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The flexible cystoscope.

We have been using the flexible cystoscope since 1987. Detailed information is given concerning the technique of flexible cystoscopy, its indications, advantages and disadvantages. A comparison is made with the results obtained using the rigid cystoscope in an initial series of 100 patients, yielding false negative results in only 8% of cases during the learning period. The flexible scope can be successfully employed for Neodymium YAG laser coagulation of superficial bladder tumours. The conclusion is reached that once the urologist has learned how to use it, he will consider the flexible cystoscope as a fundamental tool in his diagnostic armamentarium and false negative results will decrease almost to zero, especially if additional investigations, namely cytology, are routinely adopted.

Cystoscopes

A user's guide to flexible cystoscopes.

This survey, carried out on behalf of the BAUS Instruments Committee, aims to assist the urologist in choosing a flexible cystoscope. The 5 most commonly available flexible cystoscopes (from ACMI, Olympus, Pentax, Storz and Wolf) were assessed in a clinical setting for handling, image quality and user satisfaction. Several technical characteristics, including deflection range, irrigant flow rate and optics, were tested in the laboratory. Whilst all instruments were satisfactory, the favourite of our testing panel was the Olympus CYF-2, which also came out best in the technical assessment and has the most comprehensive service support. The cheaper Storz instrument also performed well.

Cystoscopes

[Initial clinical experience with video-cystoscope].

The endoscopic image processing system which has a very small change coupled device (CCD) at the distal tip of an endoscope, can give us a quite different imaging information from the conventional optical endoscopes, of which the main functions were just to "see inside the human body". The advantage of this endoscopic image processing system has been well recognized but, since the scope diameter could not be made smaller due to the size limitations of the CCD chip itself, the system has not been utilized in the field of Urology. In cooperation with Olympus Optical Co., we have studied a system called Urological Video Information System (UVIS) in order to utilize the image processing system for Urology. In our system a special light source with RGB light output is utilized together with a conventional optical cystoscope and a video converter is connected to the eyepiece of the scope in order to observe endoscopic images on the monitor. Endoscopic images can be stored in an image filing system when necessary. The image quality of UVIS is inferior to that of the conventional cystoscopes at the moment and there are several other technical problems to solve but, as witnessed in the field of Gastroenterology, it is expected that this kind of electronic system will become much more important in the future. This report covers the current problems and some considerations of them as an initial study.

Acute Disease

Development of a carbon dioxide laser cystoscope.

A 50-watt carbon dioxide continuous laser coupled to a Zeiss surgical microscope was used to study the characteristics of laser-induced lesions on the exteriorized canine bladder. The relationship of energy to the depth of the lesion created by the laser was evaluated. Healing, vertical temperature transmission and hemostasis were studied. A prototype carbon dioxide laser cystoscope then was constructed and used endoscopically to create surgical lesions in the intact canine bladder.

Animals

The use of a cystoscopically placed cobra catheter for directed irrigation of lower pole caliceal stones during extracorporeal shock wave lithotripsy.

As the general experience with extracorporeal shock wave lithotripsy (ESWL) for renal calculi broadens, it is increasingly evident that the clearance of stone fragments in lower pole calices needs to be improved. The stone-free rate after treatment for lower caliceal stones is consistently less than that for other upper tract locations. Use of a cystoscopically placed cobra catheter for directed irrigation during ESWL resulted in an increase of our lower caliceal stone-free rate at 1 and 3 months of followup to 71% (15 of 21) compared to 33% (8 of 24) of randomly selected controls at 1 month and 54% (13 of 24) at 3 months. We conclude that pre-ESWL placement of a cobra catheter into the lower pole calix and intermittent irrigation during the procedure are potentially useful adjuncts in the successful treatment of lower caliceal calculi.

Cystoscopy

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