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At least 793 records · Page 44Linked to original sources

PubMed2006

Urothelial carcinoma after external beam radiation therapy for prostate cancer.

PURPOSE: We reviewed the clinical course of patients in whom urothelial carcinoma developed following radiation therapy for prostate cancer. MATERIALS AND METHODS: A retrospective review of all patients between 1990 and 2005 with the diagnosis of bladder and prostate cancer was performed. Of 125 total patients new onset urothelial carcinoma developed in 11 after undergoing external beam radiation therapy for prostate cancer. RESULTS: Whole pelvis external beam radiation therapy with a proton boost to the prostate was the radiation modality in 7 of the 11 patients (64%), while the remaining 4 patients received standard external beam radiation only. Urothelial carcinoma was detected a mean of 3.07 years after completion of radiation therapy in the proton group, compared to a mean latency period of 5.75 years in the standard radiation group (p = 0.09). Average patient age at diagnosis was 72 years (range 64 to 84). All patients presented with gross hematuria and had cystoscopic findings of coexisting radiation cystitis. Of the 11 patients 5 (45%) presented with grade 3 carcinoma and eventually 7 (64%) required radical cystectomy. Urothelial tumors with sarcomatoid features (carcinosarcoma and spindle cell sarcomatoid) developed in 2 patients (18%). Of the 11 patients 10 (91%) were nonsmokers at the time of urothelial carcinoma diagnosis. CONCLUSIONS: Urothelial carcinoma in patients with previous radiation therapy for prostate cancer is often high grade, and the majority of patients have cancer progression requiring cystectomy. A high incidence of urothelial carcinoma with sarcomatoid features was seen in these patients.

Aged↗

PubMed2006

Suprapubic prostatectomy with a novel catheter.

PURPOSE: We evaluated the postoperative morbidity and technical complications of a new handmade catheter used for suprapubic prostatectomy. MATERIALS AND METHODS: A total of 146 patients with lower urinary tract symptoms who had indications for open prostatectomy were enrolled in the study from January 2003 to August 2004. Of the patients 96 were treated with a novel technique without a urethral catheter but with a special handmade cystostomy catheter, while the other 50 underwent the traditional procedure using cystostomy and a urethral catheter. The same surgical team operated on the 2 groups. Clot retention episodes, hemoglobin decreases, irritative symptoms, voiding status after cystostomy removal and incontinence were evaluated postoperatively. Three months later we followed the patients with symptom score, maximum flow rate and cystoscopic examination. RESULTS: Preoperatively mean International Prostate Symptom Score was 31.6 in each group. Postoperatively none of the patients with the novel catheter complained of significant irritative urinary symptoms, clot retention and true or stress urinary incontinence. Of the cohorts 94% were satisfied with voiding but 86% of controls were satisfied. There was no report of urinary tract infection or epididymo-orchitis in the cohorts, while we found epididymo-orchitis in 4 controls (8%). Three months after the operation the mean International Prostate Symptom Score was 4.4 (range 1 to 7) and the mean maximum flow rate was 22.6 ml per second (range 14 to 25) in patients with the novel catheter, and 4.2 (range 1 to 7) and 22.5 ml per second (range 15 to 25), respectively, in those with the traditional catheter. At followup there was no bladder neck contracture but 4 patients (4.1%) showed some degree of membranous urethral stricture. We also noted 7 controls (14%) with urethral stricture. CONCLUSIONS: Transurethral prostate resection has been introduced as the surgical treatment of choice in patients with benign prostatic hyperplasia. However, open adenomectomy still has a place. Urethral catheter-free suprapubic prostatectomy can be safely applied with a low postoperative risk of infection, incontinence and stricture formation.

Aged↗

PubMed2006

Experience with 100 cases treated with botulinum-A toxin injections in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics.

PURPOSE: In this prospective, nonrandomized, ongoing study we evaluated the efficacy and safety of botulinum-A toxin injections in the detrusor muscle to treat patients with idiopathic overactive bladder resistant to conventional treatment, such as anticholinergic drugs. MATERIALS AND METHODS: A total of 23 men and 77 women with a mean age of 63 years (range 24 to 89) with nonneurogenic overactive bladder, including urgency-frequency syndrome, and incontinence despite the administration of maximal doses of anticholinergics were consecutively treated with injections of 100 U botulinum-A toxin in the detrusor muscle at 30 sites under cystoscopic guidance. Micturition diary, full urodynamics, neurological status and urine probes were performed in all participants before treatment. Bladder biopsies were done only in cases of suspected bladder fibrosis or unclear findings. Special attention was given to reflex volume, maximal bladder capacity, detrusor compliance, post-void residual urine, urgency and frequency/nocturia. Clinical, urodynamic and quality of life assessments were performed at baseline, and 4, 12 and 36 weeks after botulinum-A toxin treatment. RESULTS: Overall after 4 and 12 weeks 88% of our patients showed significant improvement in bladder function in regard to subjective symptoms, quality of life and urodynamic parameters (p <0.001). Urgency disappeared in 82% of the patients and incontinence resolved in 86% within 1 to 2 weeks after botulinum-A toxin injections. Mean frequency decreased from 14 to 7 micturitions daily (-50%) and nocturia decreased from 4 to 1.5 micturitions. Mean maximal bladder capacity increased 56% from 246 to 381 ml, mean detrusor compliance increased from 24 to 41 ml/cm H(2)O and pretreatment detrusor instability (mean reflex volume 169 ml) resolved in 74% of patients. Mean volume at first desire to void increased from 126 to 212 ml and mean urge volume increased from 214 to 309 ml. There were no severe side effects except temporary urine retention in 4 cases. Only in 8 patients was the clinical benefit poor and analysis revealed preoperative low detrusor compliance. Mean efficacy duration +/- SD was at least approximately 6 +/- 2 months and then symptoms began to increase. CONCLUSIONS: Our results show that intradetrusor botulinum-A toxin injections may be an efficient and safe treatment option in patients with severe overactive bladder resistant to all conventional treatments.

Adult↗

PubMed1994

High resolution 2-dimensional electrophoretic analysis of proteins in saline bladder washings.

Human urine contains a spectrum of proteins derived from various organs in the body. This investigation was undertaken to identify a group of proteins secreted primarily by bladder urothelium. Saline bladder washouts were collected from 9 male and 4 female patients undergoing routine cystoscopic examination. Each sample was sieved, desalted, freeze-dried and solubilized in urea mix. identical amounts of proteins were pooled according to donor sex. All individual and pooled samples were then subjected to 2-dimensional gel analysis using the ISO-DALT system. Profiles of both groups of subjects were highly reproducible, comparable and resembled those of urine and plasma. Several hundred spots were visualized although most of them as yet remain unrecognized. The proteins identified in bladder washouts include albumin, transferrin, IgG gamma-heavy chain, Gc-globulin, alpha 1-antichymotrypsin, alpha 1-antitrypsin, alpha 1-acid glycoprotein, G4, IgG light chains, alpha 1-microglobulin, and low and high density lipoproteins. Most importantly, while some abundant urinary macromolecules such as Tamm-Horsfall mucoprotein and most acidic urinary proteins were undetectable, albumin and transferrin were relatively less expressed. The 2-dimensional profiles we developed can be used as a data base to study urothelium derived proteins in various disease conditions such as bladder cancer.

Cystoscopy↗

PubMed1994

Laser sphincterotomy and ablation of the prostate using a sapphire chisel contact tip firing neodymium:YAG laser.

I report a modified technique for use of a contact laser for urological endoscopic surgery in spinal cord injury patients. Instead of the usual technique of passing the laser probe for surface vaporization, subsurface buttonholes were drilled with subsequent incision of the overlying tissue. As a result, creation of an adequate channel was expedited with excellent hemostasis. A total of 40 spinal cord injury patients (mean age 50.1 years, range 28 to 76) underwent transurethral surgery for bladder outlet obstruction using a sapphire contact laser tip. Of the patients 50% had undergone previous transurethral surgery and were not voiding well. Urodynamic studies demonstrated detrusor-sphincter dyssynergia in 37 patients (92.5%). A voiding cystourethrogram was done in 83% of the patients and showed vesicoureteral reflux in 17%. On cystoscopic examination 32.5% of the patients had an associated enlarged prostate, 32% stricture of the bulbous urethra and 20% bladder neck stenosis. Apart from transurethral sphincterotomy in these patients, ablation of the prostate, stricture and eradication of bladder neck stenosis, as indicated, were also done with the contact laser. Blood loss was approximately 25 to 50 ml. per procedure except for 2 initial patients with a blood loss of 100 to 150 ml. Approximately 3,500 to 8,900 joules accumulated energy were used for transurethral sphincterotomy and 11,000 to 37,000 joules for transurethral resection of the prostate. An indwelling Foley catheter was placed postoperatively for a mean of 3 days (range 1 to 8). All patients were followed for 6 to 23 months (mean 13.1). Four patients failed laser transurethral sphincterotomy: 1 due to inadequate initial incision and 3 who initially underwent laser transurethral incisions of the prostate and had persistent detrusor-sphincter dyssynergia (all had relief following laser transurethral sphincterotomy). All subsequent patients are voiding well with a wide open bladder neck and posterior urethra as shown on a voiding cystourethrogram.

Adult↗

PubMed1994

Use of electrocoagulation in the treatment of vesicovaginal fistulas.

The role of electrocoagulation for the treatment of vesicovaginal fistulas has not been clearly defined. To determine the use of this therapeutic modality, 15 cases of fistulas treated with electrocoagulation were retrospectively reviewed. Fulguration represented the primary treatment in 12 patients and the secondary treatment in 3 after an initial attempt at open surgical closure failed. In all instances fistula size was estimated to be 3.5 mm. or less. A Bugbee electrode, which was inserted into the fistula either cystoscopically or vaginally, was used to destroy the epithelial lining of the fistula tract. Following the procedure the bladder was decompressed with a large indwelling Foley catheter for at least 2 weeks. Fulguration was successful as the sole treatment modality in 9 of 12 patients (75%) and as an alternative intervention after failure of an open surgical repair in 2 of 3 (66%). Therefore, 11 of the 15 women (73%) had complete resolution of the fistulas with this technique. We conclude that fulguration is usually effective in managing patients with vesicovaginal fistulas a few millimeters in size or less. This technique should be used as an initial treatment for appropriately selected patients and in women with small residual fistulas after open surgical failure.

Electrocoagulation↗

PubMed1994

Collagen implantation for post-prostatectomy incontinence: early experience with a transrectal ultrasonographically guided method.

Ten patients with post-prostatectomy urinary incontinence underwent collagen implantation via the transrectal ultrasonographic guided method. Mean followup was 14 months (range 9 to 18 months). The procedure was performed through the perineum with the patient under local or epidural block anesthesia. The mean amount of collagen implantation was 20.0 ml. (range 10 to 37.5) and the mean number of treatments was 1.5 sessions (range 1 to 3). Results were successful in 6 patients, 1 of whom was completely cured (became dry). There were no marked complications associated with this procedure. We previously performed collagen implantation under cystoscopic observation. However, the ultrasonography guided method allows for the bladder neck to be identified and the needle to be positioned with real-time monitoring. After insertion of a urethral balloon catheter, the bladder neck and needle can be visualized clearly by transrectal ultrasonography. In our series the average amount of collagen injected was less than in the conventional method but the results were superior. In conclusion, transrectal ultrasonographically guided collagen implantation via the transperineal approach may be superior for the treatment of urinary incontinence.

Aged↗

PubMed1994

Cystitis associated with tiaprofenic acid.

Ten patients with cystitis associated with tiaprofenic acid were reviewed. All patients displayed similar cystoscopic and histological features, and all failed a variety of initial therapies but achieved a dramatic improvement or resolution of symptoms with discontinuation of the tiaprofenic acid. Drug-induced cystitis may be more common than previously recognized.

Aged↗

PubMed1994

Techniques for bypassing and stenting ureteral obstructions.

The advent of current endourological equipment and combined cystoscopic fluoroscopy allows the urologist to divert and/or stent the majority of benign and malignant ureteral obstructions in either a retrograde or antegrade fashion. We report on our recent experience in managing 105 obstructed renal units to formulate a troubleshooting endourological algorithm for bypassing and stenting ureteral obstructions. The methods described allow for safe and successful stent diversion in the majority of patients with ureteral obstruction requiring initial or primary endourological management. The algorithm presents alternative techniques for bypassing and stenting ureteral obstructions.

Algorithms↗

PubMed1994

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↗

PubMed1994

Endoscopic treatment of vesicoureteral reflux with a chondrocyte-alginate suspension.

Injection of polytetrafluoroethylene (Teflon) or collagen has been used in the endoscopic treatment of vesicoureteral reflux. Although the principle of an endoscopic treatment is valid, there are concerns regarding the long-term safety and effectiveness of these substances. In search of a different injectable material we conducted experiments using chondrocytes in a biodegradable polymer solution for the treatment of vesicoureteral reflux in an animal model. Reflux was created in 4 mini-pigs and confirmed with a cystogram. Cartilage was obtained from the auricular surface of each animal. Chondrocytes were harvested and expanded in vitro. The cells were individually quantitated and concentrated to 40 million cells per cc. The cell suspensions were mixed with a sodium alginate and calcium sulfate solution. Each pig was injected unilaterally in the subureteral region with the autologous chondrocyte suspension. The opposite ureter served as an internal control in all animals. Cystograms showed resolution of reflux in the treated side and persistence of reflux in the opposite untreated side in each instance. Excretory urograms revealed no evidence of obstruction. Histological examination of the subureteral region demonstrated cartilage. Autologous chondrocytes can be readily harvested, expanded in vitro and injected cystoscopically. The cells survive and form a cartilage nidus that is nonantigenic. This system is able to correct reflux without any evidence of obstruction.

Alginates↗

PubMed1994

Dorsal nerve block for management of intraoperative penile erection.

Intraoperative penile erection during general anesthesia can delay or prevent the completion of cystoscopic or penile surgical procedures. The dorsal penile nerve block is offered as a treatment for intraoperative erection. Advantages of this technique include less potential for cardiovascular complications and improved postoperative analgesia.

Adult↗

PubMed1994

Embolization to control iatrogenic ureteral hemorrhage: a case report.

Gross hematuria following percutaneous or endourological intervention is well known and widely documented. We report an unusual case of angiographically documented hemorrhage from a ureteral branch that was injured by cystoscopic removal of a Double-J stent, and subsequent successful transcatheter embolization. This case demonstrates the important role of angiographic diagnosis and therapy in the management of iatrogenic hemorrhage.

Aged↗

PubMed1994

The effects of intraurethral lidocaine anesthetic and patient anxiety on pain perception during cystoscopy.

Despite current practice there is no evidence to demonstrate the efficacy of intraurethral lidocaine gel as an anesthetic for rigid cystoscopy. To evaluate the usefulness of lidocaine in decreasing pain associated with cystoscopy, we performed a prospective, randomized, controlled, double-blind study comparing lidocaine gel with a water based lubricant. The effects of pre-procedure anxiety and prior experience with cystoscopy on pain perception were also evaluated. Physician perception of pain experienced by the patient was compared with the actual pain experienced. We found no decrease in pain perception in men or women following lidocaine gel instillation with a 5 or 10-minute dwell time compared to instillation of the plain lubricant. Increased preprocedure anxiety correlated with increased pain perception in women. Personal experience with prior cystoscopic procedures significantly decreased the current pain perception in men. Physicians underestimated the patient pain perception in all groups. Overall, we found the use of lidocaine gel to be of no benefit in routine rigid cystoscopy. Lowering pre-procedure anxiety may decrease the amount of pain perceived by women but not by men.

Adult↗

PubMed1993

Predictability of recurrent and progressive disease in individual patients with primary superficial bladder cancer.

The ultimate goal of prognostic assessment is optimization of individual counseling. Often, however, studies on prognostic factors focus on discriminating between high risk and low risk subgroups without considering the relevance of 1 or more factors for predicting disease outcome in individual patients. We quantified the accuracy of prediction of future recurrences and disease progression in individual patients with primary superficial bladder cancer. The study cohort consisted of 1,674 patients who were followed prospectively between 1983 and 1991 in the Netherlands. By analyzing half of the patients with proportional hazards regression, we computed relative risks of recurrence and progression. A prognostic index score based on these relative risks was then applied to the other half of the patients to determine whether group outcome could be predicted accurately. To assess the accuracy of prediction in individuals we used a method similar to the construction of receiver operating characteristic curves in diagnostic test assessment. The 3-year risk of first recurrence was 55% (95% confidence interval 51 to 59%). The 3-year risk of first progressive disease was 10% (95% confidence interval 8 to 12%). For the risk of first recurrence, tumor stage, tumor extent and multicentricity had statistically significant prognostic ability. Prognostic factors for the risk of disease progression were tumor stage, grade, multicentricity and the result of random biopsies from cystoscopically normal-appearing urothelium. For patients with a prognostic index score that suggested a low risk for recurrent and progressive disease the predicted 3-year risk of first recurrence was still 44% but the predicted 3-year risk of progression was only 3%. For patients with a prognostic index score that suggested a high risk the predicted risks were 74% and 22%, respectively. These predicted risks appeared to be fairly accurate when applied to the other half of our case series. However, in any 2 patients chosen at random the chance that the patient with the worst predicted prognosis would have a shorter recurrence-free and progression-free followup was calculated to be only 58% and 67%, respectively. Although the available prognostic factors in superficial bladder cancer may be useful to identify high risk and low risk subgroups, predictability in individuals is highly inaccurate. More relevant prognostic factors are needed to decrease current overtreatment and undertreatment rates, and to improve the followup policy.

Adult↗

PubMed1993

Cell wall deficient bacteria as a cause of idiopathic hematuria.

Idiopathic hematuria in the absence of bacteriuria is a medical challenge. Routine cultures of catheterized bladder and endoscopically obtained ureteral urine specimens from a 22-year-old woman with a 6-week history of hematuria showed no growth after 24 to 48 hours of incubation. However, bacterial variants were grown on enriched media. Colonies were typical cell wall deficient/defective bacteria. Phase and electron microscopy of cystoscopic urine specimens obtained by retrograde ureteral catheterization as well as phase microscopy of the cultures revealed the classic morphology of these organisms. When the variant cultures were subcultured the organisms reverted to their related walled forms, that is Streptococcus agalactiae and Staphylococcus haemolyticus. Because the colonies of these organisms showed various patterns of biochemical reactivity, each phenotype was tested against 15 antimicrobials. Collectively, all biotypes had a common susceptibility to only nitrofurantoin. The patient was treated with nitrofurantoin for 6 weeks. Four days after initiation of therapy she had complete remission of hematuria. During the next 3 years she remained well and free of hematuria.

Adult↗

PubMed1993

Potassium thiophosphate laser treatment of genitourinary hemangioma in the pediatric population.

Multiple hemangiomas of the urogenital system are uncommon lesions that usually recur and can cause significant morbidity. Three pediatric patients with urethral, bladder, penile, scrotal and vaginal hemangiomas underwent treatment of these lesions with the potassium thiophosphate laser. All patients had multiple lesions and suffered from recurrent bleeding before treatment. Potassium thiophosphate photocoagulation was delivered to the surface, urethral and vaginal lesions. Treatment-associated bleeding did not occur in any case. Followup urogenital and cystoscopic examinations revealed complete obliteration or marked diminution in the size of the treated hemangiomas. All patients had a decrease in the frequency and intensity of bleeding episodes and 2 were subsequently without further episodes of bleeding. Potassium thiophosphate laser photoablation provides excellent results in the pediatric population and is preferred to more extensive surgical intervention.

Child↗

PubMed1993

Hypocellular bladder wash specimens and their clinical significance.

Bladder wash flow cytometry specimens containing less than 1,000 cells were defined as hypocellular. Between June 1981 and December 1990, 5,676 bladder wash flow cytometry specimens were collected, of which 142 (2.5%) were deemed hypocellular. Of the 132 evaluable patients with hypocellular specimens 34 (30%) had documented evidence of carcinoma compared to 52% for the entire population. Among the 34 patients 30 had transitional cell carcinoma, of which 12 were carcinoma in situ, 9 stage Ta or T1 and 9 stage T2 or greater. Thus, there was no obvious relationship between stage or grade of carcinoma versus probability of a hypocellular specimen. Differences in irrigation techniques of different urologists in the operating room using general anesthesia versus catheter and cystoscopic irrigation in the outpatient clinic are discussed as possible explanations for the hypocellular specimens.

Biopsy↗