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At least 19 recordsLinked to original sources
PubMed2003

[Virtual cystoscopy with reduced tube current: an alternative to cystoscopy?].

PURPOSE: Virtual cystoscopy at different mAs settings in patients with tumors of the bladder in comparison with cystoscopy and axial CT. MATERIALS AND METHODS: The study included 28 patients with bladder tumors and 28 patients without tumors as control group. The bladder was distended with air and scanned at two different mAs settings (protocol 1 and 2). The radiation exposure was reduced by 82 % for protocol 2 in comparison with protocol 1. Three readers compared virtual cystoscopy with cystoscopy and axial CT as to tumor location and size. Sensitivity, specificity and accuracy were calculated. RESULTS: Of the 47 tumors seen at cystoscopy, all readers detected 45 tumors by virtual cystoscopy using protocol 1 and 44 tumors using protocol 2, with p > 0.05 in comparison with cystoscopy. Virtual cystoscopy showed higher sensitivity than axial CT (97.2 % vs. 86.5 % for protocol 1) and (96.5 % vs. 86.5 % for protocol 2) with the same specificity (100 %). The accuracy was 0.982 for protocol 1 and 0.978 for protocol 2. In comparison with virtual cystoscopy, axial CT shoved more often over- and underestimation of the tumor size. CONCLUSION: Virtual cystoscopy at reduced mAs setting is a modality suitable for the detection of polypoid tumors, but does not provide data of the mucosa and thus cannot replace cystoscopy yet.

Adult↗
PubMed2002

Diagnostic potential of virtual cystoscopy of the bladder: MRI vs CT. Preliminary report.

The aim of the study was to evaluate the diagnostic potential of the half-Fourier acquired single-shot turbo spin echo (HASTE) sequence for MRI cystoscopy compared with CT cystoscopy and the gold standard conventional cystoscopy. The MRI- and CT cystoscopy was performed in 29 patients with bladder tumors documented at cystoscopy and a control group using a 1.5-T unit (6-mm slice thickness) and a helical CT (3-mm collimation, pitch 1) after filling the bladder with air. Axial MRI and CT images were transferred to a workstation for application of virtual cystoscopy and compared with routine cystoscopy. Axial images and virtual cystoscopies were read by three readers for size and location of tumors. Forty-seven tumors were diagnosed at cystoscopy (12<1 cm, 35>/=1 cm). The sensitivity for detection of tumors smaller than 1 cm was 88.9% at MRI cystoscopy and 100% for tumors of 1 cm or larger. These results were not statistically different from the other modalities. Three tumors smaller than 1 cm were not detected at CT cystoscopy, four not all identical at MRI cystoscopy. One tumor with a wall thickening was detected on axial CT and MR images and CT cystoscopy by all observers, but only by two at MRI cystoscopy. The MRI cystoscopy is a diagnostic modality with results comparable to conventional and CT cystoscopy.

Aged↗
PubMed2002

Virtual cystoscopy of the contrast material-filled bladder in patients with gross hematuria.

OBJECTIVE: The objective of this study was to evaluate the usefulness of virtual cystoscopy of the contrast material-filled bladder in evaluating patients with gross hematuria. SUBJECTS AND METHODS: Seventy-three consecutive patients who had gross hematuria and whose upper urinary tracts had a normal appearance on single-detector helical CT scans were prospectively evaluated with virtual cystoscopy. Source CT data for virtual cystoscopy were obtained on a multidetector CT scanner with 1.25-mm slice thickness and transferred to a workstation for interactive navigation using volume rendering. Two radiologists independently interpreted the virtual cystoscopic images, and discrepancies were resolved by consensus. All patients also underwent conventional cystoscopy. We assessed the agreement between the findings on virtual and conventional cystoscopy. Using conventional cystoscopy as the gold standard, we evaluated the usefulness of virtual cystoscopy as an aid in identifying bladder lesions and detecting abnormal bladders. RESULTS: Virtual cystoscopy depicted 60 lesions in the bladders of 43 patients. Fifty-six lesions (in 41 bladders) revealed on virtual cystoscopy were true-positive findings. Four lesions in two bladders with abnormal findings were false-positive. On virtual cystoscopy, the radiologists missed three lesions in two abnormal bladders that were identified on conventional cystoscopy. On virtual cystoscopy, 15 (88%) of 17 lesions smaller than 0.5 cm were identified. The agreement between the findings of virtual and conventional cystoscopy was excellent in the reviewers' identification of bladder lesions (kappa = 0.83) and detection of abnormal bladders (kappa = 0.89). The sensitivity and specificity of virtual cystoscopy were 95% and 87% for identifying bladder lesions and 95% and 93% for detecting abnormal bladders. CONCLUSION: Virtual cystoscopy of the contrast material-filled bladder is useful for the evaluation of the bladder in patients with gross hematuria.

Adult↗
PubMed2001

Routine follow-up cystoscopy in detection of recurrence in patients being monitored for bladder cancer.

BACKGROUND AND AIMS: Cystoscopy and urine cytology are the standard tools for monitoring superficial bladder cancer. The sensitivity of cystoscopy is, however, limited to the tumours that can be visualised, and the sensitivity of cytology is relatively low in low-stage/low-grade tumours. Therefore, new tumour markers have been developed. BTA stat has been reported to have high sensitivity in detecting both primary and recurrent bladder tumours, and may have the potential to detect tumours that cannot be visualised by routine cystoscopy including recurrences in upper tract. The objective of the study was to analyse the reliability of routine follow-up cystoscopy by further investigating patients with positive marker status, BTA stat Test and urine cytology, but negative cystoscopy. MATERIAL AND METHODS: 446 consecutive patients being followed for bladder cancer were analysed in a prospective multicenter study. A voided urine sample was obtained prior to cystoscopy and split for culture, cytology and BTA stat testing. In the case of positive marker status, BTA stat Test or urine cytology, but negative cystoscopy patients were further investigated by i.v. urography or renal ultrasound and random biopsies. The sensitivity of routine follow-up cystoscopy is reported. RESULTS: Of 446 patients 131 (29.4%) had a bladder cancer recurrence at routine cystoscopy. Of the remaining 315 patients not having recurrent tumour at cystoscopy, 56 patients (17.8%) had positive BTA stat Test result, 6 (1.9%) had positive cytology and 5 were positive by both tests. Nine recurrences that were missed at routine follow-up cystoscopy were detected by further investigations making the total number of bladder confined recurrent tumours 140 (140/446, 31.4%). Five of these 9 recurrences were high grade lesions (1 T1G3, 4 CIS), of which 4 were detected by positive cytology. The overall sensitivity of cystoscopy was 93.6%. CONCLUSIONS: We found that routine follow-up cystoscopy may miss over five percent of the recurrent tumours. Although cystoscopy remains the gold standard for bladder cancer follow-up, it is suggested that even with negative cystoscopy patients with positive marker status, BTA stat Test and especially urine cytology, should be considered at risk for coexisting, and in some case even high grade recurrence.

Adult↗
PubMed1999

[Virtual cystoscopy of bladder neoplasms. Preliminary experience].

PURPOSE: We investigated the comparative sensitivity of virtual and conventional cystoscopy in patients with urinary bladder cancer. MATERIAL AND METHODS: Twelve patients (8 men and 4 women; mean age: 61 years, range: 49-73) with findings of bladder cancer at conventional cystoscopy were submitted to volumetric spiral CT of the urinary bladder. Before the examination, the urinary bladder was distended with 180-200 mL of air. CT findings were then sent to an independent workstation to generate interactive intraluminal views of the bladder. The findings of virtual cystoscopy were compared with those of conventional cystoscopy in 11 patients and with the findings of transurethral resection after urethrotomy in one patient. All lesions had pathologic confirmation. RESULTS: Eighteen (90%) of 20 masses detected on conventional cystoscopy were visualized with virtual cystoscopy. The latter allowed readers to identify 13 of 13 masses (100%) > 1 cm and only 5 of 7 (71%) < 1 cm; three 4-mm masses were missed. Although only a subjective evaluation of lesion size was possible on conventional cystoscopy, there seemed to be good agreement on mass size and site with both techniques. DISCUSSION: Cystoscopy plays a key role in the diagnosis of urinary bladder carcinoma. However cystoscopy is invasive, has a limited field of view and lacks an objective scale; moreover, it is not indicated in patients with severe urethral strictures or active vesical bleeding. In our study, virtual cystoscopy depicted all the masses > 1 cm, and a lesion in a diverticulum with a small opening. Virtual cystoscopy was also very useful in a patient with urethral stricture (who could no be submitted to conventional cystoscopy) where it showed the lesion before transurethral resection after urethrotomy. The virtual technique could also be complementary to conventional cystoscopy in evaluation of bladder base and anterior bladder neck, as well as for postchemotherapy follow-up. Unfortunately virtual cystoscopy does not allow biopsy of suspicious lesions.

Aged↗
PubMed1990

Morbidity following cystoscopy: comparison of flexible and rigid techniques.

Recent reports on the value of local anaesthetic flexible cystoscopy have emphasised excellent tolerance and preference for the technique over general anaesthetic rigid cystoscopy. However, no study has yet compared the post-operative morbidity rates of these procedures. Tolerance, preference and post-operative symptoms in 100 patients undergoing local anaesthetic flexible cystoscopy were compared with those in 100 patients undergoing general anaesthetic rigid cystoscopy. On initial questioning, 89% of patients found flexible cystoscopy painless and 92% expressed a preference for the same procedure on a future occasion; 98 patients who underwent flexible cystoscopy and 87 who underwent rigid cystoscopy returned a questionnaire on symptoms 1 week after the procedure. The incidence of post-operative symptoms was 33% following flexible cystoscopy and 76% following rigid cystoscopy. Patients in both groups who were undergoing check cystoscopy had a lower incidence of morbidity than those undergoing cystoscopy for other reasons. The results suggest that flexible cystoscopy was well tolerated and preferred by most patients. The morbidity associated with the procedure was also significantly less than that associated with rigid cystoscopy under general anaesthesia.

Adolescent↗
PubMed1997

The use of the bladder-tumour associated analyte test to determine the type of cystoscopy in the follow-up of patients with bladder cancer. The United Kingdom and Eire Bladder Tumour Antigen Study Group.

OBJECTIVE: To assess the use of the bladder-tumour associated analyte test (BTA, Bard UK) to determine whether patients with bladder cancer scheduled for cystoscopy under general anaesthesia can have local anaesthesia instead. PATIENTS AND METHODS: A total of 272 patients who were scheduled for general anaesthesia cystoscopy were entered into a prospective multicentre study. The BTA test was performed on a specimen of freshly voided urine and the type of cystoscopy was determined according to whether the result was positive or negative. Patients with a negative BTA result were examined with the flexible instrument, under local anaesthesia, instead of the planned general anaesthetic cystoscopy. RESULTS: In 59 patients, the BTA test was positive and tumour was found (true positive), in 145 patients the test was negative and cystoscopy was negative (true negative), in 25 patients the test was positive and cystoscopy was negative (false positive) and in 43 patients, the test was negative but tumour was found on flexible cystoscopy; the patient underwent subsequent cystoscopy under general anaesthesia (false negative). The sensitivity and specificity were 58% and 86% respectively. The use of the BTA test resulted in fewer patients needing cystoscopy under general anaesthesia and saved about 25,500 POUNDS ($31,000) OR 76 POUNDS ($114) PER PATIENT. CONCLUSION: THE integration of the BTA test into the follow-up of patients with bladder cancer may help to select those suitable for cystoscopy, under a local anaesthetic and this will result in cost savings as well as sparing patients the more invasive procedure. The test is not sufficiently sensitive to replace cystoscopy and there were false-negative results despite high-grade recurrence. Thus, when the test is used as part of a follow-up programme, a timely back-up of cystoscopy under general anaesthesia should be arranged for patients with false-negative results.

Anesthesia, General↗
PubMed2001

Cost-effectiveness of universal cystoscopy to identify ureteral injury at hysterectomy.

OBJECTIVE: To evaluate the cost-effectiveness of routine cystoscopy at the time of abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy in terms of cost per ureteral injury identified and treated. METHODS: Using a hospital-based perspective, a decision-analysis model was constructed to estimate the outcomes and costs of cystoscopy or no cystoscopy at the time of abdominal hysterectomy. A similar model was constructed for vaginal and laparoscopically assisted vaginal hysterectomy to account for the cost of conversion to laparotomy. Cost estimates were based on estimated costs of Duke University Medical Center and from average Medicare reimbursements for similar Diagnostic Related Groups from the Health Care Financing Administration. The incidence of ureteral injury was obtained from a review of the literature. Sensitivity analyses were performed for the following variables: ureteral injury rate, silent ureteral injury rate, cost of cystoscopy, and cost of therapeutic interventions. We assumed a silent renal death rate of 0%. RESULTS: Routine cystoscopy at abdominal hysterectomy was cost-saving above a threshold ureteral injury rate of 1.5%. At a ureteral injury rate of 0.2%, the marginal increase in the cost of routine intraoperative cystoscopy was $108 per abdominal hysterectomy, with an associated cost of $54,000 per ureteral injury identified. In comparison, at a ureteral injury rate of 2%, routine cystoscopy gave a marginal cost savings of $44 per hysterectomy, with a cost savings of $2200 per ureteral injury identified intraoperatively. At the baseline ureteral injury rate of 0.5%, routine cystoscopy had a marginally increased cost of $83 per hysterectomy, with an incremental cost-effectiveness of $16,600 spent per ureteral injury identified. The model constructed for vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy yielded a threshold ureteral injury rate of 2%, above which routine cystoscopy was cost-saving. In both models, the incidence of ureteral injury and the cost of readmission were the two variables with the greatest influence on cost-effectiveness. CONCLUSION: The cost-effectiveness of routine intraoperative cystoscopy depends on the rate of ureteral injury independent of the route of hysterectomy. If that rate exceeds 1.5% for abdominal hysterectomy and 2% for vaginal or laparoscopically assisted vaginal hysterectomy, then routine cystoscopy is cost-effective.

Cost-Benefit Analysis↗
PubMed2004

Improved detection of urothelial carcinoma in situ with hexaminolevulinate fluorescence cystoscopy.

PURPOSE: In this European multicenter study we compared hexaminolevulinate (HAL) fluorescence cystoscopy and standard white light cystoscopy for the detection of carcinoma in situ (CIS) in patients suspected of having high risk bladder cancer. MATERIALS AND METHODS: This study was a prospective controlled, within-patient comparison of standard and HAL fluorescence cystoscopy. Eligible patients received an intravesical instillation of 50 ml HAL 8 mM solution. Cystoscopy was performed using a D light system, which provided white and blue light at 375 to 440 nm. The bladder wall was inspected and mapped, first under white light, followed by blue light. All tumors and suspicious areas identified under white light and by red fluorescence were resected or biopsied. Histological findings were assessed by an independent central pathologist blinded to the identity of the biopsies. RESULTS: Of 211 evaluable patients 83 (39%) had CIS, of whom 18 (22%) were detected by HAL cystoscopy only, 62 (75%) were detected by standard and HAL cystoscopy, 2 (2%) were detected by standard cystoscopy only and 1 (1%) was detected by nonguided biopsy. Therefore, HAL cystoscopy identified 28% more patients with CIS than standard cystoscopy. The side effects of HAL instillation were negligible and no unexpected events were reported. CONCLUSIONS: HAL fluorescence cystoscopy improves the detection of bladder CIS significantly, which has consequences for clinical management and may improve the patient prognosis. The procedure is easily implemented as an adjunct to standard cystoscopy and it adds no significant risk of complications.

Adult↗
PubMed2002

Validation of a flexible cystoscopy course.

OBJECTIVE: To examine the instructional effectiveness of a course for nurses wishing to learn flexible cystoscopy, using a virtual reality flexible cystoscopy simulator to measure the outcome. SUBJECTS AND METHODS: Fourteen urology nurse practitioners with no previous experience of cystoscopy were taught the basic techniques of flexible cystoscopy. They then had supervised group instruction during which they practised flexible cystoscopy on an inanimate latex model, and were taught how to handle the cystoscope, followed by unsupervised practice, including use of the virtual reality (VR) simulator (URO Mentor, Simbionix, Israel). They then undertook a cystoscopy task on the simulator; within the bladder there were 10 flags (numbered 1-10) at key positions. By visualizing and photographing each of the flags the subject would have visualized the entire bladder mucosa. The number of flags seen was thus used as a measure of how much of the bladder mucosa was examined. The VR simulator also measured the total procedure time. After a day of training the subjects were reassessed and the changes in performance evaluated. Subjects were also asked their opinion of the use of VR for flexible cystoscopy. RESULTS: The median (range) time to complete the procedure before the course was 3.33 (2-5.5) min and the number of flags seen 7 (6-9). After the course, the median time decreased to 2.85 (1.5-4.42) min and the number of flags seen increased to 8 (6-9). The change in time was significant (P = 0.03) but the difference in the number of flags was not (P = 0.12). All 14 subjects enjoyed the use of VR for learning flexible cystoscopy; they all reported that they were more confident in handling a flexible cystoscope and in undertaking flexible cystoscopy. CONCLUSION: The virtual reality simulator was an effecctive tool for teaching flexible cystoscopy.

Adult↗
PubMed2001

The role of intraoperative cystoscopy in prolapse and incontinence surgery.

OBJECTIVE: Unrecognized ureteral and bladder injury are a known source of morbidity and mortality in gynecologic surgery. The objective of this study was to determine the frequency that intraoperative cystoscopy during prolapse and incontinence procedures produced a change in intraoperative management to prevent ureteric and bladder injury. STUDY DESIGN: This study reviewed the charts and operative reports of 235 cases of routine intraoperative cystoscopy during prolapse and incontinence surgery during a 2-year period in a tertiary care urogynecology unit. Demographic data and potential risk factors for intraoperative urinary tract injury were recorded. Cases that involved a change in management brought about by intraoperative cystoscopy with intravenous indigo carmine were compared with cases in which intraoperative cystoscopy was normal. Variables were compared with use of the Student t test and the chi(2) test. RESULTS: Of 235 cases, 11 were excluded. Of the 224 remaining cases, 12 (5.3%) underwent changes in intraoperative management as a result of cystoscopic findings. Eight cases involved ureteric blockage. Patients with abnormal cystoscopies did not differ from patients with normal intraoperative findings with regard to age, weight, parity, maximum grade of prolapse, estimated blood loss, or previous surgery. In 58% of patients with abnormal cystoscopies, there was no suspicion of technical difficulty on the basis of previous surgical history. Preoperative renal imaging did not predict cases with abnormal cystoscopy. There were no cases of complications caused by the intraoperative cystoscopy. CONCLUSION: Intraoperative cystoscopy with intravenous injection of indigo carmine is a safe technique that can detect otherwise undetected intraoperative compromise of the urinary tract during prolapse and incontinence surgery. It is recommended that cystoscopy be used liberally to reduced the frequency of serious sequelae from urinary tract injury.

Adult↗
PubMed2001

Immediate versus delayed outpatient flexible cystoscopy: final report of a randomized study.

PURPOSE: To evaluate discomfort experienced by men undergoing an immediate versus delayed outpatient flexible cystoscopy after topical local anesthesia. PATIENTS AND METHODS: Two hundred eighty eight consecutive men with superficial bladder tumors were randomized to undergo immediate or delayed surveillance flexible cystoscopy after intraurethral instillation of lidocaine jelly. The patients recorded their level of pain experienced during cystoscopy on a 4-point pain scale and on a 10-point visual analogue (VAS) scale. RESULTS: Of the 288 patients, 145 underwent immediate cystoscopy and 143 had a delayed cystoscopy. The mean pain score on a scale of 1 (no pain) to 4 (severe pain) was 1.6 after immediate cystoscopy compared with 1.5 after delayed cystoscopy (p=7). The mean VAS score on a scale of 1 (no pain) to 10 (most painful) was 1.8 after immediate cystoscopy versus 1.7 after delayed cystoscopy (p=5). CONCLUSION: There was no difference in pain perception among men undergoing an immediate or a delayed outpatient flexible cystoscopy using the same local anesthetic.

Aged↗
PubMed2002

Stage Ta-T1 bladder cancer: the relationship between findings at first followup cystoscopy and subsequent recurrence and progression.

PURPOSE: We studied the relationship of first cystoscopy findings with recurrence and progression rates in a large, population based series of patients with bladder cancer. MATERIALS AND METHODS: All 463 patients with an initial diagnosis of stage Ta-T1 bladder cancer in western Sweden in 1987 to 1988 were followed at least 5 years. The 355 patients who were treated with transurethral resection only until repeat cystoscopy or longer were selected for this report. RESULTS: Negative first cystoscopy findings were associated with significantly decreased recurrence and progression rates for all grades, and for stage Ta and T1 tumors. However, some patients with initial high grade carcinoma (WHO 2 to 3) had stage progression despite negative first cystoscopy. On multivariate analyses first cystoscopy findings and papillary urothelial neoplasm of low malignant potential versus grades 1 to 3 but not stage and the number of tumors had prognostic significance for time to recurrence. Only first cystoscopy findings and grade had prognostic significance for time to stage progression. CONCLUSIONS: Our data support other groups who recommend a less intense cystoscopy followup schedule in patients with negative cystoscopy findings 3 months after initial transurethral bladder resection. We recommend that patients with initial papillary urothelial neoplasm of low malignant potential and low grade carcinoma (WHO 1) with negative first cystoscopy findings undergo repeat cystoscopy at month 12. In our opinion followup should not be less intense in patients with high grade carcinoma (WHO 2-3), even in those with stage pTa disease.

Cystoscopy↗
PubMed1999

Lower urinary tract injury during the Burch procedure: is there a role for routine cystoscopy?

OBJECTIVE: This study was undertaken to evaluate the use of intraoperative cystoscopy for the detection of incidental bladder or ureteral injuries during abdominal urethropexy procedures and to determine whether the incidence of injuries warrants the routine use of cystoscopy. METHODS: We reviewed the medical records of 109 consecutive patients who underwent abdominal urethropexy procedures between November 1990 and February 1996 at a teaching institution. Each underwent intraoperative cystoscopy. We determined the incidence of cystotomy and ureteral obstruction and attempted to determine surgical factors that might be associated with an increased risk of injury. RESULTS: Ten of 109 patients (9%) had bladder or ureteral injury, including 1 cystotomy during retropubic dissection, 6 cases of a transvesical suture noted during cystoscopy, 1 cystotomy recognized before closure, 1 case of ureteral obstruction found during cystoscopy, and 1 case of ureteral obstruction not recognized at cystoscopy. Cystoscopy allowed detection of 7 of 9 (78%) otherwise unrecognized events. The only injury that resulted in significant postoperative morbidity was the unrecognized ureteral obstruction. There was no association between incidence of lower urinary tract injuries and surgical risk factors. CONCLUSION: Intraoperative bladder or ureteral injuries during urethropexy procedures are not uncommon, with an incidence of 9% in our series. There is minimal morbidity if these injuries are detected and corrected during the operation, whereas morbidity may be significant if they remain unrecognized. With a potential for unrecognized injury in 8% of Burch procedures without the use of cystoscopy, routine use of cystoscopy during urethropexy procedures appears to be warranted.

Cystoscopy↗
PubMed2001

Diagnostic efficacy of fluorescence cystoscopy for detection of urothelial neoplasms.

BACKGROUND AND PURPOSE: A major problem diagnosing bladder cancer using conventional white-light cystoscopy is that flat and tiny papillary neoplasms can be overlooked. Fluorescence cystoscopy is based on the detection of protoporphyrin IX (PpIX)-induced fluorescence in urothelial neoplasms through the topical administration of 5-aminolevulinic acid (ALA). The diagnostic efficacy of fluorescence cystoscopy in urothelial neoplasms was evaluated in this study. The focus of this investigation was to ascertain whether fluorescence cystoscopy could make a major contribution to staging and improving the choice of adjuvant therapy after transurethral resection. PATIENTS AND METHODS: A series of 62 patients with suspected bladder cancer were investigated by fluorescence cystoscopy. An intravesical instillation of ALA was conducted 2 hours prior to fluorescence. A total of 274 tissue samples were obtained from the fluorescing and nonfluorescing areas of the bladder. RESULTS: The sensitivity and negative predictive value of fluorescence cystoscopy were 98.0% and 94.7%, respectively, but the specificity was low (42.9%). Among a total of 148 lesions of urothelial neoplasm, 58 foci (dysplasia in 5, carcinoma in situ in 19, stage Ta in 15, T1 in 15, above T2 in 4) that were invisible under white-light cystoscopy were detected by fluorescence cystoscopy. The final histopathologic status was changed in 45% of patients (28/62) according to this technique. Among these patients, eight (13%) needed additional therapy, including a radical cystectomy in one patient and intravesical therapy in 10. CONCLUSIONS: The ALA-based fluorescence cystoscopy technique is a safe and simple procedure that enhances the detection of flat and papillary urothelial neoplasms. Moreover, it will be able to provide useful information that will enable proper staging and appropriate further treatment.

Adult↗
PubMed1988

Rigid versus flexible cystoscopy. A controlled trial of patient tolerance.

The cost-efficiency and time-saving associated with out-patient flexible cystoscopy have propagated its use nationwide. However, only minimal attention has been paid to the feelings of patients exposed to this physically and emotionally invasive technique. We studied 53 consecutive patients attending for check cystoscopy at the time of their first flexible cystoscopy. Acting as their own historical controls, their feelings about rigid cystoscopy under general anaesthesia and subsequent flexible cystoscopy under local anaesthesia were assessed: 6/53 (11%) preferred rigid cystoscopy under general anaesthesia. The only significant association with their dislike of flexible cystoscopy, was their desire to stay in hospital overnight. It was concluded that with careful counselling and attention to individual needs, the preference for flexible cystoscopy over rigid cystoscopy under general anaesthesia can approach 100%.

Ambulatory Care↗
PubMed2002

Reliability of MR imaging-based virtual cystoscopy in the diagnosis of cancer of the urinary bladder.

OBJECTIVE: Our purpose was to evaluate MR imaging-based virtual endoscopy in patients with urinary bladder cancer compared with conventional cystoscopy as the gold standard. SUBJECTS AND METHODS: Twenty-five patients with urinary bladder cancer diagnosed on conventional cystoscopy underwent MR imaging of the pelvis. Patients were examined without external bladder filling or administration of IV contrast medium. No medications were administered. The data obtained by MR imaging were reconstructed for virtual endoscopy on a workstation. The locations and sizes of tumors were individually determined and compared with results of conventional cystoscopy. RESULTS: Twenty-four patients were evaluated; one patient's examination was excluded from analysis because of metallic artifacts. Seventeen patients were diagnosed with a single bladder tumor. Five patients had two tumors each, and two patients had three tumors. Tumor diameter ranged from 0.4 to 6.4 cm. Thirty (90.9%) of 33 tumors detected on cystoscopy were visualized with virtual endoscopy. The detection rate for 23 tumors of 1 cm or greater was 100%. Difficult conditions for conventional cystoscopy, including hematuria, anterior wall involvement, and urethral strictures, had no deleterious impact on virtual cystoscopy. Difficulties in detection on virtual endoscopy were associated with flat bladder tumors with minimal surface elevation. CONCLUSION: The results of this study suggest a high reliability in the diagnosis of urinary bladder cancer by MR imaging-based virtual cystoscopy-a noninvasive method, independent of medication or contrast enhancement, that may be of value for screening, primary diagnosis, and surveillance. Virtual MR cystoscopy may be indicated when conventional cystoscopy cannot be performed or is ineffective.

Aged↗