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[Optimal technique of virtual cystoscopy on single-detector helical CT, and clinical application].

The optimal technique of virtual cystoscopy (VC) was determined on single-detector helical CT using a bladder phantom, and its clinical utility was evaluated. A phantom simulating the urinary bladder with 2 dome-shaped polyps (diameters 5 and 10 mm) was constructed. Imaging specifications were as follows: collimation, 3 and 5 mm; pitch 1; reconstruction interval, 1 and 2 mm. The polyps were positioned parallel and perpendicular to the scanning direction. Using these data sets, virtual cystoscopic images were generated by a voxel transmission technique. The threshold values were changed from -950 HU to -250 HU. Three radiologists evaluated visualization of the polyps in terms of proportion and shape on different collimations, threshold values, and location, for each size of polyp. Results indicated that the optimal technique of VC was as follows: collimation 3 mm, pitch 1:1, reconstruction interval 1 mm, and threshold value from -550 HU to -500 HU. VC depicted 13 (81.3%) of 16 lesions on the urinary bladder and prostate diseases noted on conventional cystoscopy using the optimal scanning technique. VC enabled evaluation of the accurate shape of lesions and their relation to adjacent mucosa.

Adult↗

[Echography and cystoscopy: 2 diagnostic means in bladder tumor (1)].

Study of 88 patients with vesical tumour who were performed a vesical ultrasound scan followed by cystoscopy. Comparison of both methods as to their ability to discriminate the location, size and number of the tumours. Both ultrasound scan and cystoscopy diagnosed vesical tumour in 81.8% and 100% cases respectively, the ultrasound scan showing higher ability to detect tumours affecting both sides of the bladder.

Cystoscopy↗

Selection of antibiotic coverage in vascular patients undergoing cystoscopy.

Bacteremic seeding of prosthetic vascular grafts represents a cause for graft infection; transurethral procedures account for one source of bacteremia. Therefore, a prospective study of 200 patients undergoing cystoscopy was conducted to identify the incidence of bacteruria and factors associated with it, organisms involved and their antibiotic sensitivities. Positive cultures were found in 21%. The incidence was 64% in in-patients and 8% in out-patients. Positive cultures were found in 12% of patients who received antibiotics and 29% who did not. Four percent showed signs of bacteremia. The cultures identified both Gram positive and negative organisms; multiple organisms grew in 22%. Gram negative organisms were more common in in-patients. Candida grew in 8%. The Gram positive organisms were sensitive to ampicillin (92%), sulfatrimethoprim (75%) and cefazolin (60%); Gram negative to aminoglycosides (100%) and cefazolin (92%). In view of the unpredictable and multiple organisms, it is recommended that pre-cystoscopy cultures be performed and specific antibiotic coverage be based on the sensitivities.

Anti-Bacterial Agents↗

Comparison of ultrasonography, intravenous pyelography and cystoscopy in detection of urinary tract lesions due to Schistosoma haematobium.

The use of ultrasound in detecting urinary tract alterations by Schistosoma haematobium such as hydronephrosis and bladder calcifications was studied in 125 patients of the out-patients department of a district hospital in SE Tanzania, in an area highly endemic for this disease. Ultrasound was compared with plain abdominal X-ray (in 33 patients), intravenous pyelography (29), cystoscopy (31) and simple urine examination (125). Except for bladder calcifications which could not be demonstrated other than by X-ray, sonography compared favorably with IVP and cystoscopy and proved therefore to be a valuable tool in assessing S.h. related morbidity. In children moderate and advanced hydronephrosis were always associated with an irregular bladder wall and correlated strongly with the prevalence and intensity of S.h. infections as well as with haematuria and proteinuria. Important congestive pathology was observed in 1 out of 10 infected children and in 1 out of 20 examined adults.

Adolescent↗

A percutaneous perineal approach for cystoscopy in male dogs.

A percutaneous perineal approach is presented as a further technique for rigid cystoscopy in male dogs. The anatomy of the urethra in the male dog prevents rigid cystoscopy by non-surgical means but a fine flexible fibrescope may be used. Perineal urethrotomy and prepubic percutaneous puncture techniques using rigid endoscopes have been described; however, both have possible serious complications. This new procedure allows access for visual examination, biopsy and resection as necessary and appears to have few adverse sequelae.

Animals↗

Propofol ('Diprivan') for outpatient cystoscopy. Efficacy and recovery compared with althesin and methohexitone.

In two non-concurrent investigations, propofol was compared with methohexitone and with Althesin as an intravenous anaesthetic for cystoscopy in outpatients. In the comparison between propofol and methohexitone the 60 patients also received alfentanil in similar dosage; in comparison with Althesin (43 patients) the Cremophor formulation of propofol was used. During induction of anaesthesia propofol caused fewer excitatory effects than either methohexitone or Althesin, and less pain than methohexitone. There was no difference in the incidence of apnoea caused by propofol 1.5 mg/kg and Althesin 0.05 ml/kg, or propofol 2 mg/kg and methohexitone 1.5 mg/kg. Induction of anaesthesia by propofol was faster than that by Althesin. The use of alfentanil 7 micrograms/kg at induction of anaesthesia apparently increases the incidence of apnoea seen at that time and during maintenance of anaesthesia, but an overall dose of approximately 1 mg reduces the mean dose of propofol required from 0.459 mg/kg/min to 0.192 mg/kg/min and improves the quality of anaesthesia. During maintenance of anaesthesia propofol produced less myoclonia and movement than Althesin, and fewer hiccups than methohexitone, but the mean minimum systolic arterial pressure observed in the propofol group was less than that seen in the methohexitone group. Immediate recovery of consciousness was faster and better after propofol than methohexitone, and fewer complications were seen after propofol than Althesin. Recovery of coordination and perception, tested by the digit substitution test, was faster after propofol than methohexitone. Exact comparisons of recovery of ocular tone (Maddox Wing test) between the anaesthetics were not possible as both Althesin and methohexitone rendered some patients incapable of taking the tests in the early post-operative period. In response to a take-home questionnaire, patients stated that they were drowsy for a shorter time, and ate earlier after propofol than after methohexitone. No patient who received propofol vomited or was nauseated and all would wish to receive the same anaesthesia again. The studies suggest that propofol is preferable to both Althesin and methohexitone for intravenous anaesthesia for cystoscopy in outpatients.

Adult↗

[Cystoscopy and its importance in urology].

From the enumeration of modern endoscopic methods for diagnosis and treatment of urological disease, the characteristics of their value and their importance for modern urology becomes evident that by means of these methods, the basis of which was created 100 years ago with the introduction of the cystoscopy, examination and treatment became possible in all regions of the urinary tracts. Based on cystoscopy a subspeciality in urology developed, which might be called endoscopic surgery in urology. The endoscopic treatment methods are relatively atraumatic and loaded with a more insignificant complication rate than the open operative interventions. However, they demand an exact knowledge of the indications and contraindications. By the great possibilities which nowadays open the modern methods of endoscopic diagnostics and therapy we are indebted to their inventors still 100 years after the detection of the cystoscope, among the inventors German researchers and masters play an important role.

Color↗

The significance of cystoscopy for the diagnosis of urothelial tumour.

Authors have studied the aetiology of asymptomatic microhaematuria on the basis of complete urologic examinations including cystoscopy, excretory urography, ultrasound, urinalysis and urinary cytology. In 10 out of 422 patients transitional cell carcinomas of the urinary bladder were found. Bladder cancer was the most common malignancy among the lesions found by our evaluation of patients with microhaematuria. We conclude that cystoscopy should be an essential part in the aetiological evaluation of microscopic haematuria.

Adult↗

Screening cystoscopy and survival of spinal cord injured patients with squamous cell cancer of the bladder.

PURPOSE: Yearly cystoscopy has been advocated in spinal cord injured patients with chronic or recurrent urinary tract infections secondary to the increased risk of squamous cell cancer of the bladder. We examined the effectiveness of this protocol in our patients. MATERIALS AND METHODS: The medical records of all spinal cord injured patients with squamous cell cancer of the bladder between 1980 and 1996 were reviewed for the method of detection of the lesion. Screened patients (those presenting with chronic or recurrent urinary infections) were considered asymptomatic and were compared to symptomatic patients (those presenting with overt signs or symptoms of the bladder lesion) with respect to age, latency since spinal cord injury, treatment of neurogenic bladder, therapy, pathological stage and survival. RESULTS: Of 14 patients (9 symptomatic at presentation) 13 underwent cystoprostatectomy, while 1 presented with metastatic disease and was treated with supportive care only. Three symptomatic patients received adjuvant radiation therapy for positive lymph nodes or margins. Pathological stage was more advanced in the symptomatic group, including 7 patients (78%) with stage pT3a or pT3b (4 had positive lymph nodes), 1 with stage pT1N0M0 and 1 with stage pT2N0M0 cancer. In the asymptomatic group 3 patients had stage pT2N0M0, 1 had stage pT3aN0M0 and 1 had pT3bN0M0 disease. Overall and cancer specific survival rates for symptomatic patients were 44 and 50%, respectively, with a median of 40 months to death. In the asymptomatic group there was 1 noncancer related death, while the remaining patients were alive at a mean followup of 8.2 years. CONCLUSIONS: Cystoscopy to screen for squamous cell cancer of the bladder in spinal cord injured patients with chronic or recurrent urinary tract infection results in an earlier stage at diagnosis and appears to convey a survival advantage. Such a protocol should be strictly followed and careful prospective studies must be performed to ascertain if this will become significant.

Carcinoma, Squamous Cell↗

[The clinical value of fluorescence cystoscopy in the detection of superficial transitional epithelial cell carcinoma of the bladder].

The prognosis of superficial bladder cancer in terms of local recurrence and transformation into invasive cancer is related to the multiplicity of tumor sites and the concomitant presence of "flat" tumours, such as dysplasia and carcinoma in situ. This study of 51 patients emphasizes the value of fluorescence cystoscopy in the early detection of superficial transitional cell carcinomas. This method is based on induction of fluorescence in carcinomatous sites which selectively accumulate an endogenous photosensitizer, protoporphyrin IX, in response to intravesical administration of its precursor, 5-aminolevulinic acid. The sensitivity of the method in the present series was close to 93%. Fluorescence cystoscopy is a simple and reliable method to map the bladder mucosa looking for areas of dysplasia and carcinoma in situ.

Administration, Intravesical↗

[Chronic irritative urinary syndrome. Diagnostic value of cystoscopy, urinary cytology and biopsy].

Chronic irritative urinary syndrome (CIUS), is a diagnostic concern for urologists from the moment that it becomes chronic and there is no etiologic diagnostic available. The objective of this study is to find out the diagnostic value of Cystoscopy, Urinary cytology and Biopsy of the vesical mucosa. A prospective, descriptive study was conducted in 30 patients who developed CIUS. Cystoscopy showed visible damage in 7 patients (31.8%); urinary cytology, 22 patients with cytologic changes (73.3%); and vesical biopsy, 24 patients with histologic changes (80.0%). The authors conclude that CIUS occurs more frequently in females than in males, the age range with higher incidence are 43 and 45 years. The most common diagnosis are unspecific chronic inflammatory changes followed by metaplasia.

Adult↗

Use of magnetic internal ureteral stents in pediatric urology: retrieval without routine requirement for cystoscopy and general anesthesia.

In children the use of internal ureteral stents has the added morbidity of requiring general anesthesia for stent retrieval. Magnetically tipped ureteral stents were developed to allow easy retrieval without the need for anesthesia or cystoscopy. For pyeloplasty we generally do not use a stent or nephrostomy tube but we treated 7 children 2 1/2 months to 11 years old in whom we believed there was an indication for stenting and in whom we used a magnetically tipped stent. The catheters were removed with a magnetically tipped catheter retriever without the need for anesthesia in 6 of the 7 cases and cystoscopy was not required in any case. Our initial impression is that when stenting is advised the magnetically tipped ureteral stent appears to be a good alternative, especially in children, since it avoids the need for anesthesia and cystoscopic retrieval.

Child↗

Laparoscopic ureteroneocystostomy with vesicopsoas hitch: nonrefluxing ureteral reimplantation using cystoscopy-assisted submucosal tunneling.

PURPOSE: We described laparoscopic nonrefluxing ureteral reimplantation with a psoas hitch using a submucosal tunneling technique combined with cystoscopy. PATIENTS AND METHODS: We performed this operation on two female patients. The first patient had a right lower-ureteral stricture after a laparoscopy-assisted vaginal hysterectomy, and the second patient had a left distal-ureteral stricture after a left laparoscopic oophorectomy, which was performed for endometriosis. We performed laparoscopic intravesical ureteral reimplantations with a psoas hitch using submucosal tunneling after a submucosal injection of normal saline was provided under cystoscopy. RESULTS: The operative times were 325 and 280 minutes, respectively. The estimated blood loss was 300 mL in the first case and 120 mL in the second. The hospital stays were 5 and 3 days, respectively. There were no postoperative complications. Follow-up voiding cystourethrography and intravenous urography demonstrated normal compliance and function of the kidneys and ureters with no vesicoureteral reflux. CONCLUSIONS: Laparoscopic intravesical nonrefluxing ureteroneocystostomy with a psoas hitch is a safe and feasible procedure. Cystoscopic submucosal injection of normal saline during submucosal tunneling is beneficial.

Adult↗

Clinical significance of negative and equivocal urinary bladder cytology alone and in combination with DNA image analysis and cystoscopy.

BACKGROUND: We evaluated the individual and combined ability of cytology (CYT), image analysis (IA), and cystoscopy (CYSTO) to predict the presence of transitional cell carcinoma (TCC) at 6 months of follow-up in patients with or without a prior history of urothelial carcinoma and negative (NEG) or equivocal (atypical or suspicious) urinary CYT. METHODS: Fifty-one patients (43 with prior TCC) provided 57 urinary samples that were evaluated by CYT and DNA IA. Forty-nine patients were evaluated by CYSTO. Disease status was reassessed at 6 months by a combination of clinical, CYSTO, CYT, and histologic follow-up. RESULTS: At 6 months' follow-up, the incidence of recurrence for patients with diploid, broad diploid, or aneuploid DNA histograms was 38%, 73%, and 100%, respectively. In the same group of patients, 43% of patients with NEG and "atypical" CYT recurred compared with 83.3% of patients with "suspicious" CYT. The predictive value (PV) of a positive (+) CYSTO evaluation was 100%; however, a NEG CYSTO examination was correct in only 73% of cases. Sensitivities of CYT, IA, and CYSTO to predict recurrence were 54%, 59%, and 62.5%, respectively, whereas the combined sensitivity of all three modalities was 72%. The +PV of combined CYT and IA in patients with prior TCC was 90% with aneuploidy 100% specific for malignancy; the NEG PV of combined CYT, IA, and CYSTO was 70%. CYT, IA, and CYSTO were highly significant in predicting recurrence (P = 0.0017, P = 0.0026, and P = 0.0002, respectively) whereas tumor grade and degree of invasiveness as assessed on initial biopsy were not significant. However, 11% of patients recurred between 6 months to 1 year who had NEG CYT, NEG CYSTO, and NEG IA. CONCLUSIONS: Diagnostic accuracy increases in patients with NEG or equivocal CYT if supplemented by DNA IA and CYSTO. In patients with no history of TCC, equivocal urine CYT and/or abnormal DNA IA can occur after chemotherapy, radiation therapy, or viral infection. In these patients, the combined approach together with accurate history is essential for correct diagnosis. For the small subpopulation of patients who recur but demonstrate no abnormalities on combined testing, more sensitive diagnostic tests, such as chromosomal abnormalities by in situ hybridization, need to be developed.

Adult↗

Clot retention and spontaneous rupture with secondary pneumatosis of bladder wall following routine cystoscopy.

In this article we report an unusual case of spontaneous rupture of bladder wall following office-cystoscopy. It took place in a patient who suffered from low-stage highgrade carcinoma of bladder with the different aggressive behavior. Finally, he underwent radical cystectomy, which showed micropapillary carcinoma and pneumatosis within the bladder wall. The cause of the latter finding is rather puzzling and has been never reported previously.

Blood Coagulation↗

Correlation of cytology and cystoscopy.

A total of 152 patients had cytology and cystoscopy performed for either initial or recurrent bladder tumors and postoperative control examinations. Positive cytology was found in 97 per cent of patients with pathologically proved bladder tumors. However, 23 per cent of the patients with negative cytology had positive cystoscopic and pathologically proved findings. Without cystoscopic examination a significant number of recurrent tumors may be missed because of a negative cytology.

Cystoscopy↗

Plasma concentrations of lidocaine resulting from instillation of lidocaine jelly into genitourinary tract prior to cystoscopy.

Plasma concentrations of lidocaine were measured over a period of three hours following the instillation of lidocaine jelly (Xylocaine 2% Jelly) into the genitourinary tract of 30 patients (15 male, 15 female) scheduled for cystoscopy. The mean quantity of jelly instilled was 21.4 Gm (11-27.5 Gm) and of lidocaine HCl administered thereby 428 mg (218-550 mg). Plasma concentration reached measurable levels in only 5 cases, never exceeding 0.2 microgram/ml.

Adult↗

Flexible cystoscopy in surgical repair of traumatic urethral strictures in children.

Flexible cystoscopy via a suprapubic cystostomy tract was utilized to locate the proximal segment of a complete traumatic disruption of the bulbar urethra secondary to a pelvic fracture. With the fiberoptic light of the instrument visible in the perineum, the proximal urethra was easily and safely dissected free from the enveloping fibrotic scar tissue and a simple one-stage urethroplasty performed. The patient is voiding normally eight months postoperatively.

Child↗