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Three patients with high spinal lesions, admitted to the hospital for cystoscopy and lithotripsy, showed signs of severe hypertension due to mass reflex during this operation. This symptom was controlled with an intravenous drip of Arfonade¿, and the patients felt quite comfortable without any other anaesthesia. Other possibilities for handling such patients are discussed.
The presence of bacteriuria 48-72 hours after cystoscopy has been correlated with the sex and previous history of the patient, and with the use of chlorhexidine 1/5,000 and water as alternative irrigant solutions. The infection rate was higher in women than in men. Chlorhexidine in the irrigant solution protected against postoperative bacteriuria in patients who did not have a history of previous urinary infection, but did not do so where there was such history.
Of 161 flexible cystoscopies performed in an out-patient endoscopy suite, the incidence of urinary tract infection was 7.5%. Infection rates were higher in patients with a history of previous urinary tract infection or where an additional procedure was also performed. No difference was noted between the infection rates in men and women.
A healthy 54 year old man was investigated for haematuria. In spite of a proven urinary tract infection a cystoscopy was carried out with no antibiotic therapy. As a result he developed systemic infection leading to two independent, and potentially fatal, complications: vertebral osteomyelitis and a mycotic false aneurysm.
Methods have been sought for the in vivo marking of tiny papillary tumors of the bladder and flat urothelial lesions such as dysplasia or carcinoma in situ, which can easily be missed during conventional endoscopy under white light. A new procedure is reported for the fluorescence detection of urothelial dysplasia and early bladder cancer. The method is based on intravesical application of 5-aminolevulinic acid (ALA). ALA if applied exogenously induces accumulation of protoporphyrin IX (PPIX) in the urothelium of the bladder. PPIX is an intensively red fluorescing agent. The mean ratio of fluorescence intensity between urothelial cancer and normal epithelium was found to be 17:1. Fluorescence excitation was achieved by violet light from a krypton ion laser (lambda = 406.7 nm) or from a xenon arc lamp with a bandpass filter system (lambda = 375-440 nm). Both light sources proved to be of equal suitability for fluorescence excitation. Fluorescence microscopy revealed that the PPIX fluorescence is strictly limited to the urothelium. It could not be detected from the submucosa or muscle of the bladder. Bladder wall biopsies were taken from 90 patients with suspicion of bladder cancer under fluorescence view. The fluorescence detection proved to be of high sensitivity (98%). No serious side effects which would preclude further clinical testing, especially no cutaneous photoreaction, were observed. Tumor-associated fluorescence induced by topical ALA application offers new perspectives in the diagnosis and treatment of bladder cancer. In case of suspicious or positive urine cytologic findings, ALA fluorescence cystoscopy may be useful for detecting the precise site of the malignancy. The procedure might be helpful in complete resection or coagulation of urothelial neoplasms. Due to this, diminishing recurrence rates are expected. However, this hypothesis has to be studied in prospective clinical trials.
Cystoscopy can be routinely performed in female rhesus macaques using a pediatric cystoscope. It reveals no major differences between the rhesus and human bladder. Ureteral physiology is also similar to that of man.
The initial investigation of haematuria in the adult includes intravenous urography and cystoscopy. If these investigations reveal no cause for haematuria we propose that renal ultrasound should be considered, and illustrate this with two series of patients from different hospitals (147 from St. Peter's Hospitals, 35 from St. James' Hospital, Balham, London) with primary adenocarcinoma of the kidney.
OBJECTIVE: To report a case of gentamicin-associated acute tubular necrosis following single-dose exposure. SETTING: Central-city, university-affiliated teaching hospital. PATIENT: An 82-year-old man, admitted for evaluation of shortness of breath, appetite reduction with weight loss, and stable renal insufficiency, developed urinary retention, which prompted a urologic evaluation followed by a cystoscopy. INTERVENTIONS: A single 1.6-mg/kg (actual body weight) dose of gentamicin was administered as prophylaxis prior to this procedure. RESULTS: A significant decline in renal function was observed 48 hours following gentamicin administration. A nephrology evaluation excluded pre- and postrenal causes and attributed this episode of nonoliguric acute tubular necrosis to a single dose of gentamicin. CONCLUSIONS: Although not consistent with currently proposed mechanisms and reported onset of aminoglycoside-induced nephrotoxicity, an etiology other than that concluded by this case report appears unlikely.
The cost of caring for people in the community with long-term indwelling catheters varies widely but represents a significant amount of NHS spending. A rapid access catheter clinic was established at a Bristol hospital, for people experiencing difficulties with their long-term catheters, to facilitate prompt assessment and treatment. Many patients were found to be severely disabled with mobility problems and relied on hospital transport to attend the clinic for flexible cystoscopy. As a consequence the concept of undertaking this procedure on a domiciliary basis was introduced with a view to cutting costs, improving time management and offering a more reliable service to patients. A prototype battery-powered flexible cystoscope was developed to facilitate this service and five visits were undertaken. Feedback from patients indicated a preference for the domiciliary service and cost benefits were identified. As a result of these initial experiences, we are now planning a pilot study to establish the feasibility and costs of providing a domiciliary service on a permanent basis and gather qualitative data from patients on quality-of-life issues.
PURPOSE: To report our clinical experience with intravesical instillations of 5-aminolevulinic acid (5-ALA) for the photodynamic diagnosis of bladder cancer and to assess any side-effects of the diagnostic method. MATERIALS AND METHODS: Photodynamic diagnosis was performed in 18 patients of which 14 were men and 4 women with a median age of 71 years (range 44-84), 7 were primary cases and 11 were recurrent cases with bladder cancer. Two to two and half hours prior to endoscopy 1.5 g 5-ALA dissolved in 50 ml of 8.4% sodium hydrogen carbonate (NaHCO3) solution was instilled intravesically. For fluorescence excitation a blue light source (D-LIGHT System, Karl Storz Endoscopy Japan K. K.) was used. Under white and fluorescence light guidance, tumor locations were recorded, cold cup biopsies were taken and tumors were resected. The levels in images of the 5-aminolevulinic acid-induced fluorescence were compared with the pathological results. The area under the receiver operative characteristic (ROC) curve (AUC) in blue light endoscopy was also compared with that in white light endoscopy. RESULTS: Among the 129 specimens obtained by transurethral biopsy 45 were obtained from polypoid lesion and 84 from non-polypoid lesion, and among the 76 malignant diseases 36 were obtained from polypoid lesion and 40 from non-polypoid lesion (including 19 carcinoma in situ), and 21 patients with dysplasia were detected pathologically, with a sensitivity of 89.5% and specificity of 58.5% with a predictive accuracy of 77.0%. The AUC in blue light endoscopy was more than that in white light endoscopy in not only all cases (p = 0.010) but also in cases with non-polypoid lesion (p = 0.007) and recurrent cases (p = 0.002). Duration of 5-ALA instillation with a median time of 80 (range 30-150) min. did not seem to affect the accuracy of photodynamic diagnosis. Procedures were well tolerated by all patients with mild bladder irritability but no systemic side effect. CONCLUSION: Photodynamic diagnosis with intravesically applied 5-ALA is more effective than observation by conventional cystoscopy in detecting bladder cancer without additional risk or complication, and is expected to become a golden standard in the detection program.
We reviewed retrospectively 172 cystoscopies performed in May, 1997, at the Complejo Hospitalario de la Caja del Seguro Social. All the studies were ambulatory and under local anesthesia. The most frequent indications for the endoscopic procedures were the Prostatic Syndromes 27% (47/172), uretheral strictures 13% (22/172) and lithiasis 10%(17/172).
Subcutaneous injection of the carcinogen dibutylnitrosamine into male rabbits led to bladder papillomas, hemangiomas, and carcinomas within 17 to 26 months. The progress of the developing bladder lesions was readily followed by cystoscopy.
The urology nurse practitioner in one trust expanded her skills to perform flexible cystoscopy. This has reduced waiting times for patients and has led to improved service delivery and continuity of care. Auditing of the protocol used ensures there is a high, consistent standard of follow-up care for all patients.
The findings of a regional audit found that Salford had a high incidence of superficial bladder cancer. It was felt that the needs of the patient population could best be served by introducing a nurse-led cystoscopy service. This paper reports on the findings of a postal survey to evaluate the appropriateness and quality of care offered by the new service.
In view of comparatively-high incidence of papillary, well or moderately-well differentiated, transitional cell carcinomas in urology, and of frequent recurrence of carcinomas after appropriate procedures, we have undertaken the correlative study on urinary cytology with cystoscopy, pathology and the amount of fibrinogen and degradation products of fibrinogen and fibrin (FDP). Cytopathologically, 191 cases were confirmed histologically for cancers out of 442 cases studied cytologically; among these 442 classes IV and V were found in 136 cases, and 99 of 136 cases (72.8%) had cancers. Admittedly, we were unable to suspect tumors cytologically in 24.5% of the cases. As to histological gradings and cytology, 48.7% of classes I and II in well differentiated were found against 52.9% and 57.1% of classes IV and V in moderately-well and poorly differentiated carcinomas, respectively. Urinary FDP assay was quite promising; out of 19 cases with both positive cytology and FDP, 18 (94.7% had carcinomas histologically, whereas 12 of 56 cases (21.4%) with both negative cytology and FDP bore cancers. Subsequently, several proposals for improving the diagnostic accuracy were discussed. We concluded the importance of accumulating more cases by combining several diagnostic procedures, especially among well and moderately-well differentiated carcinomas.
This article gives a brief summary of a student project required in a perioperative internship program in a large medical center hospital. The Perioperative Nursing Data Set (PNDS) was used to determine activities necessary in developing a nursing care plan for patients undergoing cystoscopy. The project description and the total care plan is shared with the reader.
From 1996 to 2002 we examined and treated 224 patients with invasive cancer of the urinary bladder (ICUB). The examination complex included clinical, laboratory, radiation tests, endoscopic and morphological investigations of the surgical material. The patients received four types of treatment: transurethral resection (TUR) of the bladder wall (n = 102) alone; TUR+MVAC chemotherapy (n = 56); open resection of the urinary bladder only (n = 38); open resection+MVAC chemotherapy (n = 28). In diagnosis of papillary lesions sensitivity of cystoscopy (CS) was 66.6%, fluorescent CS (FCS)--95.2%. Sensitivity in diagnosis of squamous tumors was 33.3 and 91.6%, respectively. The best results were achieved in patients with pT2A tumor invasion depth, G1 differentiation of tumor cells after TUR with adjuvant polychemotherapy (PCT) recurrences in these patients arose by 41.2% less frequently than in patients after TUR only, 5-year survival in patients after TUR+PCT was 83.3%. Thus, FCS improves diagnosis of urinary bladder tumors (sensitivity of CS was 70.0% vs that of FCS--95.0%). In cancer of the urinary bladder the organ can be saved only at stage pT2G1. A method of choice is TUR of the bladder wall with adjuvant PCT.
Image guided-surgery systems facilitates surgical planning phases of endoscopic procedures. In this paper, we used a software package for 3D surface model generation and vizualization of the urinary bladder, based on magnetic resonance (MR) cross sectional images of the pelvis. The patients group consisted in 6 patients diagnosed with urinary bladder tumour. They were submitted to MRI exam. Twelve consecutive cross sectional images of the pelvis were aquired (TR (repetition time) = 600 msec, TE (echo time) = 19 msec, slice thickness = 6 divided by 7 mm, FOV (field of view) = 36 cm. All these images were transferred to a personal computer running the 3DSlicer software. We obtained, for each patient, a 3D model of the pelvis including the urinary bladder. In This way, the surgical enviroment was simulated and we are able to investigate the bladder by virtual cystoscopy. The virtual endoscopy may be used as a tool in the preoperative training and in surgical planning.