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PubMed2006

Preliminary report on analysis of bladder-wall vasculature using conjunctival microvascular analysis in patients with and without transitional-cell carcinoma.

PURPOSE: To develop a technique to analyze the bladder microvasculature during cystoscopy to assess the conjuctival microvascular morphology at the capillary level. This technique could be an adjunct to visual examination of the bladder during cystoscopy for diseases that are presumed to affect the vasculature. PATIENTS AND METHODS: Subjects with transitional-cell carcinoma (TCC) were chosen because of their frequency of cystoscopy. A total of 12 male patients, ages 45 to 80 years, underwent cystoscopy: four without TCC and eight with TCC by bladder biopsy. The images were digitally recorded and enhanced using a custom image-analysis system. The blood vessel length (VL) and diameter (VD) and blood vessel volume (BVV) were measured. RESULTS: The VD was significantly greater in TCC than in non-TCC patients only in the lower-order vessels. The VL was significantly longer in TCC than in non-TCC, again in the lower-order vessels. In the higherorder vessels, the VL was significantly shorter in TCC than in non-TCC. The BVV in the lower-order vessels was significantly greater in TCC than in non-TCC patients. CONCLUSIONS: Differences exist in the morphology of surface microvessels between TCC and non-TCC bladders. Using the current technique, capillaries (VD < 10 microm) are not visible, so refinement of imaging and recording technologies is required to measure capillaries in order to simulate microvascular morphometry in the conjuctiva.

Aged↗

PubMed1994

Same day diagnostic service for new cases of haematuria--a district general hospital experience.

OBJECTIVE: To describe the running of a special haematuria diagnostic service which catered for a flexible cystoscopy on the same day as the first clinical visit. The impact of this service especially with regard to the timing of the intravenous urogram (IVU) is discussed. The service was designed to facilitate early diagnosis, particularly of bladder tumours, in new cases of haematuria. Potentially this would allow a more effective planning of operating lists and implementation of early definitive treatment. PATIENTS AND METHODS: Within the setting of a District General Hospital, new cases of haematuria were studied (42 male, 29 female, mean age 60 +/- 13 years). Fifty-one had a pre-clinic IVU whereas 20 had this deferred until after their first visit. All patients underwent a flexible cystoscopy under local anaesthesia on their first visit. New cases of bladder cancer were placed on the next available list for definitive treatment whilst patients with normal cystoscopy were referred back to the clinic for further investigations. RESULTS: Altering the timing of the IVU helped in reducing hospital delay from 33 +/- 19 days (range 9-92 days) to 22 +/- 9 days (range 8-52 days; P < 0.04); the number of diagnostic cystoscopies performed within 4 weeks increased from 65% to 95%. CONCLUSION: The same day diagnostic service has not been difficult to administer. Patient acceptability was excellent and design objectives were achieved.

Adult↗

PubMedDate not supplied

Urine cytology as a screening test for bladder infiltration in cervical cancer.

Ultrasound is currently used as a screening test for bladder infiltration in patients with advanced-stage cervical cancer at our institution. Cystoscopy is reserved for patients with abnormal bladder ultrasound findings. This study was undertaken to reevaluate this policy and to compare the results of different screening tests. The study was carried out in Pretoria academic complex. All newly diagnosed cervical carcinoma patients stage II and above were included in this study. The standard staging investigations were done on all patients. In addition, urine midstream and catheter specimens were sent for cytology. Cystoscopy and biopsy were performed on all patients. Two hundred twenty-eight patients were enrolled into this study. At cystoscopy, 47 patients had bladder mucosa suspicious of malignant infiltration, of which 17 had bladder mucosa infiltration diagnosed on histology. Urine catheter cytology has a sensitivity of 94% and specificity of 82% for bladder mucosa infiltration. The predictive value of a positive test is 31% and for a negative test is 99%. Catheter urine cytology is a very useful screening test for bladder infiltration in patients with cervical cancer. Cystoscopy should be reserved for patients with abnormal urine cytology in resource-poor settings with a large burden of disease.

Biopsy↗

PubMed1984

Cystoscopic examination of male and female dogs.

The use of cystoscopy is advocated as an aid to the early differential diagnosis of disease of the canine bladder. Techniques are described for carrying out urethroscopy and cystoscopy in both male and female dogs using modern medical diagnostic instruments. Males were examined with flexible paediatric bronchofibrescopes, which permitted urethroscopy and cystoscopy, but to obtain extensive biopsies or undertake cauterisation of the bladder surface with rigid endoscopes, a simple perineal urethrostomy was necessary. The bladder of females, on the other hand, was examined by cystoscopy and biopsied using standard rigid cystoscopes and resectoscopes.

Animals↗

PubMed2000

Proposal for changes in cystoscopic follow-up of patients with low-grade pTa bladder tumor.

OBJECTIVES: The cystoscopic follow-up of superficial bladder cancer accounts for a considerable workload for urologists and is also an invasive procedure with high costs. There is a potential benefit both to the urologist and the patient if unnecessary cystoscopies can be avoided. METHODS: The recurrence and progression rates of 120 patients with pTa G1 or G2 and small (<4 cm) transitional cell carcinoma were evaluated retrospectively. RESULTS: The recurrence rate was 6.5% (8/120) at 3 months. The recurrence rates at 6 and 9 months were 6.7 (8/119) and 3.6% (4/112), respectively. However, when the third month (first check) was clear, the recurrence rates at 6- and 9-month cystoscopy were 4.3 (5/116) and 2.7% (3/111), respectively. The recurrence rate at 12 months was 8% (8/99). For G1 tumors, the recurrence rates at 3, 6, 9 and 12 months were 6 (5/84), 5 (5/83), 2.5 (2/80) and 7% (5/71), respectively. The same results for G2 tumors were 8 (3/36), 8 (3/36), 6 (2/32) and 10.5% (3/28), respectively. The progression rate for the first year was lower than 1%. The difference between G1 and G2 tumors according to recurrence rate within the first year was not statistically significant (p>0. 05). CONCLUSIONS: This study supports the proposal that for patients with small and welldifferentiated pTa tumors at diagnosis, if the first control cystoscopy is clear, it is appropriate to perform the second check cystoscopy 1 year from initial resection and subsequent controls yearly. One should note that the study group included the most suitable patients for cystoscopic follow-up according to size and multiplicity of the tumor. This change in policy is further supported by the fact that progression occured in less than 1% in this group of patients.

Carcinoma, Transitional Cell↗

PubMed2004

NMP22 BladderChek Test: point-of-care technology with life- and money-saving potential.

A new, relatively obscure tumor marker assay, the NMP22 BladderChek Test (Matritech, Inc.), represents a paradigm shift in the diagnosis and management of urinary bladder cancer (transitional cell carcinoma). Specifically, BladderChek should be employed every time a cystoscopy is performed, with corresponding changes in the diagnostic protocol and the guidelines of the American Urological Association for the diagnosis and management of bladder cancer. Currently, cystoscopy is the reference standard and NMP22 BladderChek Test in combination with cystoscopy improves the performance of cystoscopy. At every stage of disease, BladderChek provides a higher sensitivity for the detection of bladder cancer than cytology, which now represents the adjunctive standard of care. Moreover, BladderChek is four-times more sensitive than cytology and is available at half the cost. Early detection of bladder cancer improves prognosis, quality of life and survival. BladderChek may be analogous to the prostate-specific antigen test and eventually expand beyond the urologic setting into the primary care setting for the testing of high-risk patients characterized by smoking history, occupational exposures or age.

Biomarkers, Tumor↗

PubMed1988

Serial transabdominal sonography of bladder cancer.

In 23 patients with known transitional cell carcinoma of the bladder, 58 serial transabdominal sonograms were obtained, providing 35 cases in which interval change could be evaluated by sonography. Results were correlated with cystoscopy or surgery. Sonography accurately gauged change in 29 instances (83%), of which 13 showed increase, four decrease, and 12 stability of tumor. Errors in assessing interval change occurred when surgery between sonograms caused secondary bladder deformity or patchy edema of the bladder wall; these were misinterpreted as tumor growth. When smooth bladder thickening was present, sonography could not differentiate flat tumor from edema. In no case in which the bladder wall was normal on sonography was tumor found. In four cases sonography was a more accurate indicator of depth of tumor than cystoscopy was. These results suggest that sonography is a useful adjunct to cystoscopy and may be a dependable means of decreasing the frequency of invasive procedures to evaluate the extent of bladder disease. The use of these two techniques together may improve the accuracy achieved by using cystoscopy alone.

Carcinoma, Transitional Cell↗

PubMed1985

Control for recurrences of urinary bladder tumours by transabdominal ultrasonic scanning.

By transabdominal ultrasonic scanning of the filled bladder it is possible to examine the surface of the bladder urothelium in the outpatient clinic. In a "blind" study of 129 patients controlled for recurrences of urinary bladder tumours the results of dynamic transabdominal ultrasonography were compared with the results of cystoscopy. The ultrasound could identify the recurrences of 5 mm or above in size significantly. Below 5 mm in dimension, when positioned in the dome of the bladder or at severe trabeculation the ultrasonic scanning lead to a misdiagnosis. No invasive recurrences were overlooked by ultrasonography. We will advocate that transabdominal ultrasonic scanning replace routine cystoscopy in low-risk patients with superficial bladder tumours of the Ta category and a low grade after the primary transurethral treatment and no or few recurrences of the same Ta category at the first control cystoscopy. On the other hand we will recommend to continue cystoscopy of patients with frequently recurring urinary bladder tumours, the high grade Ta tumours, carcinoma in situ because of the risk of invasive growth, and patients with primary invasive tumours including those with the superficial invasion (category T1).

Adult↗

PubMed2005

Occult intraperitoneal bladder injury after a tension-free vaginal tape procedure.

Occult bladder injury may sometimes go unrecognized during tension-free vaginal tape (TVT) procedures. We report a case of occult intraperitoneal bladder injury that occurred during a TVT procedure. There was no sign of bladder perforation on the initial cystoscopy, which was performed just after the insertion of the trocar. Signs of general peritonitis appeared after the patient started to void the next day. A postoperative cystogram and cystoscopy showed an intraperitoneal bladder injury and a pinhead-sized ulcerative lesion in the right lateral wall of the bladder. We suspect that at the time of initial cystoscopy, the trocar passed through the submucosal area without violating the bladder mucosa. The occult bladder injury may have been caused after the initial cystoscopy by advancing the rough edge of the prolene tape during the extraction of the trocar. This report is the first description of such an occult bladder injury during a TVT procedure.

Adult↗

PubMedDate not supplied

NMP22: a sensitive, cost-effective test in patients at risk for bladder cancer.

BACKGROUND: This study was designed to determine the clinical utility of NMP22 as a urinary marker for the early detection of transitional cell carcinoma (TCC) of the bladder in patients with hematuria or other indications for risk of malignancy. Its utility will be measured by sensitivity and specificity estimates as compared to cystoscopy. Since urine cytology is normally collected in this population of patients, it will also be analyzed and compared to cystoscopy. MATERIALS AND METHODS: Each patient submitted a single voided urine which was stabilized with the NMP22 urine collection kit or preserved in the appropriate cytology medium for cytopathologic testing. All patients provided the urine samples before cystoscopic exam. Of the 146 patients, there were 43 patients with microscopic hematuria and 13 with gross hematuria. Other indications for cystoscopy included unexplained or medically refractory voiding. There were 8 patients with biopsy confirmed bladder cancer and 138 patients with benign conditions of the bladder. RESULTS: The median NMP22 value for the bladder cancer malignancies was 27.8 U/mL (95% Confidence interval: 10.5-32.1 U/mL). The median NMP22 value for the benign conditions of the bladder was 3.25 U/mL (95% Confidence interval: 2.5-3.8 U/mL). The urinary NMP22 values from the bladder cancer group was statistically different (p < .000001 Mann-Whitney U test) than the NMP22 values in the benign conditions group. Using a reference value of 10.0 U/mL, the sensitivity of NMP22 was 100% with a specificity of 90%, while cytology had a sensitivity of 25% and a specificity of 100%. Due to its high negative predictive value, using NMP22 alone could have eliminated 124 cystoscopies with total savings ranging from $24,824 to $63,264 depending on the type of insurance carrier. CONCLUSIONS: This study indicates that urinary NMP22 is a useful, cost-effective marker for the early detection of bladder cancer.

Biomarkers, Tumor↗

PubMed1999

[The BTA stat test in the follow-up for bladder cancer].

OBJECTIVE: To evaluate the utility of the BTA stat test in the follow-up of asymptomatic patients with superficial carcinoma of the bladder. METHODS: In 122 asymptomatic patients on follow-up for superficial bladder carcinoma, a sample of recently voided urine was obtained prior to cystoscopy and BTA stat test and cytology were performed. Thereafter we performed cystoscopy and TUR in those patients suspected of having recurrent bladder carcinoma. RESULTS: 51 patients had bladder cancer and 71 were tumor free. The sensitivity was 60.78% for the BTA stat test, 45% for cytology and 98% for cystoscopy. The specificity was 87.32%, 94.36% and 90.14%, respectively. The positive predictive value and negative predictive value were 77.5 and 75.6, 85.16 and 70.5, and 87.7 and 98.46, respectively for each test. The sensitivity by grade was 23% for G1, 71.4% for G2 and 92.8% for G3 for the BTA test versus 15.3%, 37.5% and 85.7% for cytology. The sensitivity by stage was 46.6% for Ta, 52% T1 and 100% for T2-4 and Tis for the BTA test versus 26.6%, 40% and 80% for cytology. CONCLUSIONS: The BTA stat test is superior to cytology in the follow-up of patients with bladder cancer. However, it has a low sensitivity in G1 and Ta and T1 tumors, therefore cystoscopy cannot be avoided.

Antigens, Neoplasm↗

PubMedDate not supplied

[Fluorescent diagnostics of urinary bladder cancer].

Introduction of optic markers in screening for cancer of the urinary bladder (UB) raises diagnostic significance of UB cystoscopy. Application of intravesical form of 5-aminolevulinic acid (5-ALA), precursor of photodynamically active protoporphirine IX, prevents complications in systemic use of tetracycline or hepatoprophirines. Fluorescent cystoscopy with 5-ALA (n = 59) was made in 51 patients treated in the Research Institute of Urology. UB cancer was detected in 32 patients. This procedure proved highly sensitive and specific (97.0 and 75.6%, respectively, being much more effective than standard cystoscopy and biopsy in the white light (85.1 and 81.4%, respectively). Specificity of fluorescent cystoscopy is much higher in detection of tumors and pretumor lesions (88.4%). Fluorescent diagnosis is expected to become a gold standard in the program of UB cancer detection.

Administration, Intravesical↗

PubMed2001

[Cytoscopic follow-up of initial G3T1 bladder tumors treated with BCG].

OBJECTIVE: To evaluate the cystoscopic findings during initial follow-up, the anatomopathological correlation of tumor endoscopic features and the results of standard control multiple biopsy performed 6 months after TUR in patients with G3T1 transitional carcinoma treated with BCG. METHODS: 114 patients with G3T1 bladder tumor (52% associated with Cis) were treated with 81 mg Connaught BCG intravesical instillations weekly for 6 consecutive weeks. Follow-up was performed with cystoscopy and cytology at 3 months, and cystoscopy and standard multiple biopsy at 6 months. The endoscopic findings were described as normal bladder, macroscopically tumorous lesion or erythematous lesion. RESULTS: During the first 6 months of follow-up superficial recurrence was found in 16% and 5% showed progression to muscle invasion. Tumor recurrence or progression was found in 61% and 39% at 3 and 6 months, respectively. Most of the macroscopically tumorous lesions resulted in a tumor at 3 and 6 months in 56% and 64%, respectively, and the remaining lesions were mainly inflammatory granulomas produced by BCG therapy. Twenty biopsies of erythematous areas detected only one case of Cis (5%) and 98 standard multiple biopsies of endoscopically normal mucosa detected 10 cases of Cis (overall, 3 at 3 months and 7 at 6 months); all cases were preceded by initial Cis except in one case. CONCLUSIONS: Cystoscopy performed at 3 months is very useful since it detected 61% of the superficial recurrences and 66% of the cases with progression to muscle invasion during the first 6 months. Routine biopsy of erythematous areas detected during cystoscopy is of little value since a large number of these biopsies are unnecessary in view of its diagnostic yield (5%). Since 90% of the Cis detected during the first 6 months of follow-up were patients with Cis in the initial tumor, it would be appropriate to perform standard multiple biopsy for control only in this subgroup of patients if the sensitivity of cytology is low in high grade tumors or Cis.

Adjuvants, Immunologic↗

PubMed2004

[New methods of urinary bladder cancer detection at the early stage of the disease in patients of various ages].

In the sickness rate's structure of the malignant neoplasms the urological localization take 6.8 per cent (%). Among them 70% is cancer of the urinary organs. The average age of the patients with cancer of the urinary bladder is from 65.2 to 69.7 years old. The use of fluorescent cystoscopy allows to improve the quality of the diagnostics of the urinary bladder's mucous' neoplastic changes. It is illustrated that the fluorescent cystoscopy's sensitivity is 96.9-98.7% and exeeds the sensitivity of simple cystoscopy research method for more than 20%. Carcinoma in situ was found 2 times more often than with the help of traditional cystoscopy and "blind" biopsy. Carrying out urinary bladder's wall transuretral resection under the photodynamic control increases the radical character of the endoscopic operation and allows to reduce the quantity of cancer's relapses by decreasing the amount of residual tumors. The test examination (in a year after the operation) has shown that the tumor's recurrences were registered 2.2 times more seldom in those group of patients, which had the neoplasms extracted under the photodynamic control.

Adult↗

PubMed2004

[Value of the photodynamic method in the diagnosis of superficial bladder tumors].

Photodynamic diagnosis (PDD) is one of most precise method of neoplasms recognition. The aim of the study was to estimate the value of 5-amino levulinic acid in diagnosis of superficial bladder tumours. Since 1996 to March 2004, 597 cystoscopies were performed with 5-amino levulinic acid in 151 patients with superficial bladder tumours (102 men and 49 women) aged 19-87 years old. 132 pts were treated by PDD after transurethral resection of bladder tumours (TURB). 749 specimens were taken from mucosa during PDD. Before PDD 50 ml of of 5-amino levulinic acid solution was instilled into bladder. As a source of ultraviolet light (UV) D--Light Storz xenon lamp (405 nm) was used. In 16 pts single PDD was performed in 38 double and in 97 PDD was performed three or more times (3 to 7). All pts were observed 12 months before and after PDD. In 102 from 151 pts in white light cystoscopy (WL) no changes in the bladder mucosa were found. In both kind of light (WL and UV) changes were not observed in 44 pts (29.1%). In 58 pts in WL no changes were observed but in UV places of neoplastic changes in the mucosa were found. In these cases the presence of superficial bladder tumours was confirmed. These changes were pathologically confirmed only in UV in 26 pts. Ta (G1 and G2) changes were confirmed in 52 pts (21 in WL and additionally 31 in UV). T1 changes were confirmed in UV in 26 pts but in WL in 25 pts. In 3 pts T2 changes were confirmed in both UV and WL. Cystoscopy in ultraviolet light (photodynamic diagnosis--PDD) with 5 amino levulinic acid gives more precise diagnosis of superficial bladder tumours then the one in standard white light. Cystoscopy performed to diagnose bladder tumours and early recurrence and new focus of tumours recognition without PDD is less effective. Introduction of superficial bladder tumours photodynamic diagnosis into health care system reduced recurrences and improves results of treatment.

Adult↗

PubMed2006

The significance of ultrasonography in diagnosing and follow-up of cystic cystitis in children.

Cystic cystitis is a separate form of urinary bladder inflammation, detected by cystoscopy in children with recurrent urinary infections. Cystoscopy is an invasive method, so the aim of this investigation was to determine the ultrasonographic characteristics of cystic cystitis and to assess the reliability of ultrasound in relation to cystoscopy in diagnosing cystic cystitis. The study included 115 girls with repeated urinary infections. Cystoscopy and ultrasonography was performed in all. According to the cystoscopic finding the subjects were divided into 4 groups. Lateral and posterior urinary bladder wall thickness was measured during ultrasonography. A statistically significant difference was found between all 4 groups, the method demonstrated a high degree of sensitivity (0.97) and specificity (0.91). Percentile calculations were determined for wall thickness. Ultrasonography can replace endoscopy in diagnosis and follow-up of cystic cystitis in children, with at least 50% fullness of the urinary bladder as a prerequisite.

Analysis of Variance↗

PubMedDate not supplied

[The efficacy of rigid and flexible endoscopes in the diagnosis of bladder diseases].

A comparative assessment of the efficiency of rigid and flexible endoscopes used for the diagnosis of bladder diseases (cystitis, papilloma, carcinoma in a total of 250 patients) is reported. Cystoscopy made use of a rigid catheter in 101 patients and of a flexible one, in 149. With rigid cystoscope procedure, the diagnosis was correct in 72.2%, doubtful in 13.9%, and erroneous in 13.9%. Major causes of the failure of cystoscopy in this group of patients were bleedings small volume of the bladder, tumor disintegration incontinence, prostatic adenoma, fistula, the tumor outside rigid endoscope's visibility range, or grave condition of the patient. Fiber cystoscopy made use of 6 mm endoscopes, corresponding to No 18 by Charrière's scale. Flexible endoscope procedure proved effective in 98.7% of the patients, including 11 patients after a failure with rigid cystoscopy. Principal advantages of vesicle fibroscopy are that the method is absolutely atraumatic, painless, quick, has no dead zones and makes possible complete examination of the mucosa of diverticula or any exophytic formation, and target biopsy.

Cystoscopes↗

PubMed2006

Endoscopic management of ureteral complications following renal transplantation.

Management of ureteral complications after kidney transplantation can be done with a surgical, percutaneous, or endoscopic approach. The aim of this study was to determine the success rate of the endoscopic retrograde approach for the management of these complications following renal transplantation. We reviewed the records of 25 patients who underwent endoscopic management of ureteral complications after renal transplant between 1995 and 2005. Variables examined included timing of event following transplant, type of ureteral complication, equipment implemented in the procedure, operating time, success in stent placement, and complications. Initial approach was via rigid cystoscopy followed by flexible cystoscopy if needed. Initial attempts to intubate the ureteral orifice were by a flexible-tipped guide wire, and occasionally an angiocatheter guide was used for ultimate wire placement. Stents were positioned with fluoroscopic and direct visual guidance. Of 25 patients evaluated, five had a ureteral anastomotic leak with a mean time of presentation of 16.8 days. The remaining 20 patients suffered from ureteral obstruction revealed by hydronephrosis on a renal ultrasound prompted by a rising creatinine. Mean time of onset was 48 months. Although each was initially approached with rigid cystoscopy, 12 were converted to flexible cystoscopy for easier access to the ureteral orifice. Twenty of the 25 patients had successful stent placement with three failures in the ureteral obstruction group and two failures in the leakage group. Average operative time was 42 minutes. No intraoperative complications were experienced. Resolution of hydronephrosis in those with preoperative obstruction was noted and all stented urinary leaks resolved.

Anastomosis, Surgical↗