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PubMed1984

[Histological study of cases of bladder cancer and chronic cystitis with difficulty in cystoscopic diagnosis].

Twenty-seven cases in which cancer could not be distinguished from chronic cystitis were reviewed. These cases were divided into those with and those without a past history of bladder tumor. The high frequency of hyperplasia in the group with a history of bladder tumor suggested that hyperplasia may be a precursor of papillary tumor. On the other hand, proliferative lesions such as cystitis cystica and metaplasia were encountered in the group with no history of bladder tumor and 50 percent had symptoms of chronic cystitis. These findings suggested that proliferative lesions in the bladder developed by inflammatory irritation. Urinary cytology was done in 18 cases. Cytology was positive in 2 of the 3 cases of transitional cell carcinoma. Therefore, urinary cytology was useful, but it did not provide distinction in two cases of follicular cystitis and a case of squamous metaplasia was false positive.

Adult↗
PubMed1993

Comparison of direct radionuclide cystography with micturating cystourethrography for the diagnosis of vesicoureteric reflux, and its correlation with cystoscopic appearances of the ureteric orifices.

Forty-eight patients with strong clinical suspicion of vesicoureteric reflux (VUR) as the cause for their renal disease; were subjected to direct radionuclide cystography and roentgenographic micturating cystourethrography for its detection. Forty-four of them underwent cystoscopy under local anaesthesia to document the position and appearance of the ureteric orifices. Of the 92 kidney-ureter 'units' available for study, 20 had reflux positive on micturating cystourethrography and 22 had direct radionuclide cystography positivity. Two of the three units picked up on direct radionuclide cystography but missed on micturating cystourethrography were severe refluxes up to the renal pelvis. On the other hand, one unit missed on direct radionuclide cystography but picked up on micturating cystourethrography was a lower ureteric reflux. The sensitivity and specificity of direct radionuclide cystography to detect VUR as compared to micturating cystourethrography is 95% and 95.8% respectively. The localization and appearance of ureteric orifices which were classified as per Lyon's classification greatly enhanced the predictive value of determining past or present VUR. Patients with golf-hole orifices placed laterally had 100% incidence of reflux. Thus, combining direct radionuclide cystography with cystoscopy may enhance the predictive value for diagnosis of VUR even higher than a micturating cystourethrography study.

Adolescent↗
PubMed1996

Cystoscopic holmium lithotripsy of large bladder calculi.

Patients with large bladder stones are often difficult to treat endoscopically with the current modalities available to the practicing urologist. We present the results of cystolithotripsy of bladder stones larger than 4 cm with the holmium: Yag (Ho:Yag) laser. In our three patients, all patients were rendered stone free without complication using the Ho:Yag laser, with an average anesthesia time of 50 min. Minimal tissue trauma or stone movement were observed. All stones were easily fragmented, even one stone that had previously been refractory to electrohydraulic lithotripsy. Our conclusion is that the Ho:Yag laser is a safe and effective treatment for patients with large bladder stones. Its use may make it possible to eradicate stones endoscopically that otherwise would require open surgery.

Cystoscopy↗
PubMed1997

[Alternatives to the cystoscopic control of bladder neoplasms].

OBJECTIVE: Cystoscopy is the most sensitive technique for the detection of bladder tumor recurrence, but is the least accepted by the patient. In our Service, 25% of cystoscopies are poorly tolerated. Our experience with alternatives to cystoscopy is described. METHODS: Using cystoscopy as the gold standard, we analyzed the diagnostic yield of cytology, vesicorenal US and the combination of vesicorenal US and cytology. The techniques were compared for sensitivity vs 1-specificity. RESULTS: The sensitivity of the alternative techniques was limited. At best it was 0.81 when US and cytology were used in combination. The specificity was low and the incidence of false negatives was 7.3%. Similarly, the diagnostic yield was better when US and cytology were used in combination (sensitivity vs 1-specificity = 0.77). CONCLUSIONS: No technique, alone or in combination, can replace cystoscopy. However, alternate use of combined US and cytology with cystoscopy is efficient in the follow-up of bladder tumors and can reduce the number of cystoscopies. The delay in the diagnosis of recurrence probably has not negative negative influence on the history of the disease.

Cystoscopy↗
PubMed1997

[Relation between successful treatment of urinary tract inflammation and the disappearance of changes in the bladder mucosa in children and adolescents with cystoscopically proven cystitis cystica].

Bladder epithelium nodular changes called cystitis cystica are commonly found in children and adolescents suffering from long-term lower urinary tract infection. Recurrent urinary infection was found in pediatric patients with urinary tract abnormalities as well as in others without it with nearly the same frequency. The authors studied 63 pediatric patients with recurrent urinary tract infection and cystitis cystica of which 59 (94%) were females. The age of the examined patients varied from 1 to 16 years, mean 7.35 years. Thirty five of them (55.5%) had diverse anomalies of the urinary tract. Vesicoureteric reflux was demonstrated on the cystogram in 41.1% patients. Escherichia coli was found to be the major pathogenic organism in the urine. Thirty eight (60.3%) children and adolescents were treated medically for months (two years mostly) by reason of prolonged recurrent urinary tract infection before nodular changes of the bladder mucosa at cystoscopy were detected. Even thirteen (39.7%) of all studied patients were treated medically more than five years. In the present study only 47 (74.6%) of the observed patients have had an adequate follow-up and might be considered. In these cases repeated cystoscopy was performed and the successively sterile urine cultures were obtained. Twenty-one (44.3%) patients were medically treated up to one year before the urinary tract infection was eradicated and nodular mucosal changes disappeared. In 6 (12.8%) patients more than five years were needed to achieve this result.

Adolescent↗
PubMed1997

Cystoscopic staging of carcinoma uterine cervix, revisited.

Of the 378 cases of stage 3 carcinoma uterine cervix, only 10 showed vesical invasion, while 19 of 24 cases of stage 4 disease had vesical invasion. Results of this procedure did not alter the management of the disease in any of these cases. From the whole series it was concluded that cysto-urethroscopy is an unnecessary, cost ineffective, invasive procedure which has no role in either diagnosis or in planning the definitive treatment of carcinoma uterine cervix.

Carcinoma, Squamous Cell↗
PubMed1998

Cystoscopic findings consistent with interstitial cystitis in normal women undergoing tubal ligation.

PURPOSE: We test the hypothesis that women without chronic pelvic pain or irritative voiding symptoms do not demonstrate petechial hemorrhages known as glomerulations that are characteristic of patients with interstitial cystitis. MATERIALS AND METHODS: A prospective cohort design was used for examination with cystoscopy and bladder distention of 20 asymptomatic women undergoing tubal ligation. Cystoscopy with the patient under general anesthesia was performed to inspect the bladder mucosa before and after distention at 70 cm. of water pressure for 2 or 6 minutes. Photographs of the right, posterior and left of the bladder surfaces taken before and after the distention were scored on a scale of 1 to 5 using a panel of standards. Five urologists blinded to the source of individual photographs independently evaluated 120 research images interspersed with 46 other pictures from a library containing images from 19 symptomatic patients with and without interstitial cystitis. RESULTS: A total of 20 normal women with a mean age plus or minus standard deviation of 29+/-6 years consented to participate in this trial during laparoscopic tubal ligation. Photographs of bladder sites before and after distention with 890+/-140 ml. were scored as 1.4+/-0.3 (before distention) and 3.1+/-1.1 (after distention) on the scale of 1 to 5. The increase in scores following distention in normal subjects was seen to the same degree and in the same proportion as in patients with symptoms of interstitial cystitis (8 of 19 symptomatic patients in this series met current diagnostic criteria for interstitial cystitis). Slight but significant differences were seen among sites in the bladder but not between 2 and 6-minute distention durations. CONCLUSIONS: Bladder mucosal lesions characteristically associated with irritative voiding symptoms and pelvic pain in patients diagnosed with interstitial cystitis were observed in asymptomatic women.

Adult↗
PubMed2004

Instillation of anesthetic gel is no longer necessary in the era of flexible cystoscopy: a crossover study.

BACKGROUND AND PURPOSE: Whether urethral injection of anesthetic and lubricating gel prior to outpatient flexible cystoscopy is worthwhile with regard to pain tolerance has been investigated only in a parallel randomized study. A crossover study was thus designed for further elucidation. PATIENTS AND METHODS: Each of 33 male patients underwent three flexible cystoscopic examinations with intraurethral instillation of 11 mL of cold anesthetic gel (group 1), plain lubricating gel (group 2), or no gel (group 3). In every examination, 2% lidocaine gel was applied to the cystoscope. Although the cystoscopy was performed by two urologic surgeons, each patient underwent the three consecutive examinations with the same urologist. All the patients separately recorded pain levels during gel instillation, cystoscope insertion, and intravesical observation on a 100-mm visual analog scale after every cystoscopy. RESULTS: From the median scores, the degree of pain resulting from gel injection was 77.0% and 98.0% of those for cystoscope insertion and intravesical observation, respectively. For each group stratified by anesthetic method, there was no significant difference in the pain score during either cystoscope insertion or intravesical observation. CONCLUSION: The pain caused by intraurethral gel instillation is significant compared with that from cystoscope insertion and intravesical observation. Anesthetic gel instillation appears to have no significant advantage over anesthesia-free flexible cystoscopic examinations.

Administration, Intravesical↗
PubMed1997

New 3-dimensional mapping device for cystoscopy.

PURPOSE: The crucial shortcoming of cystoscopy is that it does not measure the size of observed objects, and so we developed a new device that adds measurement capability to the cystoscope. MATERIALS AND METHODS: The device consists of 5 arms linked to each other by freely bending joints. Before use 1 end of the arm is fixed to the examination table and the other end is linked to the eyepiece of the cystoscope. While linked to the arms, the cystoscope can move freely in any direction. Each joint carries an accurate sensor to measure its angle. The angle measurements are calculated collectively to obtain the 3-dimensional coordinates at the tip of the cystoscope. The tip of the cystoscope can be moved to the other side of the objects to be measured, which provides a pair of 3-dimensional coordinates, because the distance between them can be calculated. RESULTS: We could calculate the distance between the bladder neck and each ureteral orifice, and the angle of the bladder neck formed with the left and right orifices in clinical cases. By continuous measurement of the location of the bladder neck and the ureteral orifice, it was clearly demonstrated that the distance between them increased as the bladder filled. CONCLUSIONS: Our computer assisted, 3-dimensional mapping device can replace unreliable cystoscopic assessment with more reliable numerical values. New diagnostic criteria based on the exact numerical values can be established with the use of this device.

Cystoscopes↗
PubMedDate not supplied

[Cystoscopy (1879-1979) (centennial of a transcendental invention)].

The authors make a historical review of the successive stages in Man's attempt to be able to observe directly the inside of the cavities of the human body and more precisely of the bladder, which from the start long ago, led to the apparatuses invented during the first half of the 19th Century (Bozzini, Ségalas, Bonbalgini, Fisher, Avery, Desormeaux, Hacken, Cruise, Grünfeld, Luys, etc.) until the 9th March 1879 when Maximilian Nitze presented in the Vienna Medical Society and published in the journal Wiener Medizinische Wochenschrift his brilliant invention of the apparatus which completely changed the knowledge of vesical pathology: the cystoscope. Reference is made to the successive alternations that the primitive cystoscope invented by Nitze has undergone before arriving at the present-day cystoscopes of such great precision and usefulness in hospitals. Reference is also made to another series of creations designed by Nitze, such as a cystoscope for ureteral catheterism (which, however, was of no practical use and it was not until Albarrán's creation that the catheterism of the ureters could be achieved), an operating cystoscope, a ureteral probe with a dilating ball to enable stones to be expelled from the ureter, a "camera" for endoscopic photography, etc.

Cystoscopes↗
PubMed2006

Prevalence of benign microscopic hematuria among women with interstitial cystitis: implications for evaluation of genitourinary malignancy.

OBJECTIVES: To assess the prevalence of benign microscopic hematuria among a cohort of women with clinical interstitial cystitis (IC). METHODS: A total of 100 women were prospectively assessed for microscopic hematuria with postvoid sterile catheterization. The evaluation for all patients included urine culture, potassium sensitivity test (PST), cystoscopy with hydrodistension under general anesthesia, and symptom assessment with the Pelvic Pain and Urgency/Frequency (PUF) questionnaire. RESULTS: The mean age +/- SD was 37 +/- 15 years, with no difference noted in those with or without microscopic hematuria (P = 0.71). Microscopic hematuria was present in 24 (24%) of the 100 women. No patient had gross hematuria, positive urine culture, or cystoscopic findings suspicious for malignancy. The mean PUF score was 17 +/- 6. The PST was positive in 92 (92%) of 100 women, and 8 patients had only cystoscopic findings diagnostic of IC. The likelihood of a positive PST or positive cystoscopic findings among patients with microscopic hematuria was similar to that of patients without microscopic hematuria. The PST results correlated with the cystoscopic findings (P < 0.001). Of 36 patients with positive cystoscopic findings, 28 (78%) had a positive PST, and 28 (30%) of 92 with a positive PST had positive cystoscopy findings. CONCLUSIONS: In this cohort of women with IC, the prevalence of benign microscopic hematuria was 24%. These data suggest that in women at low risk of genitourinary malignancy who have clinical IC, microscopic hematuria may be an incidental finding.

Adult↗