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PubMed1977

Recurrent stress urinary incontinence in the female.

1,500 females presenting with recurrent urinary incontinence were investigated in depth. 27% required further surgery, 127 of whom were treated with a 2-team Marlex sling. Careful assessment is the key to treatment including cystoscopy and good radiological documentation. One must be aware of the capabilities and limitations of the various procedures employed for stress incontinence and select the correct procedure for the given problem. When dealing with recurrent stress incontinence the surgical procedure must take down all periurethral scar, anteriorly and posteriorly and adequately elevate the urethrovesical junction so it is not the dependent point at the base of the funnel. The Marlex sling procedure fulfills the above criteria, has been singularly effective, and remarkably free of complications.

Cystoscopy↗

PubMed1983

Blood concentration of lignocaine after application of 2% lignocaine gel in the urethra.

In 35 patients undergoing topical anaesthesia with lignocaine (lidocaine) gel (2% Xylocaine gel) the concentration of lignocaine base was measured in repeated venous blood samples. Twenty patients (group I) were given 20 ml of 2% lignocaine gel (400 mg lignocaine) and 5 patients (group II) received 40 ml (800 mg lignocaine) endourethrally. These 2 groups of patients underwent either dilation of the urethra or urethrocystoscopy. Ten patients (group III) undergoing transurethral resection of the prostate or a bladder tumour, were given 20 ml of gel (400 mg lignocaine) plus spinal anaesthesia with 2 ml of 5% lignocaine (100 mg lignocaine) with 7.5% glucose (Xylocaine "heavy"). The mean peak blood concentrations of lignocaine in these 3 groups were 0.06, 0.15 and 0.36 micrograms/ml respectively. Patients undergoing urethral dilatation had significantly higher blood concentrations than cystoscopy patients. The blood concentrations in group III were not higher than the expected value when spinal anaesthesia and lignocaine gel were given simultaneously. There was no statistically significant difference in the blood concentration between patients undergoing different types of transurethral resection (prostate and cancer of the bladder). Lignocaine applied endourethrally gives an extremely low blood concentration which is far below the level which can cause general toxic symptoms.

Administration, Topical↗

PubMed1985

The effect of intravesical thiotepa on the recurrence rate of newly diagnosed superficial bladder cancer. An MRC Study. MRC Working Party on Urological Cancer.

Four hundred and seventeen patients with newly diagnosed superficial bladder tumours (Ta or T1) were treated with complete transurethral resection and then randomised between three groups. Group 1 had an instillation of 30 mg thiotepa at the time of primary treatment. Group 2 had instillations of thiotepa at 3-monthly intervals for a year. Group 3 was given no instillation. Regular check cystoscopies revealed no significant difference in the rate at which tumours recurred in the three groups (p = 0.4 and P = 0.7 for control vs thiotepa given once and five times respectively). It was concluded that neither thiotepa regimen produced sufficient improvement to justify its use in this group of patients.

Adult↗

PubMed1990

Foley catheter balloon puncture and the risk of free fragment formation.

The incidence of free fragment formation following balloon puncture or spontaneous bursting was examined in 294 Foley catheters immersed for 48 h in urine. The catheters were divided into 3 groups: 100 were inflated to the manufacturer's recommended volume, 100 to twice the volume and 94 to 3 times the recommended volume. The catheter balloons were punctured by pricking with a hypodermic needle. The overall incidence of free fragment formation was 27.3%. For both types of catheter examined, increasing balloon volume was not associated with an increased risk of free fragment formation following puncture. However, increasing volume was associated with increased free fragment formation when the balloon burst spontaneously. In view of the high risk of free fragment formation, cystoscopy should be performed in all cases of spontaneous catheter balloon rupture or after percutaneous balloon puncture.

Catheters, Indwelling↗

PubMed1992

Detrusor mast cells in refractory idiopathic instability.

The diagnosis of interstitial cystitis (IC) is not usually considered in patients with idiopathic instability. Because histamine provokes detrusor contractions in vitro, we assessed detrusor mast cell counts in 29 females with refractory instability. Raised mast cell counts (greater than 28/mm2 of detrusor muscle, consistent with a histological diagnosis of IC) were found in 29% of such cases. Thus cystoscopy and bladder biopsy should be considered in patients with idiopathic instability which fails to respond to anticholinergic drugs, as alternative therapy may be useful. Patients with refractory instability and normal detrusor mast cell counts often gave a history of prolonged childhood nocturnal enuresis (55% of cases); in contrast, patients with intractable instability and abnormally high mast cell counts seldom gave such a history (12%). These trends may give some insight into the aetiology of idiopathic instability--"congenital" or acquired?

Adult↗

PubMed1992

Urological audit: the role for an aggressive approach to high grade superficial bladder tumours.

A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted. There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3). A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted. This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning "established" surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be introduced.

Adult↗

PubMed1994

The effect of intravesical thiotepa on tumour recurrence after endoscopic treatment of newly diagnosed superficial bladder cancer. A further report with long-term follow-up of a Medical Research Council randomized trial. Medical Research Council Working Party on Urological Cancer, Subgroup on Superficial Bladder Cancer.

OBJECTIVE: To determine the role, if any, of one and five installations of intravesical thiotepa in the treatment of newly diagnosed superficial bladder cancer. PATIENTS AND METHODS: A multicentre randomized clinical trial was carried out involving 417 patients with newly diagnosed superficial bladder cancer. After transurethral resection the patients were randomized into one of three treatment arms: no thiotepa; one instillation of thiotepa at the time of resection; one instillation at time of resection and then at 3-monthly intervals for one year (giving a total of five instillations). In all treatment arms the dosage was 30 mg thiotepa in 50 ml saline. The main outcome measures were time to first superficial recurrence, recurrence rate (defined as the number of possible cystoscopies per annum) and failure-free interval rate (where failure was defined as the development of invasive disease, metastatic disease or death from bladder cancer). RESULTS: After a median follow-up of 8 years and 9 months analysis showed no evidence of a difference between the three groups with respect to time to first recurrence, recurrence rates or the failure-free interval rate. CONCLUSIONS: This analysis confirms that the thiotepa regimens tested cannot be recommended for use outside clinical trials for patients with newly diagnosed superficial bladder cancer.

Administration, Intravesical↗

PubMed1995

Urinary basic fibroblast growth factor in patients with bladder cancer and benign prostatic hypertrophy.

OBJECTIVE: To investigate the role of urinary measurements of an angiogenic factor, basic fibroblast growth factor (bFGF), in the assessment of patients with bladder cancer. PATIENTS AND METHODS: Urine from 83 patients was assayed using a commercially available ELISA for bFGF. Thirty-eight patients had a bladder tumour and 21 had a history of bladder cancer but no disease at the time of testing. Twenty-four patients acted as controls, 16 of whom were about to undergo transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH) and eight who had no urological disease. RESULTS: Median urinary bFGF was higher in patients with active bladder cancer than in those with a clear cystoscopy (5.20 and 2.13 ng/g creatinine, respectively; P < 0.005). Median urinary bFGF was also elevated in patients about to undergo TURP (4.52 ng/g creatinine). Using a threshold value of 6.0 ng/g creatinine, the sensitivity of the test for detecting cancer was 42% and specificity was 88%. At a threshold value of 4.0 ng/g the sensitivity was 62% and the specificity 70%. CONCLUSION: The relationship between urinary basic FGF and the presence of bladder cancer was significant. The test is not sufficiently sensitive or specific to use as a screening test for bladder cancer but may be very useful in monitoring the effectiveness of systemic therapies in bladder cancer. Elevated levels of bFGF in the urine of patients about to undergo TURP suggests a role for bFGF in the pathogenesis of BPH.

Aged↗

PubMed1992

Urinary bladder carcinoma as apparent cause of antepartum haemorrhage in pregnancy.

A 34-year-old multipara presented with painless profuse genital bleeding during the third trimester of pregnancy in a state of hemorrhagic shock. Haematuria because of urinary bladder carcinoma was found to be the cause of bleeding. Cystoscopy was useful for accurate diagnosis as well as for achieving haemostasis. This case emphasizes the possibility and importance of haematuria when dealing with a patient with antepartum haemorrhage.

Adenocarcinoma, Mucinous↗

PubMed1999

Partial perforation of bladder by multiload.

A rare case of partial perforation of the wall of the bladder by an intrauterine contraceptive device (IUCD) in a puerperal woman and its subsequent laparoscopic removal is described. Cystoscopy revealed an intact bladder mucosa with the IUCD lying submucosally. This case demonstrates that an IUCD embedded in the wall of the bladder, whose mucosa is intact, can be safely removed through a laparoscope without resorting to laparotomy.

Adult↗

PubMed2005

Propensity score matching with time-dependent covariates.

In observational studies with a time-dependent treatment and time-dependent covariates, it is desirable to balance the distribution of the covariates at every time point. A time-dependent propensity score based on the Cox proportional hazards model is proposed and used in risk set matching. Matching on this propensity score is shown to achieve a balanced distribution of the covariates in both treated and control groups. Optimal matching with various designs is conducted and compared in a study of a surgical treatment, cystoscopy and hydrodistention, given in response to a chronic bladder disease, interstitial cystitis. Simulation studies also suggest that the statistical analysis after matching outperforms the analysis without matching in terms of both point and interval estimations.

Cohort Studies↗

PubMedDate not supplied

Chronic renal failure associated with nephrolithiasis, ureterolithiasis, and renal dysplasia in a 2-year-old quarter horse gelding.

A 2-year-old quarter horse gelding presented for evaluation of polyuria and polydipsia. Azotemia was detected on serum chemistry profile. Small, misshapen, hyperechoic kidneys with decreased corticomedullary demarcation, hydronephrosis, and a right nephrolith were noted ultrasonographically. The diagnosis of end-stage kidney disease and dysplasia was made histopathologically using ultrasound-guided biopsy. Two ureteroliths were found in the right ureter via cystoscopy, and a nephrolith was seen in the right kidney at necropsy. Clinical, ultrasonographic, and pathologic features of equine urolithiasis and renal dysplasia are discussed.

Animals↗

PubMed2005

Eosinophilic cystitis and its management.

Eosinophilic cystitis (EC) is a rare clinicopathological condition characterized by transmural inflammation of the bladder predominantly with eosinophils, associated with fibrosis with or without muscle necrosis. The cause of EC remains unclear, although it has been associated with various aetiological factors, such as allergy, bladder tumour, bladder trauma, parasitic infections and chemotherapeutic agents. EC is, probably, caused by the antigen-antibody reaction. This leads to the production of various immunoglobulins, which, in turn, cause the activation of eosinophils and initiates the inflammatory process. The most common symptom complex consists of frequency, haematuria, dysuria and suprapubic pain. Cystoscopy and biopsy are the gold standard for diagnosis. Additional laboratory evidence supporting the diagnosis includes proteinuria, microscopic haematuria and peripheral eosinophilia, the last one occurring in few patients. There is no curative treatment for this condition. Current treatment modalities include transurethral resection of the bladder lesion along with non-specific medical therapy, such as non-steroidal anti-inflammatory agents or steroids. Because the lesion tends to recur in spite of the above therapy, long-term follow-up is mandatory.

Algorithms↗

PubMed2006

Virtual endoscopy of the urinary tract.

Technological breakthroughs have advanced the temporal and spatial resolutions of diagnostic imaging, and 3 dimensional (3-D) reconstruction techniques have been introduced into everyday clinical practice. Virtual endoscopy (VE) is a non-invasive technique that amplifies the perception of cross-sectional images in the 3-D space, providing precise spatial relationships of pathological regions and their surrounding structures. A variety of computer algorithms can be used to generate 3-D images, taking advantage of the information inherent in either spiral computed tomography or magnetic resonance imaging (MRI). VE images enable endoluminal navigation through hollow organs, thus simulating conventional endoscopy. Several clinical studies have validated the diagnostic utility of virtual cystoscopy, which has high sensitivity and specificity rates in the detection of bladder tumor. Published experience in the virtual exploration of the renal pelvis, ureter and urethra is encouraging but still scarce. VE is a safe, non-invasive method that could be applied in the long-term follow-up of patients with ureteropelvic junction obstruction, urinary bladder tumors and ureteral and/or urethral strictures. Its principal limitations are the inability to provide biopsy tissue specimens for histopathologic examination and the associated ionizing radiation hazards (unless MRI is used). However, in the case of endoluminal stenosis or obstruction, VE permits virtual endoluminal navigation both cephalad and caudal to the stenotic segment. To conclude, VE provides a less invasive method of evaluating the urinary tract, especially for clinicians who are less familiar with cross-sectional imaging than radiologists.

Cystoscopy↗

PubMed1999

Renal haemangioma in a dog.

A three-and-a-half-year-old, spayed female, crossbred dog was presented with chronic haematuria. Diagnostic tests included abdominal ultrasonography, intravenous urography, cystoscopy and nephrectomy. Renal haemangioma was identified as the cause of the haematuria, which resolved postoperatively. A subcutaneous mass developed one month after the nephrectomy, which was diagnosed by biopsy as a cutaneous cavernous haemangioma. No other masses were reported one year later.

Animals↗

PubMed1972

Bacteremia after genitourinary tract manipulation: bacteriological aspects and evaluation of various blood culture systems.

A total of 300 patients undergoing various types of urological procedures was studied for incidence of bacteremia. An osmotically stabilized anaerobic broth with sodium polyanethol sulfonate (Liquoid) yielded more positive blood cultures than any other culture system and was also the best system by far for recovery of anaerobes. The membrane filter showed faster growth and, therefore, facilitated faster identification of the infecting organism. There was a 31% incidence of bacteremia in the patients having transurethral resection of the prostate, 17% in the cystoscopy group, 24% in the urethral dilation group, and 8% in the urethral catheterization group. The organisms found most frequently isolated in blood cultures were enterococci and Klebsiella pneumoniae. Notable were a relatively large number of anaerobes and two protoplasts. The major source of the bacteremia was previous urinary tract infection, but evidence is presented which indicates that the prostate gland and the normal urethral flora are other significant sources.

Anaerobiosis↗

PubMed1975

Diseases causing end-stage renal failure in New South Wales.

The nature of the original renal disease was determined in 403 consecutive cases of end-stage renal failure, in 317 of which the clinical diagnosis was corroborated by histological examination of the kidney. Five diseases accounted for 20 or more cases--glomerulonephritis (31% of the total), analgesic nephropathy (29%), primary vesicoureteral reflux (8%), essential hypertension (6%), and polycystic kidneys (5%). In only four cases did renal failure result from chronic pyelonephritis without a demonstrable primary cause. Greater use of micturating cystography and cystoscopy and routine urine testing for salicylate are advocated for earlier diagnosis of the major causes of "pyelonephritis". The incidence of end-stage renal failure in people aged 15-55 in New South Wales was estimated to be at least 34 new cases per million of total population each year.

Acetaminophen↗

PubMed1974

Use of intravenous urography.

Studies on 1,476 intravenous urographic examinations done in a 15-month period showed that the proportion of abnormal results varied widely-from 20% in patients with abdominal pain other than renal colic to 92% of those in prostatism. Patients with the strongest clinical evidence of haematuria were the most likely to have abnormal urograms, and to undergo cystoscopy with abnormal findings on this examination. All six patients with renal hypertension showed abnormalities other than on the urogram. Prior use of other tests may increase the effectiveness of urography.

Abdomen, Acute↗