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PubMed2006

[Maximilian Nitze (1848-1906): Obstetrician to urology].

Maximilian Carl Friedrich Nitze was born on the 18th of September 1848 in Berlin. In 1874 he passed his state examination in Leipzig for a doctorate in medicine. Nitze demonstrated the first urethroscope and cystoscope, which he had built with great effort and under considerable hardship, at the Dresden-Friedrichstadt Institute using a cadaver--this was the hour of birth of modern urology. Nitze's invention of the cystoscope and his achievements as a urologist have made urology into an independent specialist branch of medicine. This led, after his early death, to the establishment of the German Society for Urology and the Zeitschrift für Urologie in 1906, as well as the organization of the first urological congress in Vienna in 1907.

Cystoscopes↗
PubMed1998

Looking back to the advent of modern endoscopy: 150th birthday of Maximilian Nitze.

This year, 1998, marks the 150th anniversary of the birthday of Maximilian Nitze (1848-1906), a German scientist responsible for the initiation of modern endoscopy: He integrated two of his ideas in the construction of the first functional cystoscope. Nitze realized that the field of view during endoscopy could be enlarged by the use of an optical system, and that the light source should be placed on the tip of the instrument. He presented this cystoscope on October 2, 1877 for the first time, at age 28 years.

Cystoscopes↗
PubMed1988

Flexible cystoscopy and retrograde catheterization in renal transplant patients.

Catheterizing the ureteral orifice of a renal transplant patient can be difficult using traditional rigid instruments. This report describes our experience with 4 patients who underwent cystoscopy and attempted retrograde catheterization of a transplanted ureter. In all cases attempted catheterization using rigid instruments was unsuccessful, while in 3 of the 4 patients, successful cannulation was accomplished using the flexible cystoscope. These results are attributed to the expanded range of motion achieved with the tip of the flexible cystoscope. The increased mobility afforded by this instrument facilitates access to the ureteral orifice, which is often positioned on the distensible portion of the bladder.

Adult↗
PubMed2005

Comparison of hexaminolevulinate based flexible and rigid fluorescence cystoscopy with rigid white light cystoscopy in bladder cancer: results of a prospective Phase II study.

INTRODUCTION AND OBJECTIVE: Several studies have shown that rigid fluorescence cystoscopy (RFC) with hexaminolevulinate (HAL) is superior to standard rigid white light (RWLC) cystoscopy in diagnosing bladder tumours, with a clinically relevant impact on the patient's management. These studies, however, have been done with rigid cystoscopes. We carried out a study to evaluate whether the technique of fluorescence cystoscopy with HAL was also feasible with a specially designed flexible fluorescence cystoscope (FFC). METHODS: 20 patients with known or suspected bladder cancer were included in a comparative within patient controlled Phase II study. All patients signed informed consent. All patients received 50 ml of HAL (Hexvix) 8 mM 1h prior to transurethral resection. Using a D-light-C system (Storz, Germany), FFC and RFC were performed followed by RWLC. All lesions visible during these three cystoscopies were mapped, taped and resected. RESULTS: In these 20 patients (mean age 71 years (49-89), 3 females) mean HAL instillation time was 81 min. Overall 27 histologically confirmed lesions were found in 19 patients. Detection rates in these 19 patients were 14 with FFC, 17 with RFC and 15 with RWLC. Of the 27 lesions 19 were detected with FFC, 23 with RFC and 20 with RWLC. Overall fluorescence intensity using the flexible system was 76% (30-147%) as compared to RFC using a visual analogue score. No side effects were noted which were attributable to HAL. CONCLUSION: The use of FFC is feasible and seems to be comparable to RWLC and slightly inferior to RFC. Larger studies should determine the role of flexible fluorescence cystoscopy.

Aged↗
PubMed1992

Endoscopic treatment of vesicoureteral reflux with a self-detachable balloon system.

There is controversy about the use of polytetrafluoroethylene (Teflon) paste in children for the endoscopic treatment of vesicoureteral reflux due to evidence of particle migration. However, there are definite advantages in treating patients endoscopically. It is evident that the ideal substance should be able to be delivered endoscopically, conserve its volume, and be nonmigratory and nonantigenic. Towards this goal we developed a catheter with an inflatable, detachable and self-sealing silicone balloon that would fit through a 19 gauge cystoscopic needle. Hydroxy-ethyl-methyl acrylate, a hydrophilic polymer that solidifies within 60 minutes after the addition of ferrous sulfate, was chosen as the filling material for the balloon. Conceptually, the sealed balloon would prevent the migration of hydroxy-ethyl-methyl acrylate and the solidified polymer would prevent volume loss. To test this system reflux was created in 6 Hanford mini-pigs by unroofing the ureters bilaterally. In 2 pigs a previously described method of open surgery was used and in the other 4 reflux was created endoscopically using the resectoscope and laparoscopic scissors. The presence of bilateral reflux was confirmed 4 weeks later with a cystogram and the balloon was implanted unilaterally through a cystoscope. The opposite ureter served as an internal control in all animals. A repeat cystogram was performed 2 to 4 weeks after implantation, demonstrating resolution of reflux in the treated side and persistence of reflux in the opposite untreated ureter. Serial cystograms, ultrasound and excretory urography showed no reflux on the implanted side nor any evidence of obstruction. Tissue sections from various organs showed no evidence of particle migration, granuloma formation or inflammatory reaction. Short-term results show that the balloon implants are able to correct reflux without evidence of obstruction.

Animals↗
PubMed2002

Validation of a flexible cystoscopy course.

OBJECTIVE: To examine the instructional effectiveness of a course for nurses wishing to learn flexible cystoscopy, using a virtual reality flexible cystoscopy simulator to measure the outcome. SUBJECTS AND METHODS: Fourteen urology nurse practitioners with no previous experience of cystoscopy were taught the basic techniques of flexible cystoscopy. They then had supervised group instruction during which they practised flexible cystoscopy on an inanimate latex model, and were taught how to handle the cystoscope, followed by unsupervised practice, including use of the virtual reality (VR) simulator (URO Mentor, Simbionix, Israel). They then undertook a cystoscopy task on the simulator; within the bladder there were 10 flags (numbered 1-10) at key positions. By visualizing and photographing each of the flags the subject would have visualized the entire bladder mucosa. The number of flags seen was thus used as a measure of how much of the bladder mucosa was examined. The VR simulator also measured the total procedure time. After a day of training the subjects were reassessed and the changes in performance evaluated. Subjects were also asked their opinion of the use of VR for flexible cystoscopy. RESULTS: The median (range) time to complete the procedure before the course was 3.33 (2-5.5) min and the number of flags seen 7 (6-9). After the course, the median time decreased to 2.85 (1.5-4.42) min and the number of flags seen increased to 8 (6-9). The change in time was significant (P = 0.03) but the difference in the number of flags was not (P = 0.12). All 14 subjects enjoyed the use of VR for learning flexible cystoscopy; they all reported that they were more confident in handling a flexible cystoscope and in undertaking flexible cystoscopy. CONCLUSION: The virtual reality simulator was an effecctive tool for teaching flexible cystoscopy.

Adult↗
PubMed2006

A new minimally invasive technique for treating radiation cystitis: the argon-beam coagulator.

OBJECTIVE: To assess the effectiveness of the argon-beam coagulator used endoscopically for treating radiation cystitis, as radiotherapy is commonly used for treating pelvic tumours of urological origin, but intractable bleeding related to radiation cystitis remains a serious complication and requires a difficult long-term follow-up, for which cystoscopic methods of management have traditionally had limited success. PATIENTS AND METHODS: We assessed seven patients with radiation cystitis; they were treated with argon-beam coagulation after a cystoscopic evaluation. RESULTS: With a mean follow-up of 15 months, one treatment was used in six patients, with a second treatment required in one. CONCLUSION: The argon-beam coagulator appears to be a safe, well tolerated and minimally invasive treatment in patients with radiation cystitis.

Argon↗
PubMed1999

[Voice-directed robotic cystoscopy].

OBJECTIVE: In line with our previous studies in the field of robotics, a new application of our robotic arm is presented: voice-directed cystoscopy. METHODS: Cystoscopy was performed in a sow using a voice-directed robotic arm to which a cystoscope had been attached. The computer executes all the processes that enable interaction with the surgeon and communication with the robotic system. The surgeon directs the movements of the cystoscope by voice, using instructions easily recognizable by the voice identifier. RESULTS/CONCLUSIONS: This system is easy to operate and carries out the commands given by the surgeon with great precision and safety.

Computers↗
PubMed1991

[Technique of open and endoscopic laser treatment in pediatric urology].

The neodymium:YAG laser is now the most common type of laser applied in pediatric surgery. The bare fibres with diameter of 400 microns and 600 microns can be introduced through the side channel of #8 cystoscope thus the cystoscopic laser can be used even in newborns.--Generally accepted power settings are not yet available for laser therapy in pediatric urology. After 5 years of systemic laser application in children standard parameters have been established. They follow the principle of reaching the desired therapeutic goal using the least energy at the shortest exposure time possible. In the non-contact method 15-25 watts, 0.1-0.3 sec pulses and 0.3 sec intervals are recommended for coagulation, and 100 watts in continuous waves for cutting. The same pulses and intervals are advisable for the contact method using the bare fibre, but 10-12 watts are sufficient for coagulation and 20-25 for vaporization. With these settings all endoscopic procedures in pediatric urology such as the resection of urethral valves and structures, the ablation of ureteroceles and the treatment of hemangiomas can be performed.

Cystoscopes↗
PubMed1988

Flexible cystoscopy.

Flexible fiberoptic technology was first applied to cystoscopy in 1973, with greatly increased usage since 1982. Most procedures formerly performed with rigid cystoscopes can be done using flexible cystoscopes with minimal or no anesthesia. Patient positioning and precystocopy preparation and draping are simplified with the flexible fiberoptic instruments. Complete examination of the urethra and bladder can be performed with a single-lens system and with the patient in a variety of positions. Fiberoptic cystoscopy is limited in patients who are bleeding or have blood clots in their bladders. Withdrawal of irrigant or bladder drainage is cumbersome, and the fiberoptic image is currently not of the same caliber as that of the rigid-lens systems. Fiberoptic cystoscopy has become the procedure of choice for many urologists for ureteral stenting prior to extracorporeal shock-wave lithotripsy. With the advent of lithotripters that require no anesthesia, this application is likely to broaden. Future applications of flexible cystoscopy may include a flexible videocystoscope for use in diagnostic and therapeutic procedures.

Cystoscopes↗
PubMed1993

[Flexible cystoscopy in clinical and ambulatory practice].

The author describes his own experience with more than 500 examinations with flexible cystoscope. General technical parameters, differences in manipulation and various problems in evaluation of findings are mentioned. In spite of much higher price as compared with rigid instruments, the use of flexible cystoscopes has been advocated because of their medical advantages and patient's comfort.

Cystoscopes↗
PubMed1998

Lack of effect following repeated in vivo exposure of the rabbit urinary bladder to urine from interstitial cystitis patients at low infusion volumes.

We reported previously that substances in interstitial cystitis urine, when infused into the rabbit bladder, induce changes that resemble bladders of interstitial cystitis (IC) patients. Here we report our investigation of the effect of additional molecular weight subfractions of IC urine and lower infusion volume in this rabbit bladder bioassay. Urine was pooled from symptomatic IC patients, asymptomatic IC patients (in remission), and normal volunteers. Two fractions of 20x concentrated urine were obtained for each of the 3 groups: a 10-100-kD fraction and a fraction > 100 kD but <0.22 microm. Six rabbits per group were infused twice per week with 6 ml of 1 of these 6 urine fractions or saline as a control. After 6 weeks, each rabbit was cystoscoped before and after hydrodistension, bladder capacity and urea permeability were determined, and the bladder was removed for histologic examination. A questionnaire revealed a significant difference (P < 0.01) regarding voiding symptom severity between symptomatic IC patients and both normal volunteers and IC patients in remission. There was no statistically significant difference among groups of rabbits in cystoscopic bladder appearance, bladder capacity, urea permeability, or bladder histology. If a urine-borne factor is in part responsible for IC symptoms, the rabbit bladder must be filled with urine to near capacity to be able to detect a difference between IC and normal urine in this rabbit bladder bioassay.

Administration, Intravesical↗
PubMed1986

Monitoring intravesical bacillus Calmette-Guerin treatment of superficial bladder carcinoma by serial flow cytometry.

Simultaneous urinary flow cytometry, cytologic, and cystoscopic examinations were performed at 3-month intervals for a minimum of 1 year on 29 patients receiving intravesical bacillus Calmette-Guerin (BCG) treatment of superficial bladder carcinoma. Flow cytometry (FCM) and cytology were concordant in 57 of 103 examinations; both FCM and cytology were positive in 38 instances, and carcinoma was confirmed by biopsy in 35 (92.1%). In 16 instances FCM and cytology were negative, but carcinoma was present on biopsy in 5 (31.3%). Three examinations were suspicious by both techniques. The 46 determinations with discordant FCM and cytology were subdivided into pathologically confirmed recurrences (25 instances) and no evidence of pathologic and/or cystoscopic disease (21 instances). In the 25 instances of recurrences, FCM was positive in 18 (72.0%), suspicious in 3 (12.0%), and negative in 4 (16.0%), while cytology was positive in 3 (12.0%), suspicious in 9 (36.0%), and negative in 13 (52.0%). Most patients had a severe BCG-induced inflammatory response that caused an elevation of the hyperdiploid population, believed secondary to epithelial regeneration and proliferation. In the 21 instances without detectable recurrence, hyperploidy led to a relatively high proportion of positive (15) and suspicious (4) results by FCM, but only eight had distinct aneuploid populations. It is possible that this latter group, at least, is harboring occult carcinoma. Conventional cytology in the nonrecurrent group was positive in 1 (4.8%), suspicious in 7 (33.3%), and negative in 13 (61.9%). In those instances when tumor was confirmed by biopsy, the false-negative rate for FCM was 19.7%; the false-negative rate for cytology was 40.9%. Thus, FCM appears to be more sensitive but less specific than conventional cytology, having a lower false-negative but a higher false-positive rate. Although serial FCM provides an objective quantitative measure of aneuploid stemlines and hyperdiploid populations in bladder irrigation specimens and can be helpful in following intravesical BCG therapy for superficial bladder carcinoma, it should still be used with conventional cytology. The greatest difficulty with FCM at present, as with conventional cytology, is in cases of marked inflammation. The results reported here were obtained under the most stringent conditions and represent the minimum level of accuracy. Potential improvements in the technique, with the addition of immunologic or other markers, hold hope of further increasing the accuracy of FCM.

Aged↗
PubMed1992

Natural history of early bladder cancer.

Non-invasive transitional cell carcinoma (TCC) occurs as two distinct growth patterns, papillary and non-papillary (flat), which display significant differences in biologic potential. Papillary carcinoma usually presents as a low-grade lesion which frequently recurs multiple times prior to invasion; conversely, non-papillary (flat) carcinoma in situ is usually high-grade at presentation (carcinoma in situ) and frequently associated with invasion. These lesions may occur together, although papillary cancer is more easily visualized cystoscopically due to its exophytic growth; flat carcinoma in situ is often cystoscopically invisible. This report reviews existing data concerning the prognostic value of pathologic grading and staging of non-invasive and early invasive TCC. Emphasis is placed on those studies reporting surgical treatment rather than other forms of treatment.

Carcinoma in Situ↗
PubMed2002

Sonographically guided removal of a double J ureteral stent in an infant.

A 2-month-old male infant with a prenatally diagnosed obstruction of the ureteropelvic junction underwent a dismembered Anderson-Hynes pyeloplasty. A transanastomotic double J ureteral stent was placed between the renal pelvis and the urinary bladder. This report describes the subsequent removal of the double J ureteral stent from the patient's urinary bladder without the aid of a cystoscope: a rigid biopsy forceps was introduced trans-urethrally into the urinary bladder, and the stent was removed with sonographic guidance. Removal of a ureteral stent with sonographic guidance has not been previously reported in infants. This technique may be particularly useful in developing countries, where appropriate-sized cystoscopes and accessories may not be available.

Device Removal↗
PubMed2000

The usefulness of cystoscopy in the staging of cervical cancer.

OBJECTIVE: The aim of this study was to clarify the usefulness of cystoscopy in the staging of cervical cancer and to evaluate the clinical indications for performing ureteric catheterization to rule out ureteral obstruction in cervical cancer. METHODS: Both rigid cystoscopy and CT were performed before treatment in patients with cervical cancer of FIGO stage IB or greater. Cystoscopically directed biopsy specimens were taken from all areas in the bladder which were suspected of cancerous development. If a jet of urine spurting from each ureteral orifice was not found, a ureteric catheter was inserted into the orifice to rule out ureteral obstruction. The cystoscopic findings were compared with a CT examination. RESULTS: A total of 100 patients were included in the study (mean age 59 years). There were 30 stage IB cancers, 20 stage IIA, 17 stage IIB, 5 stage IIIA, 18 stage IIIB, and 10 stage IV. A total of 90 patients had squamous cell carcinomas and 10 had adenocarcinomas. Cystoscopy identified 8 patients with bladder invasion including 1 stage IIIA, 2 stage IIIB, and 5 stage IV. All of these patients had CT indication of possible invasion. CT indication of possible invasion was proved to be false by cystoscopy in 2 patients. Both the sensitivity and the negative predictive value of CT for bladder invasion were 100%. Of the 14 patients in whom ureteral obstruction was diagnosed by ureteric catheterization, 11 cases were indicated by CT scan, but for the other 3 patients CT found no significant ureteral obstruction. CONCLUSIONS: The results of this study suggest that cystoscopy is indicated only in cervical cancer patients for whom CT examination indicates possible bladder invasion. In addition, the results suggest that placement of ureteric catheterization using cystoscopy to rule out ureteral obstruction is not indicated in the staging of cervical cancer.

Adenocarcinoma↗
PubMed1997

Antegrade techniques of collagen injection for post-prostatectomy stress urinary incontinence: the Washington University experience.

Treatment of sphincteric incontinence after radical retropubic prostatectomy remains a clinical challenge. Antegrade techniques of collagen injection are a relatively new method for treatment of post-prostatectomy incontinence. Early experience with this approach has demonstrated improved outcomes compared to the traditional retrograde technique. Overall response rates of 70% cure or significant improvement compare favorably with previously reported series. The theoretical advantages of this method include improved visualization of vesicourethral anastomosis and improved access to the bladder neck. Furthermore, suprapubic catheter drainage avoids the risks of collagen molding around the catheter. The use of a flexible cystoscope for this approach is a recent modification. The smaller diameter of the flexible cystoscope has facilitated access and reduced anesthetic requirements. This system affords unimpeded delivery of collagen to regions of the bladder neck where the submucosa accommodates the injectable agent. In addition, this modality allows more precise needle positioning to provide correct angle and depth of penetration into the submucosal plane. Short-term success rates of this procedure are encouraging and suggest that it may become the primary approach. While these antegrade techniques are more aggressive than the traditional retrograde approach, they are relatively simple and draw upon principles familiar to all urologists. It is hoped that the new flexible antegrade approach will further improve our results. Longer-term follow-up studies with larger numbers of patients will be required to see whether we can accomplish this goal.

Aged↗
PubMed1996

The efficacy of urinary cytology in the detection of recurrent bladder tumours.

In a prospective study, 71 patients with superficial transitional cell carcinoma of the bladder were given topical immunotherapy with bacillus Calmette-Guerin after transurethral resection and the impact of cystoscopy and bladder wash-out cytology in assessment of recurrent tumours was investigated. Sixteen recurrences were noted histopathologically during the follow-up and 15 of them were also diagnosed properly by wash-out cytology (sensitivity 93.8%). During the follow-up, 10 patients had positive cytology results without evidence of recurrent tumour and 6 of them had recurred cystoscopically in 3 months' time. However, the remaining 4 patients were still tumour-free cystoscopically after a follow-up of 6 months (specificity 92.7%, positive predictive value 78.9%). Although, some false-positive results may be obtained by urine cytology after topical immunotherapy, urine cytology seems to be a reasonable alternative to more invasive and expensive methods during the follow-up of bladder tumours.

BCG Vaccine↗