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PubMed2005

[Section of intravesical TVT tape by a suprapubic trocar].

Since its first description in 1995, treatment of female urinary incontinence by TVT has become a routine procedure. The ascending retropubic approach can lead to a number of complications. Bladder trauma is observed in 2% to 20% of cases depending on the series. They do not have any repercussions if they are diagnosed and repaired intraoperatively, but, when they are detected later, they raise problems of diagnosis and management. The authors report 2 cases in which a combination of cystoscopy and laparoscopy was used to section intravesical TVT.

Cystoscopy↗

PubMed1992

[Vesico-uterine fistula].

We report a case of uterovesical fistula that had been diagnosed by cystoscopy, vaginoscopy and ultrasonography. Fistulorrhaphy via the transperitoneal transvesical approach resolved the passage of urine to the vagina. The decision to perform a conservative or more aggressive approach is determined by the site of the fistula.

Adult↗

PubMedDate not supplied

Intravesical gemcitabine in superficial bladder cancer: a phase II safety, efficacy and pharmacokinetic study.

BACKGROUND: We investigated the safety, efficacy and pharmacokinetics of the intravesical administration of 2000 mg gemcitabine once a week in the four weeks before transurethral resection of superficial bladder cancer (TUR), and in the four successive weeks. MATERIALS AND METHODS: Nine patients with superficial transitional cell bladder carcinoma were studied. Two thousand mg of gemcitabine dissolved in 50 ml of distilled water were administered intravesically. The dwell time was 60 min. The pharmacokinetics of gemcitabine and its metabolite, 2',2'-difluorodeoxyuridine (dFdU), were studied in plasma and urine before and after TUR. Cystoscopy was repeated 30 days after completion of the TUR treatment and subsequently at time intervals of one or two months. RESULTS: No systemic toxicity was noted, and only three patients displayed modest signs of local toxicity. One patient had recurrence 1 month after TUR, three between 3 and 6 months, and another three after 8, 11 and 18 months, respectively; two were recurrence-free after 21 and 22 months, respectively. The peak plasma concentrations of gemcitabine never exceeded 1000 ng/ml before TUR and 350 ng/ml after TUR, and declined rapidly. The plasma levels of dFdU were higher than those of gemcitabine, increased until 60 min and then declined little. Between 52% and 100% of the gemcitabine dose was present in voided urine. CONCLUSION: Intravesical gemcitabine, at the dose of 2000 mg, is well tolerated, is associated with minimal systemic absorption and has a moderate efficacy in the treatment of superficial bladder cancer.

Administration, Intravesical↗

PubMedDate not supplied

[Follow up of urinary bladder cancer--a task for the urology nurse?].

The introduction of the flexible cystoscope has simplified the examination for both the patient and the examiner. With an attached video camera to the cystoscope it showed that the assistent nurse fastly learned to interpret any finding in the bladder. In an article from England it was shown that a trained nurse cystoscopist had the same accuracy in detecting bladder tumors as a consultant urologist. The present study addresses the question if the same is valid in our department. After a period of training we started the study. 50 consecutive patients with known bladder cancer were first examined by the nurse who recorded any relapses of bladder tumor. Then the urologist examined the bladder unaware of the nurse's finding. Any discrepancy was reexamined together. 23 relapse cases of tumor were found, all which were diagnosed by the nurse. The urologist was un-able to detect 2 small grade 1 tumors. The result strengthened us to initiate a nurse-led follow up of patients with known bladder tumor. Until now about 100 cystoscopies have been done by a nurse with only good experience.

Clinical Competence↗

PubMed2005

[Urinary schistosomiasis: remarks on a case].

Urinary tract schistosomiasis is a parasitic disease caused by S. haematobium with a wide range of clinical manifestations related to the mucosal and submucosal granulomatous lesions of the bladder. It affects about 80 million people in Africa, Middle-East and India, while in Italy it is rarely seen among immigrants from endemic areas and returning travellers. The authors describe a case occurred in a 26 years old man, recently emigrated from a rural area of Ghana. He had the symptoms of a haemorrhagic cystitis. Cystoscopy and biopsy showed granulomatous lesions of bladder with calcified eggs. Microscopic examination of urine was positive for Schistosoma haematobium eggs. The therapy with Praziquantel (40 mg/Kg una tantum) was effective. The authors emphasized the risk of introduction of schistosomiasis in some regions of our country, in consideration of the presence of the intermediate host as well as of an appropriate climate.

Adult↗

PubMed2005

[Bladder leiomyoma treated by transurethral endoscopic resection].

We report a case of intravesical bladder leiomyoma in a 47-year-old patient presenting with recurrent macroscopic haematuria. The diagnosis was strongly suspected on CT and cystoscopy. Treatment consisted of transurethral resection of the mass. No recurrence has been observed with a follow-up of two years. In the light of this case, the authors discuss the diagnosis and treatment of bladder leiomyoma.

Cystoscopy↗

PubMed2005

[A rare case of transitional cell carcinoma of the ileum segment arising 43 years after ureteroileocystoplasty due to tuberculous bladder atrophy].

A 60-year-old woman visited our hospital complaining of fever up. She had undergone augmentation ileoplasty for tuberculous bladder atrophy 43 years age. Cystoscopy revealed a broadbased tumor on the ileal segment. Histopathological findings of the biopsy specimen demonstrated grade 3 transitional cell carcinoma. She was given 2 courses of chemotherapy (methotrexate, vincristine, adriamicin, cisplatin), but died of metastasis of carcinoma 4 months after diagnosis.

Anastomosis, Surgical↗

PubMed2006

[Diagnosis and treatment of interstitial cystitis: report of 16 misdiagnosed cases].

OBJECTIVE: To investigate the diagnoses and treatment of interstitial cystitis (IC). METHODS: The clinical data of 16 IC patients were analyzed respectively. The patients with urinary frequency, urgency, suprapubic pain and chronic pelvic pain. They were misdiagnosed as chronic cystitis, pelvic inflammation, endometriosis, cystophthisis and urethral syndrome, and were diagnosed finally by the means of pathology or cystoscopy. Among the 16 patients, 4 cases had the operation of ileal reservoir, Two cases had sigmoid-cysto-plasty, and 10 cases had drug treatment. The methods of IC diagnosis and treatment were discussed with the review of literature. RESULTS: The pelvic ache disappeared completely in 4 cases after the operation of ileal reservoir; Two cases after cystoplasty felt lightly discomfortable in perineum occasionally, and their bladder capacity was above 350 ml, no recurrence after operation having been found after follow-up for 24 months and 33 months; Ten cases treated with non-operative treatment improved obviously, with the O'Leary-Sant IC symptom index and IC problem index decreased from 15.4 +/- 4.1, 9.4 +/- 2.7 to 4.1 +/- 2.1 and 5.1 +/- 3.9, respectively. CONCLUSIONS: Sufficient attention should be paid to the diagnosis and differential diagnosis of IC; Early diagnosis and therapeutic alliance with manifold measures can relieve the patients' symptom and improve the quality of life.

Adult↗

PubMed2006

[A case report: Bilharzial schistosomiasis in the urinary bladder presented with gross hematuria].

A 31-year-old Japanese man who had been in Africa for two years presented with gross hematuria. He had been swimming in Lake Malawi during this period. Urinary specimen consisted of hematuria and pyuria. Cystoscopy showed tumors resembling Bilharzial tubercles located in the trigone, left lateral and posterior wall and dome. Further urine examination demonstrated eggs of schistosome haematobium. The patient was highly suspected of having Bilharzial schistosomiasis in the urinary bladder. Transurethral resection of bladder tumors was performed for diagnosis. Pathological examination revealed granuloma with many eggs of schistosome haematobium. He was diagnosed with Bilharzial schistosomiasis and was treated with 3,600 mg of praziquantel daily for two days. There have been no signs of recurrence during the one-year follow up except for excretion of degenerated eggs of schistosome haematobium in the urine specimens.

Adult↗

PubMed2006

Assessment of microscopic hematuria in adults.

Microscopic hematuria, a common finding on routine urinalysis of adults, is clinically significant when three to five red blood cells per high-power field are visible. Etiologies of microscopic hematuria range from incidental causes to life-threatening urinary tract neoplasm. The lack of evidence-based imaging guidelines can complicate the family physician's decision about the best way to proceed. Patients with proteinuria, red cell casts, and elevated serum creatinine levels should be referred promptly to a nephrology subspecialist. Microscopic hematuria with signs of urinary tract infection should resolve with appropriate treatment of the underlying infection. Patients with asymptomatic microscopic hematuria or with hematuria persisting after treatment of urinary tract infection also need to be evaluated. Because upper and lower urinary tract pathologies often coexist, patients should be evaluated using cytology plus intravenous urography, computed tomography, or ultrasonography. When urine cytology results are abnormal, cystoscopy should be performed to complete the investigation.

Algorithms↗

PubMed2006

[A case of inflammatory myofibroblastic tumor of the urinary bladder finally diagnosed by anaplastic lymphoma kinase (ALK) immunostaining].

A 52-year-old house wife presented with pain on urination. Cystoscopy and magnetic resonance imaging revealed solid and sessile tumor of 3 cm in diameter invading the bladder wall. Pathological examination of the transurethral resection specimen showed proliferation of spindle cells and epithelial cells. Since both types of cells were positive for cytokeratin immunostaining, sarcomatoid carcinoma was highly suspected. She underwent anterior pelvic exenteration and construction of continent reservoir (Penn Pouch). Since the tumor cells showed spindle cell proliferation alone without epithelial growth and positive staining for anaplastic lymphoma kinase, we corrected the final diagnosis as an inflammatory myofibroblastic tumor of the urinary bladder. She has been doing well without recurrence for 1 year.

Anaplastic Lymphoma Kinase↗

PubMed2006

[Antibacterial prophylaxis in endourological procedures].

AIM: Antibiotic prophylaxis for the prevention of postsurgical infections is a common practice in urologic surgery, as well as in endourologic procedures, both in at risk patients (local or systemic risk factors: age, immunological status, metabolic disorders, poor general conditions) or with a positive urine culture, but also in patients with urine previously sterile. As Gram-negative strains are the most common pathogens, it is reasonable to use a quinolone or a beta-lactam. METHODS: One-hundred and thirty-one patients (range 21-89 years) underwent transurethral cystoscopy (52 cases), vesical catheterism (44 cases), extracorporeal shockwave lithotripsy (17 cases) and transrectal prostatic biopsy (18 cases). An antimicrobial prophylaxis with ciprofloxacin 500 mg (22 patients, 16.8%), levofloxacin 500 mg (54 patients, 41.2%) and prulifloxacin 600 mg (55 patients, 42%) was administered. RESULTS: Globally, the incidence of urinary tract infections during 15 days after surgery was 8.4% (11 cases out of 131): ciprofloxacin 9.1%, levofloxacin 11.1% and prulifloxacin 5.5%, respectively. The patients compliance with the prophylactic treatment was good or excellent in 122 cases (93.1%) and poor in 9 cases (6.9%). No major differences between antibiotics used in prophylaxis were detected, keeping into account the limited size of the global population and subgroups defined by the endourological procedures. CONCLUSIONS: Prulifoxacin, with a broad antimicrobial spectrum, favourable pharmacokinetic properties and easy to use, can be considered a valid and well tolerated therapeutic option for the antibacterial prophylaxis in endourological procedures, both in hospital and in outpatient setting.

Adult↗

PubMed2006

Hematospermia: diagnosis and treatment.

The presence of blood in ejaculate represents 1% of all andrologic and urologic symptoms. In most cases it has a benign character and tends to regress spontaneously after the first episode. But in the same case it can be caused by bladder-prostate or systemic malignant patology, so it is necessary to subject the patient to laboratory and instrumental tests in order to find the best treatment that, as for hematospermia, is an etiological one. Most important for correct diagnosis are patient history, physical examination, laboratory tests, transrectal ultrasound examination of the prostate, MRI, CT, cistoscopy. Hematospermia is rarely associated with significant pathology, especially in younger men. The 3 factors that dictate the extent of the evaluation and treatment are patients age, the duration and recurrence of the hematospermia, and the presence of any associated hematuria. So it is possible to distinguish idiopathic from secondary hematospermia, because secondary hematospermia, i.e. the one in which the bleeding cause is known or suspected, requires an etiologic treatment. Urologists must make rational decisions based on evidence rather than practice defensive medicine. Understanding the pathophysiology and prevalence in populations of different ages helps minimize the likelihood of problems. When in doubt, performing a TRUS, cystoscopy, and basic laboratory analyses limits exposure.

Adult↗

PubMed2006

[Hydrodistention of the bladder in patients with interstitial cystitis--clinical efficacy and its association with immunohistochemical findings for bladder tissues].

We retrospectively analyzed the clinical relevance of hydrodistention under anesthesia for patients having urgency and/or lower abdominal pain who were clinically diagnosed as having interstitial cystitis (IC) from May 1996 to May 2005. Their symptoms were refractory to anticholinergic or antiinflammatory agents. Hydrodistention was performed under general or spinal anesthesia with direct vision by cystoscopy and irrigation fluid was instilled into the bladder at a pressure of 80 cmH2O. Cystoscopic findings revealed glomerulation in 26 patients (96%), cracking in 10 (37%) and Hunner's ulcer in 3. Twenty-four patients (89%) obtained improvement of the objective symptoms after treatment. However, symptoms soon deteriorated in 16 patients, and the average duration of efficacy was only 4.7 months (SD; +/-3.7). There were two episodes of complication in this treatment. Bladder rupture occurred during hydrodistention, but was successfully managed with simple percutaneous perivesical drainage. One patient with acute pyelonephritis was treated with an antimicrobial agent without any additional treatment. Although bladder specimens were examined by immunohistochemistry, tryptase and c-kit were not linked with the mast cell count, severity of symptoms or treatment efficacy. Hydrodistention of the bladder may be recommended as the first treatment choice for patients with IC because it provides relatively high efficacy. However, the short duration of the efficacy requires a second-line treatment option for better management of patients with IC.

Adult↗

PubMed2006

[A case of emphysematous cystitis: a case report].

A 86-year-old woman presented with asymptomatic gross hematuria,and visited our hospital, and a vesicorectal fistula was suspected from a computed tomographic (CT) scan. She had a lower abdominal mass and urinary retention on arrival. Pclvic CT demonstrated intramural gas in the urinary bladder,which suggested a diagnosis of emphysematous cystitis. Cystoscopy demonstrated reddish mucosa and gas within the bladder wall. The gross hematuria was improved and the intramural gas disappeared on a CT scan after urinary drainage and antibiotic therapy. Although emphysematous cystitis is almost always cured with conservative therapy, an accurate diagonosis and prompt treatment are required because rarely emphysematous cystitis can result in rupture of the urinary bladder and lead to septic shock.

Aged, 80 and over↗

PubMed1991

[Value and limitations of urinary cytology in the diagnosis of bladder tumors].

There were studied 222 patients with bladder tumors, 64 with operated transitional cell carcinoma and 166 with non-malignant diseases from cytologic and histologic point of view. Each patient was investigated by urinary cytology, endoscopy, and during the intervention biopsies were taken, which helped us to establish the histological form, the degree of differentiation and "T" element, using TNM system. All smears were stained by blue polychrome-tannin Dragan method and correlated with histological results which allowed us to appreciate cytodiagnostic as real positives, false negatives, real negatives and false positives. We signalled out some morphological aspects of malignant cells revealed by blue polychrome-tannin Dragan stain, which identified malignant elements in 87% tumors of the bladder G1, in 91.5% in G2 and 93.5% in G3; results were enhanced using washings of the bladder. There was some causes for false negatives results: a calcified tumor in its surface, tumors developed in vesical diverticulum, a limited exfoliation and a wrong interpretation of exfoliated cells. In patients transurethrally operated for tumors of the bladder the urinary cytology identified malignant elements in 22 of them; four presented tumors in the moment of endoscopic examination and 18 were considered as "apparently false-positive"; eleven of them developed tumors in the next 6-24 months from the intervention. In patients with non-malignant diseases false positives results were related specially to urinary lithiasis and chronic renal failure. Results of initial and survey cytodiagnosis allowed us to increase the period between traditional cystoscopies.

Carcinoma, Transitional Cell↗

PubMedDate not supplied

[Evaluation of tumor staging using echography in bladder tumors (2)].

The paper shows the value of echography in tumoral grading based on 87 patients who besides cystoscopy, bimanual touch and histology study by transurethral resection, had an echography performed. Sensitivity achieved for tumour detection through echography was 85% with a positive predictor value of 98.8%. On the 72 patients who were diagnosed a tumour through echography, TUR histology showed an echography under-grading of 2.7% (2 cases) and an over-grading of 9.7% (7 cases) with grading correlation in 86.3% cases.

Cystoscopy↗

PubMed1991

[Patent urachus associated with abdominal abscess: report of a case].

A case of the patent urachus associated with abdominal abscess was reported. A 44-year-old woman was consulted to our clinic with the complaints of bladder irritability and discharge from the navel on October 27, 1987. A fist-sized tumor around the umbilicus was pointed out and the cystography from the umbilicus demonstrated that the contrast medium reached to the urinary bladder. The cystoscopy showed the protruded lesion on the dome of the bladder. The pre-operative diagnosis was patent urachus. She received resection of the urachus on November 11, 1987. The pathological finding was pyogenic granuloma of the urachus due to chronic inflammation.

Abdominal Muscles↗