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At least 1,495 records · Page 83Linked to original sources

PubMed1994

Stage IB carcinoma of the cervix: are all staging tests and procedures necessary?

The prognostic value and cost effectiveness of generally recommended ancillary tests and staging procedures in 115 patients with clinical Stage IB carcinoma of the cervix were retrospectively reviewed. All 112 intravenous pyelograms, 108 barium enemas, 102 cystoscopies and 98 sigmoidoscopies were normal. No malignant cells were found in pelvic washings. Of 111 patients who had paraaortic lymph node biopsies, only one had a positive node. This node was grossly enlarged and clinically suspicious. Paraaortic lymph node status was not influenced by tumor grade, prior conization, lymphovascular space involvement, depth of stromal invasion, positive pelvic lymph nodes or number of paraaortic nodes biopsied. The tests evaluated in this study are unnecessary and should no longer be performed in patients with clinical Stage IB carcinoma of the cervix. In addition, paraaortic lymph node biopsies in the absence of clinically suspicious nodes are not warranted. Eliminating these tests and procedures would result in substantial savings in health care cost.

Adenocarcinoma↗

PubMed1993

[Video laparocystoscopy: diagnostic and operative possibilities].

Bladder endoscopy and videolaparoscopy, both outcomes of human intelligence applied to technology, allow in association, to evaluate bladder proliferent alterations in the depth, providing the possibility to perform a radical treatment, including perithoneum, without risks of ileum injuries. Aim of the method is to increase diagnostic and operative effectiveness of the simple cystoscopy by the adding of the endoperithoneal control of the bladder just by the videolaparoscopy. By this new technique at least two main advantages may be achieved: the check at full thickness of the bladder wall by translightening; the transurethral resection with laparoscopic assistance.

Cystoscopy↗

PubMed1993

[Antimicrobial prophylaxis in urethrocystoscopy. Comparative study].

Instrumentation of lower urinary tract is a predisposing factor for the development of urinary infection. Incidence of infective complications following urethrocystoscopy has been evaluated in a multicenter, prospective, comparative and randomized study in 2,284 patients, who had a previous negative urine culture. Patients were randomized into two groups: one to be used as control and the other one to received antimicrobial prophylaxis prior to instrumentation (ceftriazone, 1 gr intramuscular). Clinical and microbiological responses were evaluated at 48-72 hours and 4 weeks after cystoscopy. Symptomatic bacteriuria was observed in 10.2% of patients in the control group and in 2.5% in the prophylaxis group (p < 0.000); asymptomatic bacteriuria in 3.02% and 1.52% (p > 0.05) and irritative syndrome with sterile urine in 2.93% and 2.60% (p > 0.05), respectively. Thus, the use of prophylaxis reduced the incidence of infective complications in these patients.

Adolescent↗

PubMed1995

[Urinary cytology of transitional-cell carcinoma].

The authors report on their experience about urinary cytology in 1991. They studied 100 patients with cytology and histology, carried by cystoscopy and cold-mapping biopsy, trying to have notice about cytological value and proficiency.

Biopsy↗

PubMed1995

[Usefulness of the 24-hour delayed film of upper gastrointestinal series for the diagnosis of sigmoidovesical fistula: report of 3 cases].

Recently, sigmoidovesical fistula is not a rare disease as a result of the change of our food style and increase in the age ratio. However, in general, the preoperative image diagnosis is difficult. We have experienced three cases of sigmoidovesical fistula, examined by barium enema, cystography, upper gastrointestinal series, cystoscopy, colonic fiberscopy and computed tomography. The fistulas were identified preoperatively by the 24-hour delayed film of upper gastrointestinal series. By this method, the regions of sigmoidovesical fistula were identified, and the patients were operated. We concluded that the 24-hour delayed film in upper gastrointestinal series might be useful to diagnose the sigmoidovesical fistula.

Adult↗

PubMed1996

[Neuroendocrine cell carcinoma of the urinary bladder: a case report].

We report a case of neuroendocrine cell carcinoma of the urinary bladder. The patient was a 70-year-old man, complaining of pollakisuria. Cystoscopy and computerized tomography revealed a nonpapillary tumor. The tumor was removed by transurethral resection. Because of muscular invasion (T2) and histological grade, total cystectomy and ileal conduit were carried out. Examination of the resected specimen indicated pathological TO. He rejected our proposal to have chemotherapy. Twelve months post-operatively he was alive without recurrence.

Aged↗

PubMed1996

Can hematuria be a predictor as well as a symptom or sign of bladder cancer?

In a case-control study of urinalysis screening in the prevention of death from bladder cancer, hematuria was present in a higher proportion of cases than controls as long as five or six years before the diagnostic evaluation that led to the diagnosis of bladder cancer. In a separate cohort study data base that permitted the follow-up of 1046 persons with a physician's diagnosis of hematuria, 11 cases of bladder cancer were diagnosed more than two (mean 7.4) years after the hematuria diagnosis (4.3 cases expected; age-sex standardized morbidity ratio, 2.5; 95% confidence interval, 1.3-4.5). Bladder cancer was ruled out initially by cystoscopy in 8 of the 11 cases. Although we cannot be certain that preexisting bladder cancer or bladder cancer risk factors did not cause the bleeding, we hypothesize that hematuria can be a predictor as well as a manifestation of bladder cancer, based on a tendency for bladder mucosa with premalignant changes to bleed. The implications for screening and clinical practice remain to be determined.

Aged↗

PubMed1996

[Diagnosis and treatment of bladder and prostate cancer in early stages].

Both bladder and prostate cancer could be treated successfully when diagnosed at the early period of their natural history. Cystoscopy is the most important diagnostic test for the early detection of bladder cancer, particularly in patients complaining of asymptomatic macrohematuria. Superficial bladder cancers (Stage Ta or T1) could be treated by either transurethral resection or intravesical instillation of anticancer drugs with the bladder function reserved. Among diagnostic modalities for prostate cancer, transrectal sonography (TRS) offers the most reliable information in staging the disease. Organ-confined prostate cancer (Stage A or B) is expected to have good prognosis when treated by either radical prostatectomy or hormonal manipulation. Mass screening using digital rectal examination, prostate specific antigen and TRS is promising for the early detection of prostate cancer.

Cystoscopy↗

PubMed1977

Asymptomatic hematuria. Diagnostic approach.

Before classifying hematuria as asymptomatic, the physician should be sure that there are no symptoms pointing to underlying disease. The laboratory workup includes urinalysis, clinical chemistry and renal function tests, and hematologic studies. Intravenous pyelography is done to demonstrate any structural abnormalities, and cystoscopy and retrograde pyelography may be necessary to diagnose hemorrhagic cystitis, tumors of the bladder or other portions of the urinary tract, or calculi not found on intravenous pyelography. If these steps have not determined the cause of bleeding, renal parenchymal disease is probably present and a renal biopsy is indicated. The most common lesions found on renal biopsy are focal proliferative glomerulonephritis and diffuse proliferative glomerulonephritis.

Biopsy↗

PubMed1997

Clinical evaluation of cats with nonobstructive urinary tract diseases.

OBJECTIVE: To identify the underlying cause of clinical signs in cats with nonobstructive diseases of the bladder and urethra. DESIGN: Prospective case series. SAMPLE POPULATION: 109 cats examined by the urology service of The Ohio State University's veterinary teaching hospital because of stranguria, hematuria, pollakiuria, or urination in inappropriate locations. PROCEDURE: History was obtained and a CBC, serum biochemical analyses, serologic tests for FeLV and feline immunodeficiency virus, urinalysis, bacterial culture of urine, and contrast radiography or urethrocystoscopy (females only) were performed. RESULTS: 16 cats had cystic calculi: 8 had struvite uroliths, 7 had calcium oxalate uroliths, and 1 had a urolith of unknown composition in conjunction with an anatomic defect. Anatomic defects, including diverticulae, urethral strictures, and a malpositioned urethra, were identified in 12 cats. A urinary tract infection was identified in 1 cat, and neoplasia was diagnosed in 2. One of the cats with neoplasia also had a struvite urolith. The remaining 80 cats did not have an anatomic defect, urolith, or tumor. Ten of these cats also did not have radiographic or cystoscopic abnormalities and were presumed to have a behavioral disorder. The remaining 70 cats had radiographic or cystoscopic abnormalities, and idiopathic cystitis was diagnosed. In 14 of the cats with idiopathic cystitis, results of a urinalysis were normal. Cats with idiopathic cystitis were significantly more likely to eat dry food exclusively (59%) than were cats in the general population (19%). CLINICAL IMPLICATIONS: Results suggest that idiopathic cystitis occurs commonly in cats with stranguria, hematuria, pollakiuria, or inappropriate elimination and is associated with consumption of dry foods. Contrast radiography or cystoscopy is necessary for differentiating idiopathic cystitis from behavioral disorders in some cats.

Animal Feed↗

PubMed1977

Evaluation of conventional diagnostic tests for detection of recurrent carcinoma of the cervix.

The use of routine diagnostic tests to evaluate patients periodically after treatment for carcinoma of the cervix has been reviewed. Of 169 patients treated at Brooke Army Medical Center for carcinoma of the cervix, 73 were evaluated after their treatment by a group of six diagnostic tests referred to collectively as an oncologic survey. The survey consisted of an intravenous pyelogram (IVP), chest roentgenogram, barium enema, cystoscopy, proctoscopy, and bone scan. Although 16 patients developed recurrent tumor, the oncologic survey detected only three recurrences that had not already been suspected by physical examination. Only the IVP and chest roentgenogram were of sufficient benefit to suggest their routine use for the detection of recurrent cancer. The other tests included in the oncologic survey were not beneficial when used routinely and should be reserved to evaluate patients otherwise suspected of recurrent cancer.

Barium Sulfate↗

PubMed1997

Vesico-colic fistulae in the Grampian region: presentation, assessment, management and outcome.

Over a 12-year period, 67 patients presented with a vesico-colic fistula. The mean age was 69 years (range 19-96 years), with symptoms predominantly referred to the urinary tract. Cystoscopy and barium enema confirmed the presence of a fistula in 60 and 44% of patients respectively. A computerized tomography (CT) scan, used in only seven patients, revealed the fistula in each case. The underlying pathology included diverticular disease (62%), carcinoma (27%) and inflammatory bowel disease (6%). Fifty-one patients proceeded to surgery, of whom 32 (63%) had a sigmoid/recto sigmoid resection with primary anastomosis, and 13 (25%) a Hartmann's procedure. A diverting colostomy alone was employed to palliate cases of widespread carcinoma. No patient subsequently had the Hartmann's reversed. In addition to colonic resection, 48 (92%) patients had a simultaneous bladder procedure, varying from simple oversew in 32 (70%) patients to cystectomy and ileal conduit in three (6%). Wedge excision with primary bladder closure was practised in 12 (24%). Fistula recurrence occurred in seven (14%) patients, and the 30-day mortality was 10%. Surgery for vesico-colic fistula has an appreciable morbidity and mortality, yet if offers the only hope of achieving permanent symptomatic control.

Adult↗

PubMed1997

[The variability of the leakage pressure threshold due to exertion "the Valsalva Leak Point Pressure" as a function of the filling volume of the bladder].

OBJECTIVE: To determine the influence of the bladder filling volume on the Valsalva Leak Point Pressure (VLPP) in patients investigated for urinary stress incontinence. PATIENTS AND METHODS: 50 patients investigated for urinary stress incontinence were included in this prospective study. Evaluation consisted of clinical examination, urodynamic examination with simultaneous fluoroscopic assessment and cystoscopy. VLPP was measured while standing every 100 cc during filling until the cystomanometric bladder capacity. RESULTS: We observed a significant reduction of VLPP as a function of bladder filling volume. The VLPP measured at 200 cc constituted the reference value in view of its sensitivity and specificity for the diagnosis of type III urinary stress incontinence (Blaivas' classification). CONCLUSION: Measurement of VLPP must be standardized and interpreted as a function of bladder filling volume.

Adult↗

PubMed1997

The evaluation and treatment of prolonged hematuria in adolescents.

The causes of hematuria in children have not changed significantly during the past several decades. However, recent advances in endoscopic technology have allowed the pediatric urologist greater ability to evaluate and treat the child's source of hematuria. Close cooperation between urologist, nephrologist, and pediatrician should ensure that evaluation and management of these children is done in an efficient and definitive manner. Herein is reported the presentation and evaluation of an adolescent girl whose history is similar to other adolescents who have presented to our urologic department with a long history of painless, gross hematuria. We suggest that patients whose clinical presentation is similar to this child's be evaluated with renal and bladder ultrasound, intravenous urography, and when necessary, cystoscopy and ureteroscopy for treatment of their hematuria.

Adolescent↗

PubMed1997

[Congenital cysts of the seminal vesicles with ipsilateral kidney agenesis. Clinical aspects of 7 cases].

Seminal vesicle cysts with ureteral ectopy and ipsilateral renal agenesis or dysplasia are rare congenital malformations. This study reports 7 consecutive cases in a single center and, for the first time in the literature, reports long-term results on 5 cases. Patients were between the age of 15 and 57 years. The malformation was diagnosed in all cases with excretory urography, computed tomography, magnetic resonance imaging and cystoscopy. 5 patients were followed after diagnosis for 26 to 119 months (mean 52 months). Only 2 of 7 patients primarily presented with nonspecific lower urinary tract symptoms. One patient (15 years old) showed significant enlargement of the cysts with compression of the urinary bladder and signs of urinary incontinence 10 years after primary diagnosis. The other 4 patients had no changes of their malformation. In conclusion, seminal vesicle cysts with ipsilateral renal agenesis are now more frequently diagnosed because of the increasing use of sectional imaging procedures. They are mostly asymptomatic and their morphology does not change with time. These data support the concept of only treating symptomatic patients.

Adolescent↗

PubMed1997

Membrano-bulbo-urethral junction stenosis. Posterior urethra obstruction due to extreme caliber disproportion in the male urethra.

OBJECTIVE: Based on 4 cases of infravesical obstruction due to extreme caliber disproportion between the posterior urethra and the penile urethra, a pathophysiological mechanism for this dynamic obstruction is given and endoscopic treatment is described. SUBJECTS: Four cases of membrano-bulbo-urethral junction (MBUJ) stenosis, seen between September 1995 and April 1996, are described. Two boys had previous successful valve resection but still showed extreme ballooning of the posterior urethra. The other 2 boys showed bladder instability on urodynamics and the male variant of the spinning top urethra on voiding cystourethrography (VCUG). RESULTS: All cases were successfully treated by endoscopic incision at the 12 o'clock position of the kink between the posterior and the penile urethra which is seen when the full bladder is expressed. Disproportion in the posterior urethra, seen on VCUG, together with bad urinary flow measured on uroflowmetry raise the suspicion of MBUJ stenosis. CONCLUSION: Although rarely seen, extreme caliber disproportion in the male urethra can cause obstruction. Ballooning of the posterior urethra, caused by urethral valves, bladder instability resisted by voluntary sphincter contraction or congenital posterior urethral dilatation, creates an obstructive kink in the urethra comparable to some obstructions in ureteropelvic junction stenosis. If suspicion of such a form of obstruction arises, cystoscopy during pressure on the full bladder is mandatory in order to see the obstruction, descending as a membrane from the vault of the urethra.

Adolescent↗

PubMed1997

[Diagnosis and treatment of vesicouterine fistula occurring after cesarean section].

Eleven cases of vesicouterine fistula were reported. The initial diagnosis was made when urinary incontinence was occurring. The diagnosis was best confirmed by cystoscopy and hysterography, which was positive in 9 cases. The ultrasonographic examinations allow to visualize the fistula in 5 out of 6 cases examined and to establish the diagnosis. If sonographic examination visualizes the fistula, the performing of hysterography is not necessary. The management consists of the cure of the infection of the urogenital tract and abdominal operation based on the excision of the fistula and closing of the bladder and uterus. All operated patients were cured.

Adult↗

PubMed1998

[Primary urothelial carcinoma of the urethra. Apropos of a case].

We report an unusual case of primary transitional cell carcinoma in the bulbar urethra. The patient was a 52-year-old man with a history of sexually transmitted disease. The clinical presentation was bladder retention with urethral bleeding. Radiological examination and cystoscopy showed a bulbar urethral tumor. The pathological diagnosis was Grade III transitional cell carcinoma with invasion of the corpus spongiosum (T2). Partial resection of the urethra was performed and the patient has been without evidence of disease for two years.

Carcinoma, Transitional Cell↗