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PubMed2001

Flexible video cystoscope with built-in high-frequency cauterizing element for transurethral resection of bladder tumor.

The major advantage of the flexible video cystoscope is that a digital signal can be obtained while high frequency cauterization is carried out. Cauterization while observing a digital signal picture was not possible before this new model was developed. We decided to use this new cystoscope to resect a bladder tumor and coagulate the bleeding because the patient could tolerate only local anesthesia due to severe heart disease complications. We successfully treated the patient with this technique and no complications were noted. This new flexible video cystoscope was found to be safe for resecting bladder tumor under local anesthesia.

Aged↗
PubMed2004

Use of 7.5F flexible pediatric cystoscope in the staging and management of urethral stricture disease.

BACKGROUND AND PURPOSE: In the evaluation and treatment of patients with urethral strictures, assessment of the stricture is of paramount importance. To date, urologists have relied on retrograde or antegrade urethrography or both to define stricture length and associated characteristics. Antegrade urethrography typically requires suprapubic access to the bladder, adding to the morbidity of stricture treatment. Herein, we describe the feasibility of using a new method for diagnosing, staging, and managing urethral stricture disease. PATIENTS AND METHODS: Twenty-four men with urethral strictures underwent urethroscopy with a 7.5F, 26-cm "pediatric" flexible cystoscope to stage and manage their disease. Comparison of urethroscopy with retrograde urethrography was made with respect to characterizing the stricture. RESULTS: In all cases, the urethral strictures could be navigated with the 7.5F cystoscope. Documentation of the stricture length and the density of scar tissue and identification and characterization of additional pathology (urethral calculi proximal to the stricture in two patients) were possible in all cases, including four patients with recurrent stricture after complex urethroplasty. CONCLUSION: The 7.5F, 26-cm pediatric flexible cystoscope represents a useful tool in the diagnosis and management of urethral stricture disease. Further studies will be necessary to determine the cost-effectiveness, patient morbidity, and ability to tailor therapy appropriately in comparison with standard retrograde urethrography or voiding cystourethrography.

Cystoscopes↗
PubMed1993

Actively deflectable, flexible cystoscopes: no longer solely a diagnostic instrument.

The recent evolution of actively deflectable, flexible endoscopes has included the flexible cystoscope. Improvements in optics, deflectability, and the size of the outer sheath and working channel have been accomplished. A superior flexible cystoscope is one with an outer sheath of 16F or less and working channel large enough to admit standard endoscopic instruments (> or = 6F). The 180 degrees two-way thumb-directed deflection and a removable light bundle are significant improvement. We present 55 patients with either urethral, bladder, or upper urinary tract lesions who were treated at the bedside using the flexible cystoscope in many settings. Local anesthesia alone was usually used. Flexible cystoscopy was also used for emergency intraoperative consultation requiring endoscopy. A treatment cart was constructed consisting of a light source, endoscopic instruments, irrigating supplies, and the endoscope. Urethral strictures, perforation, and bladder neck contractures were treated. Ureteral catheters were placed under direct vision. Removal of ureteral stents and foreign bodies, treatment of small bladder tumors with the Nd:YAG laser, and fragmentation of bladder calculi with the pulsed-dye laser were also therapeutic applications. Explanations of each treatment type and the instruments used concurrently with this endoscope are provided.

Biopsy↗
PubMed1998

Transurethral prostate ablation using saline-liquid electrode introduced via flexible cystoscope.

An interstitial saline-electrode has been developed to couple radiofrequency (RF) energy to prostate tissue in order to produce large lesions quickly and controllably. In this study, we attempted to produce similar results using a flexible catheter introduced transurethrally via a flexible cystoscope. An insulated 4F catheter with an extendable needle electrode (26-gauge, 5-mm exposed metal tip) was introduced through a port of a flexible cystoscope into the urethra of 10 dogs via a small perineal incision (required for the canine U-shaped urethra). Under visual endoscopic guidance, the electrode was placed in the center of the prostate and the needle electrode extended at an angle into the prostate, one lobe at a time. Hypertonic saline (14.6% NaCl) was infused at 2 mL/min through the needle electrode into the tissue for 30 seconds before and during RF application. The energy (50 W, 475 kHz) was delivered for 30, 45, 60, or 90 seconds (RFT System; U.S. Surgical Corporation). Prostate and urethral temperatures were monitored using thermocouples mounted on the catheter. There was an automatic high-temperature shut-off if the urethra reached >42 degrees C or if impedance reached >300 omega during RF energy application. Prostate sizes ranged from 1.4 x 2.0 x 1.4 cm to 5.0 x 4.5 x 4.2 cm. In this group, there were no automatic shut-offs at any of the energy durations, and the lesions produced ranged from 1.3 x 1.3 x 1.1 cm (0.99 cm3) to 1.6 x 2.7 x 2.2 cm (5.03 cm3). The average ablation volumes produced were 1.76 cm3 at 30 seconds' RF application, 2.42 cm3 at 45 seconds, 3.96 cm3 at 60 seconds, and 5.03 cm3 at 90 seconds. Histologic examination revealed typical coagulation necrosis in the treatment zone without tissue desiccation. Introduction of the saline-electrode through a flexible cystoscope provides a minimally invasive procedure that quickly and controllably produces large lesions that may provide effective treatment for benign prostatic hyperplasia with less patient discomfort.

Animals↗
PubMed1987

The integrated cystoscope: an alternative to conventional and fibreoptic cystoscopy.

This report describes a new integrated rigid cystoscope which has been designed for diagnostic and therapeutic cystoscopy under local anaesthesia. The small external diameter (17.5 F) and large instrument channel permit maximum irrigant flow and operating potential whilst causing minimum discomfort to the patient. We believe this instrument to be a practical alternative to conventional cystoscopes, including the fibreoptic cystoscope.

Cystoscopes↗
PubMed2006

Ultrasonographic characteristics and cystoscopic correlates of bladder wall invasion by endophytic cervical cancer.

OBJECTIVES: To present the ultrasonographic findings and explore cystoscopic correlates of endophytic cervical cancer invading the bladder wall. METHODS: We retrospectively reviewed the imaging files in 19 cases of cervical cancer, comprising six cases of endophytic lesions invading the bladder wall (study group) and 13 cases of endo- or exophytic, clinical stage IB1 lesions without bladder wall invasion (controls). Bladder wall infiltration or invasion was confirmed by cystoscopic biopsy or surgical findings or both. All 19 patients had undergone transvaginal ultrasound examination to evaluate the cervix and lower urinary tract. The main measures included tumor volume of the primary cervical neoplasm, tumor protuberance, mobility of the cervix over the lower bladder wall, continuity of the endopelvic fascia and echogenicity and morphological texture of the bladder wall and its thickness. RESULTS: A tumor protuberance emerging from the cervicocorporeal junction and invading the bladder in the supratrigonal area was seen in the study group but not in the controls. Disruption of the endopelvic fascia, a thickened bladder wall, changes in the bladder mucosa and interruption of the entire bladder wall were ultrasonographic characteristics demonstrating the sequential stages of bladder wall invasion. The morphological changes in the bladder wall on ultrasound examination were categorized into four stages. Based on the morphological classification, two of the six patients in the study group belonged to stage I, one to stage II, one to stage III and two to stage IV of bladder wall invasion. CONCLUSIONS: In cervical cancer, transvaginal ultrasonography helps to explore sequential changes seen in bladder wall invasion, information that is not as readily available from cystoscopic examination.

Adult↗
PubMedDate not supplied

Combined percutaneous antegrade and cystoscopic retrograde approach in the treatment of distal ureteric fistulae.

PURPOSE: To determine the efficacy of a cystoscopic approach, as definitive treatment of ureteral fistulae, after failure of antegrade ureteral stent insertion. METHODS: Of 43 ureter fistulae encountered over 4 years, 10 postoperative and/or postradiotherapy fistulae could not be stented via an antegrade approach alone. A cystoscopic approach was used, with the antegrade approach available as back-up, if necessary. RESULTS: In two patients the ureteral orifice could not be visualized cystoscopically, thus precluding the retrograde approach. In the eight remaining patients, the retrograde approach alone never allowed successful stenting. In six patients, combined antegrade and retrograde approaches permitted stent insertions. In three of those six patients, a complex catheterization procedure was necessary. In two patients the combined approach failed altogether. Therefore, 6 of 10 patients underwent a successful stenting procedure with the combined approach; all ultimately closed the fistula. CONCLUSION: Antegrade stent insertion remains the treatment of choice for ureteral leaks. If the antegrade approach fails, the retrograde approach alone is not likely to be successful. Instead, a combination of both approaches often does succeed.

Adult↗
PubMed2004

Popliteal cystoscopic excisional debridement and removal of capsular fold of valvular mechanism of large recurrent popliteal cyst.

PURPOSE: The purpose of this study was to evaluate the effectiveness of cystoscopic excisional debridement and removal of unilateral flow of the capsular fold of valvular mechanism in the posteromedial corner of the recurrent popliteal cyst. TYPE OF STUDY: Retrospective review. METHODS: From March 1998 to May 2000, we treated 14 cases of popliteal cyst by cystoscopic excisional debridement. The cysts were relatively large cysts, about 5 cm in diameter on sonography. Conservative treatment for about 1 year, with about 3 aspirations failed. The mean follow-up duration was 29.7 (24 to 36) months. We used Rauschning and Lindgren criteria for evaluations. We estimated surgical time. Patients underwent sonography 6 months and 1 year after surgery. Pain, range of motion, and recurrence were checked 1 year after surgery. RESULTS: The average surgical time was 45 (31 to 58) minutes. The time to pain elimination and full range of motion was 1 or 2 days after surgery. No recurrence was noted in any patients. At the last follow-up, patients reported no discomfort or pain, and all had free range of motion. Preoperatively, Rauschning and Lindgren criteria were grade 0 in 0 cases; grade 1 in 3 cases; grade 2 in 10 cases; and grade 3 in 1 case. At 2 weeks after surgery, criteria were grade 0 in 13 cases and grade 1 in 1 case; at final follow-up evaluation, all were grade 0. Hematoma occurred in 1 case. However, in cases lost to follow-up and in short-term follow-up cases, technical errors occurred: not entering within the cyst in 2 cases, extravasion in 1 case, and recurrence in 1 case. CONCLUSIONS: A popliteal cystoscopic excisional debridement by motorized shaver and removal of the capsular fold of the valvular mechanism is an effective alternative to the open technique of treating popliteal cysts.

Adult↗
PubMed1998

Muscle-invasive bladder cancer treated with external beam radiotherapy: pretreatment prognostic factors and the predictive value of cystoscopic re-evaluation during treatment.

PURPOSE: To determine the relationship between tumour and patient characteristics and local control and survival for patients with T2 and T3 bladder cancer treated with radical external beam radiotherapy and to evaluate the predictive value of cystoscopic response evaluation during radiation on final outcome. MATERIALS AND METHODS: Records from 379 patients with non-metastasized T2 or T3 transitional cell carcinoma of the bladder were reviewed. All patient received external beam radiotherapy at The Netherlands Cancer Institute during the period from 1977 to 1990. The total dose varied from 50 to 75 Gy with a mean of 60.5 Gy and a median of 60.4 Gy. The median follow-up was 22 months for all patients and 82 months for the 30 patients still alive at last follow-up. A stepwise procedure using proportional hazard regression was used to identify prognostic factors with respect to local recurrence and survival. RESULTS: One hundred thirty-six patients experienced a local recurrence and 120 of these occurred before regional or distance metastases. The actuarial results at 5 years were 40.3% local control (SE 4.0%), 24.9% disease-free rate (SE 3.0%) and 22.2% overall survival (SE 2.2%). In the univariate analysis age, performance status, result of intravenous pyelography (IVP) and T-stage were found to be related to overall survival and multifocality was related to local control. Multivariate analysis revealed that only age and T-stage were related to survival and only multifocality was related to local control. In patients with solitary tumours who were identified as having the most favourable outcome. local control was 50% at 5 years. Local control in 89 patients who had a cystoscopic evaluation during treatment was identical regardless of whether a complete, partial or no response was observed. Furthermore, local control was identical in patients selected on the basis of a favourable response and in unselected patients. CONCLUSIONS: Although we identified some significant prognostic factors, their predictive value is not strong enough to allow accurate estimation of treatment effect and disease outcome. Cystoscopic response evaluation during treatment was found not to provide reliable information to direct further treatment. Prospective studies to identify ways to select patients for bladder conservation using definitive radiotherapy are urgently needed.

Aged↗
PubMed1995

Use of ultrasound and cystoscopically guided pancreatic allograft biopsies and transabdominal renal allograft biopsies: safety and efficacy in kidney-pancreas transplant recipients.

The use of allograft biopsies to guide treatment after solid organ transplantation is a valuable tool in the detection and treatment of rejection. Prior development and use of the cystoscopically guided pancreatic allograft biopsy have allowed for more accurate and timely diagnosis of pancreatic allograft dysfunction, possibly contributing to our 1-year pancreas graft, renal allograft and patient survival rates of 87.1%, 88.5% and 96.8%, respectively. We reviewed our experience, examining efficacy and complication rates of pancreas and kidney biopsies in 31 cadaveric pancreas or combined kidney and pancreas transplants performed between June 1990 and February 1992 with at least 1 year of followup. There were 94 pancreas, 54 kidney and 53 duodenal mucosal biopsies in 29 evaluable patients. This biopsy technique uses a 24.5F side-viewing nephroscope to view the cystoduodenostomy, with the duodenum acting as a portal for biopsy needles into the pancreas. Pancreatic tissue is obtained with either an 18 gauge, 500 mm. Menghini aspiration/core needle or an 18 gauge, 500 mm. Roth core needle. Percutaneous renal allograft biopsies are performed independently or simultaneously with the pancreas biopsies using a 16 gauge spring loaded needle. Pancreas biopsies were prompted by clinical indications of rejection (decreased urinary amylase, increased serum amylase or increased serum creatinine) or by protocol (10, 21 and 40 days postoperatively). Among the biopsies 30% were required by protocol, of which 10 (36%) revealed abnormal pathological findings and 5 (18%) showed evidence of occult cellular rejection. Renal biopsies demonstrated rejection in 69% of the cases. Of simultaneous pancreas/kidney biopsies 33% revealed concomitant rejection. A total of 88 Menghini needles with 170 passes was used in 73 biopsy attempts, yielding 126 tissue cores with a 16% complication rate. A total of 41 Roth needles was used with 73 passes in 34 biopsy attempts, yielding 55 tissue cores with a complication rate of 21%. Complications included self-limited bleeding from the biopsy site in 13% of the cases, bleeding requiring clot evacuation and fulguration in 1% and asymptomatic hyperamylasemia in 12%. Renal biopsy complications included 1 arteriovenous fistula (2%). We conclude that ultrasound and cystoscopically guided pancreatic allograft biopsy and percutaneous renal allograft biopsies are safe and essential methods of obtaining tissue for histological diagnosis without serious sequelae. The Menghini and Roth needles in cystoscopically guided pancreatic allograft biopsy have similar yield and complication rates in obtaining pancreatic tissue, although they require different performance techniques. In some cases both needles are necessary and are complementary in obtaining adequate tissue.(ABSTRACT TRUNCATED AT 400 WORDS)

Abdomen↗
PubMed2002

Does the potassium stimulation test predict cystometric, cystoscopic outcome in interstitial cystitis?

PURPOSE: We establish the relationship among symptom duration, cystometric and cystoscopic findings and potassium stimulation test in patients with interstitial cystitis. MATERIALS AND METHODS: A retrospective chart review was performed of 189 patients treated at an ambulatory clinic between 1992 and 1998. Urodynamic parameters, potassium stimulation test results and subjective response to treatment were evaluated. Fisher's exact test was used for statistical analysis. RESULTS: Of the 189 patients diagnosed with interstitial cystitis 173 (92%) were female and 16 (8%) were male. The potassium stimulation test was positive in 105 (83%) patients, negative in 16 (13%) and equivocal in 6 (4%). A cystometrogram and potassium stimulation test were done in 118 patients. Bladder capacity averaged 259 ml. in patients with tests potassium positive and negative, while average bladder volume at first sensation to void was 85 ml. and 148 ml. in those with negative and positive tests, respectively. Among the 102 patients with a positive potassium stimulation test 52 had normal cystoscopic findings. CONCLUSIONS: The potassium stimulation test is not correlated with either bladder capacity or cystoscopic findings.

Administration, Intravesical↗
PubMed2003

[Low urinary tract infection and cystoscopic findings in Urogynecology Service in the Instituto Nacional de Perinatología].

INTRODUCTION: The pathogenesis of urinary tract infection and related to the host and pathogens. There are three associated factors: incontinence, cystocele and residual urine. OBJECTIVES: To know the prevalence of urinary tract infections and uropathogens in urogyneacologic patients of the Instituto Nacional de Perinatología describe the cystoscopic findings in patients with positive urocultures and antibiogram. METHODS: This is a retrospective study involving urogyneacologic patients with positive urine cultures from 1998 to 2001. Positive culture was a growth of only one microorganism more than 100,000 colonies. The antibiogram and patients files were reviewed in order to know: Symptoms, indications, diagnostic and cystoscopic findings; their distribution and differences were analyzed. RESULTS: From 3,433 urine cultures, 540 were positive (16% prevalence). Uropathogens distribution was: E. coli 70%, Klebsiella pneumoniae 6.3%, Pseudomonas aeruginosa 4.3%. The antibiogram showed resistance to beta-lactamics and third generation cephalosporin (96.59% and 85.17%). The most frequent indications were: incontinence, irritative symptoms, urethral hypermovility and pelvic organ prolapse. Urethrothrigonitis was the most frequent cystoscopic finding. Mixed urinary incontinence and urethral hypermotility were the only findings to have a important difference. CONCLUSIONS: There is a change in the uropathogens prevalence and in their antibiotic resistance. This must be considering in the treatment of urogyneacologic patients with urinary tract infections. To ensure the best outcome we must ask for a urine culture with antibiogram. The additional use of anti-inflammatory agents is convenient in the presence of urethrothrigonitis in urogyneacologic patients with urinary tract infections.

Cystoscopy↗
PubMedDate not supplied

Cystoscopic biopsy supernate. A new cytologic approach for diagnosing urothelial carcinoma in situ.

The examination of cystoscopic biopsy supernates is a new cytologic procedure that can aid the urologist in the differential diagnosis of urothelial carcinoma in situ (CIS) and cystitis. Within the past two years, the Cytodiagnostic Urinalysis Laboratory has received 79 cystoscopic biopsy supernate specimens from 29 patients; these were prepared using a membrane filtration technique and stained with a modified Papanicolaou method. Positive diagnoses were rendered on 17 (21.5%) specimens, including 7 (41%) CIS and 10 (59%) papillary neoplasms. An 87% cytohistologic correlation was seen. Of the 17 cases with biopsy specimens that were denuded and thus nondiagnostic, 11 had negative supernate cytologies and 6 had positive cytologic diagnoses. Half of these positive specimens were diagnosed as CIS. Because urothelial CIS is often a friable lesion that yields denuded bladder biopsies, the cytologic examination of cystoscopic biopsy supernates offers a valuable adjunctive method for diagnosing urothelial CIS on otherwise lost cellular material.

Biopsy↗
PubMed1984

Cystoscopic fluorescence detector for photodetection of bladder carcinoma with hematoporphyrin derivative.

Hematoporphyrin derivative, a fluorogenic substance, tends to accumulate at higher levels in most tumor tissues after intravenous injection. These properties provide a potential application for the detection of malignant tumors. We report the development and in vitro evaluation of an instrument designed to excite and detect low levels of hematoporphyrin derivative fluorescence emitted by tumor cells in the bladder after hematoporphyrin derivative administration. The light source of the instrument for specific hematoporphyrin derivative excitation is at a wavelength of 405 nanometers. Optical fibers for both the excitation and detection of fluorescence were bundled in a single 7 French ureteral catheter which can be inserted into a standard cystoscope. The fluorescence is initially detected as an electrical signal which is amplified and then converted into an audio signal. The interference of the cystoscope illuminating white light to the fluorescence signal is eliminated by a phase-sensitive electronic circuit. The instrument thus allows simultaneous viewing of the bladder and detection of hematoporphyrin derivative fluorescence produced from tumor tissues. In vitro testings using hematoporphyrin derivative solutions on filter paper indicated that the instrument detects as little as 30 nanograms per milliliter of hematoporphyrin derivative and has relatively low noise levels from normal tissues. The utility of this instrument for hematoporphyrin derivative photodetection of small tumors and carcinoma in situ in bladder is currently under clinical evaluation.

Animals↗
PubMed2002

A new small-calibre diagnostic flexible cystoscope.

OBJECTIVE: To determine whether flexible cystoscopy with a prototype slim flexible instrument is less uncomfortable than flexible cystoscopy using a standard flexible cystoscope. PATIENTS AND METHODS: In all, 200 men scheduled to undergo flexible cystoscopy for the follow-up of transitional cell carcinoma of the bladder were randomized in equal groups to flexible cystoscopy using the standard instrument or using the prototype slim-scope. Each patient had 11 mL of 2% lignocaine gel instilled intraurethrally 5 min before the procedure. At the end of the procedure the patient was asked to complete a 100-mm non-graphical visual analogue scale to rate how uncomfortable the procedure was. RESULTS: The slim-scope was very significantly less uncomfortable than the conventional instrument (anova P < 0.001). The ease of use and views of the bladder were similar to those obtained with the conventional cystoscope. CONCLUSION: The slim-scope offers a significant benefit in patient comfort, with little loss of image quality or ease of use.

Carcinoma, Transitional Cell↗
PubMed1991

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↗
PubMed1982

Flow cytometry of low stage bladder tumors: correlation with cytologic and cystoscopic diagnosis.

Flow cytometry examinations (FCM) were carried out on 110 bladder irrigation specimens from 84 urologic outpatients who had had prior conservative treatment for low stage bladder tumors. The specimens were easily obtained, and adequately cellular in all cases. Of 60 examinations on patients with no cytoscopic abnormalities, FCM and conventional cytology were both negative in 30 and both positive in 12 instances; there were 18 with positive FCM and negative cytology. Of 15 instances with cystoscopically benign appearing papillary lesions, FCM and cytology were both negative in three and both positive in three cases; FCM was positive and cytology negative in nine. Of 35 instances with suspicious cystoscopic findings, FCM and cytology were both positive in 19 and both negative in four; FCM was positive and cytology negative in 12. There were no examples of positive conventional cytology and negative FCM. These findings indicate that, after conservative treatment of low stage tumors, FCM of bladder irrigation specimens may be a more sensitive measure of cytologic abnormalities than is conventional cytology. Specimen collection is feasible as part of the routine urologic examination in an outpatient clinic.

Carcinoma in Situ↗
PubMed2006

Inverted papilloma of urinary bladder: is long-term cystoscopic surveillance needed? A single center's experience.

OBJECTIVES: To review all cases of urinary bladder inverted papilloma (IP) in our institution and determine the need for cystoscopic surveillance. IP is an uncommon benign tumor of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) suggest possible malignant potential, leading to conflicting clinical conclusions regarding the need for surveillance. METHODS: All consecutive patients from January 1991 to December 2004 with IP were included in this study. A single pathologist performed the histologic review. The patients had undergone cystoscopy and ultrasound evaluation of the kidneys every 6 months. RESULTS: Of the 52 patients, 45 were men and 7 were women. The average age at presentation was 58.9 +/- 11.8 years (range 30 to 79). No patient had a synchronous or previous bladder tumor. The most common complaint was macroscopic hematuria. Ten cases were incidental findings during bladder ultrasonography or cystoscopy. All were solitary tumors, most commonly found at the bladder neck. The average follow-up period was 62 +/- 23 months, with no recurrence. One case of subsequent noninvasive papillary TCC developed 15 months later. The initial histologic findings had revealed cytologic atypia, with suspicious urine cytology findings. On review, it was more compatible with TCC with an inverted pattern. CONCLUSIONS: Although our cases exhibited benign biologic behavior, the presence of cytologic atypia and suspicious urine cytology require exclusion of TCC with an inverted pattern. Thus, in histologically proven solitary bladder IP with no associated TCC, cystoscopic surveillance may not be necessary.

Adult↗