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Flexible cystoscopy as an adjunct to extracorporeal shockwave lithotripsy.

Ancillary procedures associated with extracorporeal shockwave lithotripsy (ESWL) include placement and subsequent removal of double pigtail ureteric stents. A simple new technique has been developed for the insertion of these stents. Using the flexible cystoscope, the procedure is performed on an out-patient basis under local anaesthesia. Placement of the stents was successful in 30/34 patients and removal was successful in 14/14 patients.

Adult↗

Superficial bladder cancer: for how long should a tumour-free patient have check cystoscopies?

OBJECTIVE: To determine the probability of a patient with superficial bladder cancer developing a recurrent tumour after having remained tumour free for 2 or more years. PATIENTS AND METHODS: One-hundred and seventy-nine patients with Ta or T1 tumours at diagnosis, a minimum follow-up of 3 years and a minimum of 2 years remaining tumour free were identified. Thirteen patients had more than one episode that was eligible for inclusion and there were therefore 192 tumour-free episodes for analysis. Survival curves of the probability of being recurrence-free against time were constructed for the whole group, for subgroups of Ta and T1 tumours and for subgroups with characteristics at diagnosis suggesting a good, intermediate and poor prognosis. RESULTS: The probability of a patient developing a recurrence after 2, 5 and 10 years of being tumour free was 43, 22 and 2% respectively. No patient had a recurrence after remaining tumour free for 12 years. No patient who had been tumour free for at least 2 years progressed to muscle invasion or metastases. There was no significant difference in the probability of recurrence between Ta and T1 tumours after 2 years of remaining tumour free. CONCLUSION: The optimum length of cystoscopic follow-up for patients with superficial bladder cancer is unknown, but patients continue to develop recurrences even after many years of being tumour free. If a patient is to discontinue cystoscopic follow-up, then alternative methods of assessment should be applied.

Adult↗

Ureteral stents: exchange under fluoroscopic control as an effective alternative to cystoscopy.

From September 1991 to February 1993, in 83 patients (74 women and nine men, aged 24-86 years), 166 double-J ureteral stents (initially placed to treat fistulas or stenoses located within the inferior third of the ureter) were exchanged during 127 procedures. Stents were extracted from the bladder through the urethra under fluoroscopic monitoring by using a lasso made of a 0.018-inch guide wire and a 7-F catheter. Then a new stent was placed over a 0.035-inch guide wire that had been previously coiled in the renal pelvis. Exchange was successful in 161 (97%) of 165 stents.

Adult↗