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PubMed1989

The importance of separation of prostatic lobes in relief of prostatic obstruction by balloon catheter urethroplasty: studies in dogs and humans.

We performed balloon urethroplasty in six older normal dogs and 10 patients with benign prostatic hypertrophy to establish the mechanism by which this technique results in relief of bladder outlet obstruction. Thirty-millimeter balloon catheters were used in both the animal and human studies. Autopsy studies showed disruption of the anterior prostatic commissure in four of the six dogs, disruption of both anterior and posterior commissures in one dog, and no disruption in the remaining dog. In all 10 patients, cystoscopy and urethrography showed disruption of the anterior commissure. Separation of the prostatic lobes by disruption of the prostatic commissures may be the most important mechanism by which balloon urethroplasty relieves urethral obstruction.

Animals↗
PubMed1991

A case of vesical leukoplakia.

A 54-year-old woman who had earlier been treated for cervical dysplasia complained of recurrent cystitis, urgency and frequency, but without signs of genital prolapse. At cystoscopy with biopsies, leukoplakia of the bladder was diagnosed. We describe how the condition is distinguished from squamous metaplasia of the trigone as seen in normal premenopausal women. An association between leukoplakia and cancer is widely accepted. Against this background, a follow-up program is outlined. The possibility of leukoplakia as a multicentric disorder of the genito-urinary tract is briefly discussed.

Biopsy↗
PubMed1980

Prostatism. II. The correlation between cysto-urethroscopic, cystometric and urodynamic findings.

The cysto-urethroscopic findings in 93 out of 107 consecutive patients referred for symptoms of bladder outlet obstruction were assessed and graded with special reference to bladder wall trabeculation, patency of the bladder neck, prostatic occlusion of the urethra, the estimated prostatic weight and the bladder neck-verumontanum distance. The cysto-urethroscopic findings of trabeculation and prostatic enlargement were not statistically significantly correlated to the cystometric demonstration of detrusor hyperreflexia. However, urodynamic parameters of infravesical obstruction judged by the opening pressure, maximum flow rate and the calculated urethral resistance were statistically significantly correlated to the cysto-urethroscopic findings of prostatic occlusion of the urethra, increased bladder neck-verumontanum distance and an increased prostatic weight estimated at cystoscopy. It is concluded that cysto-urethroscopy gives good information of as well the site as the hydrodynamic severity of organic infravesical obstruction.

Adult↗
PubMed1983

Mapping of cell cycle distribution in normal human urinary bladder epithelium.

A method is described by which urothelial cells from well defined areas in the urinary bladder mucosa can be obtained. At cystoscopy epithelial cells are aspirated by means of a ureteral catheter. The cells obtained by this selective sampling technique are well suited for morphology and for quantitative single cell measurements by flow cytometry (FCM). In the present study the cell cycle distribution has been measured by FCM. Twenty-five patients (13 males and 12 females) had urothelial cells collected from well defined areas in the mucosa and the DNA content measured from different sites separately. The distribution of bladder mucosa cells in the different parts of the cell cycle (G1, S-phase and G2 + M) is reported. No significant differences were found with regard to sex and age of the patients. Also, a low regional variation was found in the bladder mucosa indicating that the method should enable the discrimination of even small abnormal cell populations in tumour disease. No evidence of polyploidy in the human urothelium was found.

Adult↗
PubMed1984

Herald lesion of the urinary bladder.

The herald lesion of the urinary bladder is defined as an unspecific localized cystitis, eventually polypoid, in patients with symptoms from the lower urinary tract. The herald lesion is visualized by cystoscopy. Biopsies from the lesion show unspecific acute and/or chronic inflammation often accompanied by hyperplasia of the transitional cell epithelium. The herald lesion portends a neoplastic or inflammatory process in neighbouring organs. At our Institute of Pathology fourteen cases of the herald lesion were diagnosed during one and a half years. In 113 consecutive patients with ulcerative colitis and Crohn's disease no case of the herald lesion was found.

Adult↗
PubMed1985

Nonobstructive detrusor myopathy in a group of patients with chronic abacterial cystitis.

Chronic abacterial cystitis is clinically and pathoanatomically an ill-defined condition, presenting with a variety of urologic symptoms and often nonspecific histology. A retrospective histologic analysis of bladder biopsies from 101 patients with chronic abacterial cystitis revealed degenerative changes in the detrusor muscle cells (detrusor myopathy) in 25 of them. The changes were often very severe, and even fatty replacement of muscle tissue was seen. Retrospective analysis of the symptoms, urodynamics and cystoscopic findings in these patients showed that none had haematuria, but five (all women) had had urinary retention requiring catheterization. Significant residual urine was found in nine patients, and the cystometrograms showed a shift to the right. No patient had infravesical obstruction. At cystoscopy less than half of the patients had petechial bleeding after bladder distension. The aetiology and pathogenesis of the degenerative changes are unknown, despite theoretic speculation. The authors conclude that careful histologic examination can identify different clinical types of chronic abacterial cystitis. Such studies may assist future research into the nature of the problem and also the search for more rational therapy.

Adult↗
PubMed1989

The continuing challenge of bilharzial ureteric stricture.

The commonest urologic complication in 176 cases of chronic urinary bilharziasis was ureteric stricture (87 ureters in 55 patients), with the lower third of the ureter affected in 87% of the cases. Other complications included squamous-cell carcinoma of the bladder, urinary calculi and bladder calcification. Intravenous urography and cystoscopy were the most useful diagnostic methods in 76% of the cases. Post-micturition erect urography and frusemide intravenous urography gave great help in distinguishing between true mechanical and non-mechanical ureteric obstruction in patients with dilated pelvicalyceal system on conventional urograms. Only 17 of 68 dilated ureters were truly obstructed and required excision and ureteroneocystostomy. Postoperative vesicoureteric reflux developed in four of these cases. No deterioration of renal function occurred in the remaining, conservatively treated patients.

Adult↗
PubMed1997

Invasive, high grade transitional cell carcinoma of the bladder treated with transurethral resection. A survival analysis focusing on TUR as monotherapy.

Two hundred and fifteen consecutive patients admitted to our department between 1978 and 1988 were included in a retrospective study. Entrance criteria were transitional cell carcinoma of the bladder T1-4, Grade III-IV. Status of nodes and metastases were not recorded. Initially all patients had a macroscopically radical transurethral resection (TUR). Patients were followed with cystoscopies. Recurrent tumours were treated with repeated TUR (RE-TUR). In cases of progression to a higher T-stage or recurrences with multiple papillomas (> 10), adjuvant therapy was recommended. The patients were retrospectively allocated to three different groups. Group 1 had TUR only, Group 2 had TUR + adjuvant irradiation, and Group 3 had TUR and various adjuvant therapies (Table I). Median crude actuarial overall survival was 29 months. In Groups 1, 2 and 3, median crude survival was 37, 13 and 32 months, respectively. In the analysis, most emphasis was put on Group 1. For stages T1-4 in this group, the median survivals was 67, 19, 9 and 2 months, respectively. Differences were statistically significant (p < 0.05). T1 tumour stage seemed to predict a reduced risk of progression compared with the higher tumour stages (p = 0.05, Fisher's test). There was a tendency for females to progress less often than men, but the difference was not statistically significant. In conclusion, macroscopically radical TUR does not seem to offer the same cure rates as radical cystectomy. However, in a selected group of patients with a troublesome medical history, or for patients wishing minimal risk treatment, TUR might be a reasonable treatment modality.

Adult↗
PubMed1986

Are cystometric and cystoscopic examinations of any value for disabled incontinent elderly?

According to assessments made by the personnel and patients' own reports 42% of males and 54% of females aged 65 years or over and attending the day hospital in the town of Tampere were found to be incontinent. Incontinence was related to the frequency of urinating in the daytime. All incontinent patients of the day hospital were referred to the urologist at the University Hospital. Only about one third of these patients participated in the cystometric and cystoscopic examinations. The main reasons for non-attendance were unwillingness of the patient, referral of the patient to another place of care and resistant urinary infection. Urinary retention and small bladder capacity were common findings by cystometry and cystoscopy. A surgical management was recommended to seven per cent and conservative management to 93% of the patients. The concordance rates between the classification of the incontinence by anamnestic questions and the classification made by the urologist were not very high: the overall percentage of agreement was 40%. It is concluded, that not all incontinent elderly patients should be sent for cystometric and cystoscopic examination. Residual urine should be measured, if urinary retention is thought to be associated with incontinence. Furthermore, the classification of incontinence cannot be made only by using anamnestic questions.

Aged↗
PubMed1999

Irritative voiding symptoms: identifying the cause.

Most cases of irritative voiding are caused by urinary tract infections associated with common, community-acquired pathogens such as Escherichia coli. But when symptoms persist in the absence of infection, less common diagnoses must be considered. Appropriate cultures and urodynamic studies will rule out obstruction and identify detrusor hyperactivity. Definitive diagnosis of interstitial cystitis requires cystoscopy and hydrodistention.

Adult↗
PubMed2003

Primary non-Hodgkin's lymphoma of the bladder with bone marrow involvement.

Involvement of the lower urinary tract by advanced non-Hodgkin's lymphoma (NHL) has been reported in up to 13% of cases, but primary NHL of the urinary bladder is very rare. A 35-year-old man was admitted to our hospital with a chief complaint of gross hematuria with left flank pain on April 12, 2001. Cystoscopy revealed an edematous broad-based mass on the left lateral wall of the bladder, and transurethral biopsy showed NHL, diffuse large B-cell type. Abdomino-pelvic CT scan demonstrated left-side hydronephrosis and hydroureter with left proximal ureter infiltration and thickening of the left lateral wall of the bladder with perivesical fat infiltration without lymph node enlargement. Full-scale staging work-up revealed the bone marrow as the solely involved site. The lesions of the bladder and left urinary tract were nearly completely regressed after two cycles of systemic cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy with simultaneous restoration of urinary function.

Adult↗
PubMed2006

[Ascites and renal failure caused by a bladder fistula: report of one case].

Bladder fistula to open peritoneum is an uncommon cause of ascites. We report a 50 year-old woman with a history of pain in the lower abdomen and slight weight loss. The patient had a history of a repaired bladder perforation 12 years before, during a labor with forceps. The patient had microscopic hematuria and an abdominal CAT scan showed ascites. Serum creatinine was 2.2 mg/dl. An abdominal Doppler ultrasound showed normal portal and suprahepatic veins. Due to the suspicion that ascites accumulation could be urine, a sample was obtained and urea nitrogen and creatinine were measured. Since both levels were high in the ascitic fluid the patients was subjected to a cystoscopy that disclosed a fistula between the bladder and peritoneum. The patient was operated and the fistula excised. The postoperative period was uneventful, and the serum creatinine normalized.

Ascites↗
PubMed1978

Cystoscopic picture of Schistosoma haematobium in Egyptian children correlated to intensity of infection and morbidity.

Cystoscopy was done on 45 children, 5--12 yr old, infected with Schistosoma haematobium. On the basis of urinary egg output, the children were classifed as having mild, moderate, or heavy infection and the cystoscopic picture was correlated with their egg output and with their signs and symptoms. Lesions reported, in descending order of frequency, were: hyperemia, sandy patches, tubercles, ulcers, nodules, and polyps. Multiple schistosomal lesions were present in some patients and the frequency and severity of lesions correlated with the heaviness of infection. Individual variation in the severety of response to S. haematobium was observed.

Child↗
PubMed2005

Urothelial carcinoma in a child.

OBJECTIVES: Urothelial carcinoma of the bladder occurs rarely in the first 2 decades of life. We report a case of a 12 year-old child that presented with a Ta grade II/III urothelial carcinoma of the bladder. METHODS: We describe its clinical presentation and diagnostic procedures as well as treatment and follow-up. Finally, we review the literature to analyze the etiology, treatment, and surveillance of urothelial carcinoma in the pediatric population. RESULTS: Since 1950, there are less than 100 cases of urothelial carcinoma reported in patients less than 30 years, and even less in children and adolescents. Most of the small series describe these tumors as being characteristically superficial and low grade (I-ll). This child presented with silent macroscopic hematuria and an MRI revealed a solid and papillary mass measuring 2.7 cm. A cystoscopy and resection of the tumor confirmed the diagnosis. A re-resection at two months confirmed no residual tumor in the bladder. CONCLUSIONS: There is no established criteria for the etiology, treatment, and surveillance of urothelial carcinoma in the pediatric population. Children with gross hematuria as the presenting complaint should undergo a complete evaluation to rule out the presence of urothelial carcinoma.

Carcinoma, Transitional Cell↗
PubMed1989

[Clinico-statistical study on bladder tumor].

A survey was performed on 277 cases of bladder tumor including 221 males and 56 females (3.9:1), treated in the Department of Urology, Kyoto Prefectural University of Medicine. The result was as follows. The age distribution was from 24 to 86 years old with the average of 65.7. Histologically, 2 cases were diagnosed as transitional cell papilloma, 53 cases as transitional cell carcinoma G1, 111 cases as G2, 88 cases as G3, 16 cases as GX, 5 cases as squamous cell carcinoma and 2 cases as adenocarcinoma. As to the relationship between the grade and the stage, all cases of papilloma or G1 were superficial, while 7.2% of G2 and 45.5% of G3 were invasive, showing a close correlation. As to the relationship of cystoscopic findings and the stage, invasive tumors occupied 1.7% of tumors less than 1 cm in diameter, 16.7% of those 1 to 3 cm, 48.0% of 3 to 5 cm and 41.7% of more than 5 cm in diameter. Also 7.1% of papillary pedunculated tumors, 57.1% of non-papillary pedunculated, 21.7% of papillary sessile and 53.5% of non-papillary sessile were invasive. Thus cystoscopic findings of tumors correlated with the stage. The 5 year survival rates were 61.7% in all cases, 81.4% in pTa, 70.5% in pT1, 58.7% in pT2, 50.0% in pT3a, 32.6% in pT3b and 25.0% in pT4. The stage of tumors reflected the prognosis well. Careful cystoscopy and accurate grading were thought to be helpful for correct staging and for choosing a suitable treatment.

Adult↗
PubMed1992

[Vesical ultrasonography and internal examination of female patients with urethral syndrome].

Transabdominal ultrasonography of the bladder and internal examination were performed in 80 female patients without pyuria. They were divided into 3 groups: urethral syndrome with trigonitis (49 cases), asymptomatic trigonitis (16 cases) and normal bladder (15 cases) by cystoscopy. Ultrasonography of trigonitis with or without symptoms showed focal dilation of the submucosal low echo zone and mucosal irregularity around the bladder neck. On the sagittal view, the thicknesses from the surface of mucosa to that of muscle layer within 2 cm from the bladder neck were 4 +/- 1 mm (mean +/- standard deviation) in the group with urethral syndrome and in that with asymptomatic trigonitis, and 3 +/- 1 mm in the normal bladder group. Mucosa of the trigonitis with or without symptom is patients with significantly thicker than that of those with normal bladder (p less than 0.01). On internal examination, tenderness at the upper frontal wall of the vagina was present in 10 of 11 cases (91%) with urethral syndrome, in 2 of 8 cases (25%) with asymptomatic trigonitis and in one of 9 cases (11%) with normal bladder. There was a significant difference (p less than 0.005) between the degree of inflammation and the number of cases with tenderness at the frontal wall of the vagina. From these results, transabdominal ultrasonographic measurement of mucosal thickness around the bladder neck and internal examination for tenderness at the frontal wall of vagina are thought to be useful methods for diagnosis and follow-up of urethral syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Use of Nd:YAG laser and flexible cystoscope in outpatient treatment of recurrent superficial bladder tumors].

Nd:YAG laser irradiation and flexible cystoscopy were used in the outpatient management of 16 cases (21 sessions) with superficial bladder tumors. Irradiation of tumors was accomplished in all cases except 3 in which the visual field was affected by bleeding after the cup biopsy of tumors. Tumors at the bladder neck were easily irradiated through the flexible cystoscope. No tumor recurred at or near the previously irradiated site. This method provided a safe and cost-effective means to treat superficial bladder tumors in selected cases.

Adult↗