obtained with these two techniques were disappointing, but do not preclude the use of ultraviolet cystoscopy in this type of study.

ABO Blood-Group System↗

Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European centre.

OBJECTIVE: To audit diagnostic and therapeutic fetal cystoscopy for suspected posterior urethral valves (PUV). METHODS: In 13 fetuses, (14-28 weeks) the bladder was entered with a 1.3 mm embryo-fetoscope and intravesical findings documented. In 10 fetuses, an attempt was made to treat the obstruction by saline hydro-ablation (n = 4) and/or guide-wire passage (n = 9). Renal function was assessed post-natally at 10 to 34 months. RESULTS: The bladder wall was visualised in 12/13 cases and the bladder neck in 11; in 10 cases the upper urethra was entered, and the obstruction visualised in five. PUV were 'seen' in 4/9 confirmed cases, but also in one case of urethral atresia, while in two others the degree of resistance to guide-wire passage suggested atresia or prune belly. Therapeutic attempts were technically successful, at least initially, in 6/10 cases. Of the five cases with confirmed PUV and normal fetal urinary electrolytes, two have acceptable renal function at follow-up. Hydro-ablation in one case resulted in resolution of sonographic signs of obstruction, and ablated valves were confirmed post-natally. CONCLUSIONS: Semi-rigid fetal cystoscopy allows entry into the upper urethra in most obstructive uropathies, although bladder neck angulation precludes visualisation of the site of obstruction in the majority. Guide-wire passage or hydro-ablation may allow relatively atraumatic ablation of PUV in utero without the chronic bladder decompression associated with vesico-amniotic shunting. However, current technical limitations need to be overcome, possibly by the use of flexible or angled fetoscopes, before the role of cystoscopic treatment can be formally evaluated.

Cystoscopy↗

Cystoscopy in the evaluation of benign prostatic hyperplasia.

Cystoscopy has a limited role in the evaluation of benign prostatic hyperplasia (BPH). The examination is recommended in the evaluation of BPH patients with hematuria or a history of risk factors for urethral stricture. Available data suggest that bladder trabeculation in BPH is a predictor of the treatment outcome. Cystoscopy might be performed prior to invasive therapy to guide the urologist in choosing an operative approach.

Cystoscopy↗

Suprapubically assisted operative cystoscopy in the management of intravesical TVT synthetic mesh segments.

The tension-free vaginal tape (TVT) sling has become one of the most common procedures performed for the treatment of female stress incontinence. Perforations of the bladder during the TVT placement are relatively common, but are usually noted on cystoscopy and corrected at the time of the procedure. Undetected perforation may result in several complications including recurrent urinary tract infections, bladder stone formation, and pelvic pain. A novel technique is described using operative cystoscopy with suprapubic assistance, which provides an effective means for resection of intravesical mesh. Unlike traditional approaches via laparotomy, this minimally invasive procedure may allow for successful mesh removal while avoiding the morbidity of an open procedure.

Adult↗

Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves.

Percutaneous fetal cystoscopy was performed in a male fetus with ultrasonographic evidence of lower urinary tract obstruction at 19 weeks of gestation. The diagnosis of posterior urethral valves was confirmed. Percutaneous endoscopic fulguration of the valves was successfully performed at 22 weeks of gestation, and urethral patency was established. This case illustrates the feasibility of performing diagnostic and therapeutic endoscopic procedures within the human fetus for the management of a congenital anomaly. While we believe that fetal cystoscopy may improve our diagnostic, prognostic, and therapeutic capabilities in the management of fetuses with lower obstructive uropathy, studies are needed to establish the actual value, risks, and limitations of this new approach in fetal medicine.

Adult↗

Peripelvic extravasation and formation of perinephric urinoma after cystoscopy.

A hitherto undescribed complication of cystoscopy is reported wherein peripelvic extravasation and perinephric collection of urine resulted from conventional cystoscopic examination in a patient with a small-capacity bladder and vesicoureteral reflux. Prompt recognition, institution of indwelling catheter drainage, and massive antibiotic therapy led to spontaneous resolution of the flank mass. In similar cases, we suggest the use of an Iglesias resectoscope with a continuous flow and suction evacuation, even for cystoscopy and bladder biopsy.

Contrast Media↗

The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy.

OBJECTIVE: To evaluate the incidence of urinary tract injury due to hysterectomy for benign disease. STUDY DESIGN: Patients were enrolled prospectively from 3 sites. All patients undergoing abdominal, vaginal, or laparoscopic hysterectomy for benign disease underwent diagnostic cystourethroscopy. RESULTS: Four hundred seventy-one patients participated. Ninety-six percent (24/25) of urinary tract injuries were detected intraoperatively. There were 8 cases of ureteral injury (1.7%) and 17 cases of bladder injury (3.6%). Ureteral injury was associated with concurrent prolapse surgery (7.3% vs 1.2%; P = .025). Bladder injury was associated with concurrent anti-incontinence procedures (12.5% vs 3.1%; P = .049). Abdominal hysterectomy was associated with a higher incidence of ureteral injury (2.2% vs 1.2%) but this was not significant. Only 12.5% of ureteral injuries and 35.3% of bladder injuries were detected before cystoscopy. CONCLUSION: The incidence of urinary tract injury during hysterectomy is 4.8%. Surgery for prolapse or incontinence increases the risk. Routine use of cystoscopy during hysterectomy should be considered.

Adult↗

A controlled study of low and high volume anesthetic jelly as a lubricant and pain reliever during cystoscopy.

To evaluate the influence of the volume of 2% lidocaine jelly as an anesthetic during cystoscopy 241 men and women received either 11 or 20 ml. jelly intraurethrally in a randomized, double-blind fashion. Pain was recorded on a visual analogue scale by the patient and on a 3-level scale by the physician. The pain scores according to the visual analogue scale were significantly higher in the patients given 11 ml. jelly than in those given 20 ml. when all patients in the study were analyzed. There was no significant difference in the visual analogue scale between the 2 treatments in women but a significant difference was noted in men, although in men older than 55 years the difference was not statistically significant. There was general agreement between the visual analogue scale results and the physician scores but the visual analogue scale procedure was more sensitive in detecting differences between treatments. It is suggested that approximately 11 ml. 2% lidocaine jelly is the appropriate volume for women and 20 ml. is the appropriate volume for men during cystoscopy but that the lower volume of jelly may be sufficient in older men.

Aging↗

Can transabdominal ultrasonography of the bladder replace cystoscopy in the followup of superficial bladder tumors?

Transabdominal ultrasonography of the bladder was performed on 100 patients 3 to 9 months after endoscopic resection of stage Pa or Pl transitional cell carcinoma of the bladder. In 81 patients there was a close correlation between the results of suprapubic ultrasonography and cystoscopy. In 19 patients the ultrasonography results were incorrect: 4 had false positive and 15 had false negative findings. Specificity for the diagnosis of recurrence was 90 per cent and sensitivity was 74 per cent. Transabdominal ultrasonography combined with cytology studies should be part of the diagnostic approach for recurrent superficial bladder tumors. When performed before cystoscopy these studies should reduce greatly without eliminating the frequency of this investigation.

Abdomen↗