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PubMed1984

[Carcinoma of the urachus--report of 4 cases].

Four cases of urachal carcinoma are presented. The first case was a 36-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiation therapy were performed. Histological findings showed a well differentiated adenocarcinoma. He has been well for twelve years postoperatively. The second case was a 52-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiochemotherapy were performed. Histological findings showed a moderately differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The third case was 70-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed multiple tumors at the dome of the bladder, internal urethral orifice and right lateral wall. Total cystectomy, ureterocutaneostomy and postoperative chemotherapy were performed. Histological findings showed a poorly differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The fourth case was a 68-year-old woman who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. CT scan demonstrated a mass with calcification extending from the bladder dome superiorly. Partial cystectomy and postoperative chemotherapy were performed. Histological findings showed a well differentiated adenocarcinoma. She has been well for three months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1983

Hysteroscopic management of intrauterine lesions and intractable uterine bleeding.

Müllerian fusion defects, submucous myomas, and intractable uterine bleeding have been managed traditionally by major surgical intervention. However, the cystoscope-resectoscope provides the operative versatility allowing transvaginal surgical management of these situations. Forty women underwent hysteroscopy and treatment with the cystoscope-resectoscope at the Yale-New Haven Hospital. Those patients treated for septate müllerian defects also underwent concomitant laparoscopy. Therapeutic surgical use of the cystoscope-resectoscope resulted in no immediate or long-term complications. Of 11 patients with uterine anomalies treated in this fashion, 9 carried to term without difficulty. Fourteen women with space-occupying intrauterine lesions were treated and resumed normal cyclical menses for a minimum of 1 year. In all 11 patients with intractable uterine bleeding hemorrhage was controlled immediately and 6 women remained amenorrheic for a sustained period. The use of the cystoscope-resectoscope for the management of these entities provides several advantages: 1) A transcervical approach obviates the necessity for abdominal surgery, and 2) the instrument is rapidly and easily accessible to the practicing gynecologist.

Colposcopy↗
PubMed1998

Flexible transinguinal laparoscopy to assess the contralateral ring in pediatric inguinal hernias.

The incidence of contralateral patent processus vaginalis (CPPV) is >50% in infants with clinical unilateral inguinal hernia (CUIH) and decreases only slowly with advancing age. Laparoscopy through the hernia sac (transinguinal laparoscopy) to detect suspected CPPV is a safe and efficient way to minimize routine contralateral inguinal exploration, but can be technically difficult. We used flexible urologic instruments and/or angled cystoscopic lenses to make transinguinal laparoscopy easier. Over a 3-year period, 37 patients (34 boys and 3 girls) ranging in age from 4 months to 12 years (mean age 59 months) with CUIH underwent ipsilateral groin exploration and diagnostic transinguinal laparoscopy. Laparoscopy was performed with flexible 17F cystoscopes (26 cases), flexible 9F ureteroscopes (2 cases), and rigid 70 degrees cystoscope lenses (9 cases). We detected eight CPPV (22%) in our series of 20 right and 17 left inguinal hernias, in a mean transinguinal laparoscopy time of 4.5 minutes. At 26-month mean follow-up, no patient whose contralateral inguinal ring was deemed closed had developed a hernia. Flexible fiberoptic urologic scopes and/or angled cystoscope lenses make transinguinal laparoscopy easy and efficacious in the pediatric population. Our series represents the longest longitudinal study of transinguinal laparoscopy for the diagnosis of CPPV.

Child↗
PubMed1997

Liquid sterilization versus high level disinfection in the urologic office.

OBJECTIVES: Systems are available for liquid sterilization (LS) and high level disinfection (HLD) of flexible cystoscopes. Guidelines from the Association of Operating Room Nurses and the Association for Professionals in Infection Control and Epidemiology recommend HLD for urologic endoscopic equipment. We examine these methods emphasizing costs, performance of procedure, and maintenance. METHODS: The process of LS using the Steris System 1 Processor (SSP1) was studied from June 1993 to June 1994. The Voluntary Hospital Association (VHA) Plus Glutaraldehyde HLD system was evaluated from July 1994 to July 1995. Costs are those incurred by the Ochsner Department of Urology over these same periods. RESULTS: Purchase of the SSP1 system proved costly: $16,200 for purchase; $8645 for accessories, service contract, and training seminars; and $5800 for unit installation. Two gallons of glutaraldehyde including the disinfection container cost $15.60. Since government regulation requires less than 0.2 ppm airborne glutaraldehyde concentration, some facilities may need to install ventilation systems. There were no clinical differences between the two systems. Yearly operating expenses in our department for SSP1 was $6037 compared to $445 for HLD. Mean length of time to process was 35 minutes per use for SSP1 and 20 minutes for HLD. Repair of seven cystoscopes during the SSP1 period cost $11,500. No repairs were required for the cystoscopes used during the HLD period. CONCLUSIONS: Outpatient flexible cystoscopy was performed an average of 988 times per year during the study period. Major cost savings were incurred with institution of the HLD system and no endoscope repairs were necessary. There were no clinical differences between the two systems.

Costs and Cost Analysis↗
PubMed1995

Endoscope modifications for laser prostatectomy.

Prior to the development of the technique of laser prostatectomy, contemporary modifications to resectoscope design for transurethral prostatectomy had been scant. With the introduction of laser prostatectomy and the characterization of the "mini-TURP" technique, a new demand for improved continuous-flow cystoscopes and resectoscopes has developed. The ideal cystoscope design for laser prostatectomy would require the following: (1) continuous irrigant flow for optimum cooling of the laser element; (2) a large inflow port so that flow is not impaired by the presence of the fiber in the working channel; (3) a large outflow port to maximize irrigant flow; and (4) a fiber stabilizer to enable easy manipulation of the fiber in the center of the viewing field. The ideal resectoscope design for laser prostatectomy would require the following: (1) continuous flow of irrigant for cooling of the laser fiber; (2) stabilization of the laser fiber in the center of the field of view; (3) the ability to interchange electrocautery loops with laser fibers without changing the sheath; and (4) the ability to apply laser energy to tissue with the same Iglesias action used in transurethral resection of the prostate (TURP). This review analyzes the features of the new continuous-flow cystoscopes and resectoscopes manufactured specifically for use in laser prostatectomy. All manufacturers were requested to submit their most up-to-date literature and photographs of the specific instruments they manufacture. The technical specifications, advantages, and disadvantages of each instrument are discussed.

Cystoscopes↗
PubMedDate not supplied

[New unit construction urologic endoscopes].

Drawbacks of serially-produced cystoscopes are considered along with their technical perfection. The calculation results for a new light-power optical ststem for cystoscope are reported and the structure of optical tube incorporated in those unified urological endoscopes with its main parameters are given. A conclusion is made regarding the technical perfection of currently produced Soviet cystoscopes.

Biomedical Engineering↗
PubMed1986

Prognostic significance of urine cytology on initial follow-up after intravesical mitomycin C for superficial bladder cancer.

Seventy patients were given courses of intravesical mitomycin C for residual transitional cell carcinoma of the bladder following partial resection or biopsy. The patients were reassessed 3 months after the initiation of treatment by cystoscopy and cytology from cystoscopic urines and bladder washings. Twelve had no visible cancer at cystoscopic study but had positive urine cytologic findings. The incidence of tumor recurrence, cystectomy, radiotherapy, and deaths due to bladder cancer for this group of cytologically positive partial responders was analyzed. Thirty-three percent (4/12) required cystectomy, none underwent radiation therapy and none died of bladder cancer. These outcomes were compared with that of complete responders (negative cystoscopic and cytologic results) and partial responders with visible tumor (reduction by greater than 50%). We conclude that in high-grade carcinomas, particularly carcinoma in situ, positive urine cytologic findings at the initial 3-month follow-up visit following treatment with intravesical mitomycin C is as ominous a prognostic indicator as endoscopic or biopsy evidence of cancer.

Aged↗
PubMed2006

Histological changes in bladders of patients submitted to ifosfamide chemotherapy even with mesna prophylaxis.

PURPOSE: Hemorrhagic cystitis (HC) is a limiting side effect of chemotherapy with ifosfamide (IFS). Mesna is the drug of choice for prevention of HC. In this study, we analyzed cystoscopic and histological changes present in bladders of patients using IFS with mesna prophylaxis. METHODS: Thirty-three patients selected for IFS plus three doses of mesna chemotherapy regime were assigned at random to two groups: Group I or reference group consisted of 18 patients yet untreated. Group II consisted of 15 patients in whom urinalysis and cystoscopy plus vesical biopsy were performed only 24 h after receiving the last dose of IFS. The cystoscopic and histological findings were used as parameters for evaluating the results. For the former the criterion adopted was macroscopic vesical changes in accordance with Gray's criteria. Histological analyses were performed by evaluation method especially adapted to this study. RESULTS: Even under treatment with three doses of mesna, 66.7% of patients presented cystoscopic alterations and 100% showed bladder mucosa microscopic alterations such as edema, exocytosis, and hemorrhage. CONCLUSIONS: The standard protocol used for prevention of IFS-induced HC with three doses of mesna does not completely prevent bladder damage. The histopathological criteria used in this study for observation of inflammatory events allowed staging the intensity of IFS-induced urothelial and mucosal injury.

Adolescent↗
PubMed2004

MR cystography for bladder tumor detection.

The purpose of the study was to assess the diagnostic performance of MR cystography with virtual cystoscopic and multiplanar reconstructions for detection of malignant bladder tumors. Thirty-two patients with 43 bladder tumors previously confirmed by cystoscopy (mean size 2.5 cm; 0.4-9.1 cm;) were examined at 1.5 T with a three-dimensional T2-weighted turbo spin echo sequence (TR=2911 ms, TE=500 ms, echo train length 256). Virtual cystoscopic reconstructions (VC) and multiplanar reconstructions (MPR) were obtained and analyzed separately by three radiologists without knowledge of the tumor location. Intraoperative or cystoscopic findings served as standard of reference. Sensitivities and specificities were calculated using a receiver-operating characteristic analysis with five levels of confidence. Area-under-curve values were similar for MPRs (0.952), VC (0.932) and the combination of both methods (0.954). Optimal sensitivity was 92.3% for MPR and 90.7% for VC, respectively, with a specificity of 91.1% for MPR and 90.4% for VC. The combination of MPR and VC resulted in a sensitivity of 90.7% and specificity of 94.0%. MR cystography is a promising, completely non-invasive technique for the detection of bladder lesions with a high diagnostic performance.

Aged↗
PubMed2006

Minimal invasive treatment of vesicouterine fistula: a case report.

We report a case of vesicouterine fistula presenting after cesarean operation. The fistula was treated successfully by cystoscopic fulguration of the tract and hormonal amenorrhea. Although various surgical approaches to this problem have been described, to date there is no reports of treatment of this problem via cystoscopic fulguration and hormonal amenorrhea. The problem has been solved by hormonal amenorrhea and cystoscopic fulguration. We advocate this simple technique as a primary approach to proper case of vesicouterine fistulas.

Adult↗
PubMed2005

Hand-assisted laparoscopic nephroureterectomy: analysis of distal ureterectomy technique, margin status, and surgical outcomes.

OBJECTIVES: To review our experience with various techniques used to manage the distal ureter during hand-assisted laparoscopic nephroureterectomy and to evaluate the surgical outcomes, including pathologic margin status and the incidence of disease recurrence. METHODS: We retrospectively analyzed 55 hand-assisted laparoscopic nephroureterectomies performed to treat transitional cell carcinoma (TCC), with the distal ureter managed as follows: cystoscopic disarticulation in 16 patients, stapled division in 7, open distal ureterectomy in 3, and hand-assisted laparoscopic extravesical en bloc distal ureterectomy with bladder cuff in 29. The cystotomy was not closed in 7 patients. RESULTS: The coexistence of renal pelvic and ureteral tumors was common but in 27% of cases was not recognized preoperatively. One outer and four distal ureteral margins were positive for tumor (n = 2) or carcinoma in situ (n = 3). Two (29%) of the seven cystotomies that were not closed and only 1 (2%) of the 42 that were closed demonstrated extravasation. The operative time was 60 to 90 minutes longer and the estimated blood loss, open conversion rate, and indwelling catheterization time were two to three times greater for the cystoscopic ureteral disarticulation cohort. The stapled division cohort had a greater positive margin rate (29%) than the other cohorts (10% or less). With a mean follow-up of 24 months, 19 patients had developed bladder cancer, 1 prostate cancer, 1 an extravesical malignancy with synchronous liver metastasis, and 4 distant recurrence (lung in 2 and the retroperitoneum and spine in 1 each). CONCLUSIONS: The results of our study have shown that distal ureteral tumors have the greatest likelihood for a positive margin. Cystoscopic ureteral disarticulation increased the operative time and estimated blood loss. Cystotomy closure reduced the extravasation rate. We favor hand-assisted laparoscopic en bloc distal ureterectomy followed by cystotomy closure to minimize the risk of distal ureteral or extravesical recurrence.

Aged↗
PubMed2006

Novel technique for management of distal ureter and en block resection of bladder cuff during hand-assisted laparoscopic nephroureterectomy.

OBJECTIVES: To report our experience with a novel flexible cystoscopic approach to excise the en block bladder cuff and juxtavesical ureter during hand-assisted laparoscopic nephroureterectomy. The optimal technique for excising the distal ureter and bladder cuff during nephroureterectomy continues to evolve. METHODS: Hand-assisted laparoscopic nephroureterectomy was performed in 6 patients. A hand-assist device and two 5 to 12-mm ports were placed in the mid and upper abdomen. Two 10-mm clips were placed on the proximal ureter to occlude it, and the kidney was resected in the usual fashion. An additional 5 to 12-mm port was placed in the midline between the umbilicus and symphysis pubis. The ureter was dissected down into the pelvis to the level of the bladder. Without repositioning the patient, a flexible cystoscope was inserted into the bladder and a 2-cm bladder cuff excised using a 5F electrode on cutting current, with coagulating current used as needed. The specimen was removed intact through the hand port. RESULTS: The mean time to resect the distal bladder cuff was 30 minutes (range 22 to 35). The mean estimated blood loss was 254 mL. The mean operating room time was 264 minutes, mean hospital stay 6.3 days, and mean time to a general diet 2.6 days. All patients underwent cystography at 7 to 10 days postoperatively, with no extravasation or diverticula. Cystoscopic and computed tomography follow-up demonstrated no evidence of recurrence. CONCLUSIONS: This technique allows for complete resection of the kidney, distal ureter, and a cuff of bladder, avoiding repositioning.

Carcinoma, Transitional Cell↗
PubMed2006

Localized amyloidosis of the urinary tract: case series of nine patients.

OBJECTIVES: To report 9 cases of primary localized amyloidosis of the urinary tract and correlate the pathologic findings with clinical and cystoscopic information. METHODS: Patients diagnosed with amyloidosis of the ureters, urinary bladder, or urethra from 1976 to 2003 were identified. Their medical records were reviewed, and histochemical and immunoperoxidase stains were performed on the tissue. RESULTS: Eight cases of amyloidosis of the urinary bladder and one of the renal pelvis/ureter were identified. None of our cases showed evidence of systemic amyloidosis. Of the 8 patients with amyloidosis of the urinary bladder, 5 presented with gross hematuria and 1 with irritative bladder symptoms and 2 had amyloidosis detected during cystoscopic follow-up for urothelial carcinoma. The patient with amyloidosis of the renal pelvis/ureter presented with flank pain and gross hematuria. The clinical impression was malignancy in 75% of the bladder cases. Most patients with bladder involvement were treated with localized bladder resection; however, 1 patient required total cystectomy for symptom control. Of 5 patients with follow-up information, 2 developed recurrence. The pathologic assessment diagnosed amyloid deposits consistent with primary or AL type amyloid in all cases. Immunoperoxidase stains revealed lymphoid cells in the vicinity of the amyloid deposits to be lambda-restricted in 78% of cases. CONCLUSIONS: Primary amyloidosis of the urinary tract is a rare condition that mimics malignancy in its clinical presentation and cystoscopic appearance and on diagnostic imaging. In our study, all cases of urinary amyloid deposits represented localized amyloidosis rather than manifestations of systemic amyloidosis. Monoclonal lymphoid populations evolving from chronic inflammation in the urinary tract may be the source of the amyloid AL proteins.

Aged↗
PubMed1993

The risk of exposure to potentially contaminated body fluids in urological surgery.

To determine the risk of exposure to body fluids potentially contaminated with infectious organisms we instituted a prospective study of all urological procedures performed at our institution. Urological procedures were divided into 3 categories: open, cystoscopic and endoscopic surgical (transurethral resection of the prostate or bladder tumor, ureteroscopy and percutaneous procedures). We have complete data analysis on 594 consecutive patients who underwent an operation at our institution: 77 (13%) underwent an open procedure, 75 (13%) underwent an endoscopic surgical procedure and the remaining 442 (74%) underwent cystoscopic procedures. All procedures were performed by supervised house staff using universal precautions. The operating surgeon was exposed to potentially contaminated body fluids in 173 of 594 cases overall (29%). There was exposure in 17% of all open procedures, 41% of all endoscopic surgical procedures and 29% of all cystoscopic procedures. Urologists must consider themselves at high risk for exposure to potentially contaminated body fluids and take appropriate precautions.

Accidents, Occupational↗
PubMed1991

Stage T1 bladder cancer: grade is the primary determinant for risk of muscle invasion.

Tumor characteristics believed to predict for deep muscle invasion after transurethral resection of superficial bladder cancer alone were analyzed in 51 patients with stage T1 (stage A) transitional cell carcinoma of the bladder. All patients were treated at Stanford University Medical Center and none had intravesical chemotherapy at any time during the median followup of 78 months. No patient had carcinoma in situ. A total of 14 patients (27%) had deep muscle invasion. None of the patients with grade 1, 5 (22%) with grade 2 and 9 (50%) with grade 3 to 4 tumors had deep muscle invasion. Comparison of the risk of muscle invasion using pathological tumor grade at diagnosis, highest grade at any cystoscopic biopsy before the diagnosis of muscle invasion or highest grade at cystoscopic biopsy immediately antecedent to the cystoscopy at which muscle invasion was diagnosed all showed similar probability of muscle invasion. Mean interval to development of muscle invasion was 6 and 12 months in the grades 2 and 3 to 4 groups, respectively. At 36 months the cumulative probability of invasion-free survival was 62% for grade 2, compared to 50% for grades 3 to 4 cancer patients (p less than 0.005, Gehan). Univariate regression analysis demonstrated grade to be the only significant factor in predicting for invasive disease (p = 0.005), with tumors in the bladder neck to be of borderline significance (p = 0.159). On multivariate logistic regression analysis, grade remained the single tumor variable predicting for invasive bladder cancer (p = 0.004). These data suggest that of routinely available data at diagnosis and during subsequent followup cystoscopic examinations, tumor grade is the most important biological predictor of progression to muscle invasive cancer.

Aged↗
PubMed1989

Flow cytometry as a predictor of response and progression in patients with superficial bladder cancer treated with bacillus Calmette-Guerin.

Simultaneous bladder wash flow cytometry, voided urinary cytology and cystoscopic examinations were performed at 3-month intervals during a median of 18 months (range 5.5 to 50 months) in 65 patients receiving intravesical bacillus Calmette-Guerin treatment for superficial bladder cancer. Of the 65 patients treated 36 (56 per cent) had a complete response, 12 (18 per cent) had no response and 17 (26 per cent) had progression. Results of examinations at 6 months suggested that a negative bladder wash flow cytometry (29 of 36 patients, r equals 0.73, p less than 10(-7) is a strong predictor of response to bacillus Calmette-Guerin, comparable with cytological (r equals 0.60, p less than 10(-7) or cystoscopic (r equals 0.38, p less than 0.005) examinations alone or combined with cytology (r equals 0.74, p less than 10(-7)). At 6 months a positive bladder wash flow cytometry (r equals 0.44, p less than 0.0005) is as strong a predictor of disease progression as a positive cystoscopic examination (r equals 0.43, p less than 0.0005). The combination of bladder wash flow cytometry and voided urinary cytology is not superior to positive bladder wash flow cytometry alone. Median estimated interval to progression for these patients treated with bacillus Calmette-Guerin was 38 months. In the subgroup with positive bladder wash flow cytometry at 6 months the median interval to progression was 30 months. With a negative bladder wash flow cytometry at 6 months the probability of survival free of progression at 30 months was 85 per cent (p less than 0.01). Thus, negative bladder wash flow cytometry at 6 months is a strong predictor of response to bacillus Calmette-Guerin and also survival free of progression.

Administration, Intravesical↗
PubMed1987

Painful bladder disease: clinical and pathoanatomical differences in 115 patients.

The diagnostic criteria for interstitial cystitis considered as a subgroup of painful bladder disease (that is sensory bladder disease and chronic abacterial cystitis) are not well established. Some urologists rely on symptoms, while others rely on cystoscopic appearance or pathological findings. Among 115 patients with painful bladder disease we compared symptoms, and cystoscopic and urodynamic findings in those with and without detrusor mastocytosis (28 or more mast cells per mm.2) and attempted to elucidate possible differences between the groups. We chose the pathological anatomical criterion of detrusor mastocytosis to be diagnostic for interstitial cystitis. A total of 43 patients had detrusor mastocytosis and other pathological anatomical signs of interstitial cystitis, and 72 had no mastocytosis but the pathological diagnoses of chronic unspecific cystitis, fibrosis of the bladder, detrusor myopathy, intestinal metaplasia and normal findings. When the 2 groups of patients were compared we found no differences in regard to symptoms (pain, dysuria, frequency, nocturia and urgency), frequency of allergy and hysterectomy, duration of symptoms, petechial bleeding during cystoscopy with bladder distension and cystometric findings. The patients with mastocytosis differed from those without mastocytosis in that they were older, and had a higher frequency of hematuria, a higher frequency of a red, scarred and richly vascularized bladder at cystoscopy before distension, and a smaller cystoscopic bladder capacity. We conclude that by dividing patients with painful bladder into 2 groups according to the mast cell counts in the detrusor, certain differences in the clinical findings in the groups can be ruled out. However, in individual patients one cannot note with certainty to which pathological anatomical group the patient belongs, since great overlapping between the groups exists. Whether only patients with detrusor mastocytosis have interstitial cystitis depends on definitions and still remains an open question.

Adult↗
PubMed1987

Prone flexible cystoscopy: an adjunct to percutaneous stone removal.

Percutaneous removal of renal calculi is completed most often in the United States after initial placement of a retrograde ureteral catheter. Catheterization usually is accomplished with a rigid cystoscope with the patient in a dorsal lithotomy position, following which the patient must be turned to a prone position for percutaneous puncture and stone removal. We report our experience with the use of a flexible cystoscope with the patient in a prone position for placement of a retrograde catheter. In male patients this approach was difficult secondary to urethral length and angulation. Currently, in male patients we prefer a supine approach with the flexible cystoscope. In female patients the prone approach was performed easily. Among female patients prone cystoscopy for retrograde ureteral catheterization resulted in decreased operating room time, less manipulation of the anesthetized patient and creation of a 2-tiered field to maintain the sterility of the retrograde ureteral catheter. We found the prone approach to be feasible and effective in female patients.

Adult↗