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PubMed1987

The value of routine preoperative urologic evaluation in patients with colorectal carcinoma.

Routine preoperative intravenous pyelography was performed in a series of 105 consecutive male patients with rectal or rectosigmoid carcinomas who were totally free of urinary symptoms. Abnormal findings were present in 26 percent of those patients. Postoperative intravenous pyelograms were performed in 61 patients. Twenty-one percent of patients with negative preoperative intravenous pyelograms and 42 percent of patients with positive preoperative intravenous pyelograms had abnormal findings in the postoperative intravenous pyelograms. Preoperative cystoscopy was performed in 52 patients. Thirty-one percent of patients with negative preoperative intravenous pyelograms and 76 percent of patients with positive preoperative intravenous pyelograms had abnormal cystoscopic findings. The overwhelming majority of cystoscopic findings in patients with negative preoperative intravenous pyelograms were not related to the primary tumor. The findings of this prospective study suggest that routine preoperative intravenous pyelography is indicated in patients with rectosigmoid or rectal tumors without symptoms related to the urinary tract. Postoperative intravenous pyelography is indicated only in patients with positive preoperative intravenous pyelograms. Preoperative cystoscopy is indicated when the preoperative intravenous pyelogram is positive and especially if intravenous pyelography findings are suggestive of bladder-wall defect or extrinsic pressure.

Colonic Neoplasms↗
PubMed1997

Intraoperative transvesical cystoscopy for urogynecologic procedures.

Intraoperative cystoscopy is a useful adjunct to surgical procedures that may compromise the integrity of the lower urinary tract. Ureteral injury and the placement of intravesical sutures are risks, especially at teaching facilities, during operations such as retropubic urethropexy, paravaginal repair, or even simple hysterectomy. The conventional use of transurethral cystoscopy during open surgical cases may require repositioning of the patient if not previously placed in Allen stirrups. Alternative practices of bladder examination include placement of a standard cystoscope via an intentional cystotomy through the dome of the bladder. The authors have implemented the direct insertion of a 2 mm microlaparoscope through the bladder dome to verify an intact lower urinary system and found this method to be both efficacious and safe. Visualization is not compromised by the slightly smaller visual field compared to the standard 0 degrees or 30 degrees cystoscope. The perspective of the bladder neck region may be more easily oriented from the superior viewing angle. The authors prefer transvesical cystoscopy with the microlaparoscope for its ease of use, compared to their experience of performing a small cystotomy or routine transurethral cystoscopy.

Cystoscopy↗
PubMed1991

Anterior urethral valve presenting in an adult male.

Anterior urethral valves are a rare congenital anomaly which can occur singly or in combination with a proximal urethral diverticulum. A retrograde urethrogram and voiding cystourethrogram can easily make the diagnosis unless the valve is located with the glandular urethra. Cystoscopic examination of the urethra can overlook anterior urethral valves, but by altering the flow of the irrigant, the cystoscope can be used to make these valves very apparent.

Adult↗
PubMed2005

Obstruction after Burch colposuspension: a return to retropubic urethrolysis.

We compare our postoperative outcomes of a vaginal vs abdominal urethrolysis after an obstructed Burch colposuspension. We performed a retrospective review of all women who had undergone a Burch urethrolysis from 1997 through 2003. Data collected included pelvic examination, cystoscopic and urodynamic findings, surgical morbidity, and pre- and postoperative urogynecologic symptomatology. Sixteen women underwent Burch urethrolysis. Preoperative symptoms were obstructive in 6, overactive in 2, and both (obstructive/overactive) in 8. All had an acute retropubic angulation of the urethral axis as well as a retropexed urethra that prohibited sagittal rotation of a rigid cystoscope. Seventy-eight percent of the women with urodynamic information met urodynamic criteria for urethral obstruction. Average follow-up was 7 months, and of those undergoing a vaginal urethrolysis, three out of seven (43%) had resolution of their obstructive or overactive symptoms postoperatively. In contrast, seven out of nine women (78%) who underwent a retropubic urethrolysis had relief of their obstructive or overactive bladder symptoms. In our cohort study, an abdominal retropubic urethrolysis was more successful in relieving urethral obstruction than a vaginal urethrolysis.

Abdomen↗
PubMed2003

Massive debris in the intrahepatic bile ducts in choledochal cyst: possible cause of postoperative stone formation.

We investigate the incidence, treatment, and implications of intrahepatic bile duct (IHBD) dilatation debris in 42 patients with choledochal cyst treated over a recent 8-year period. Mean age at cyst excision was 6.9 years, and mean follow-up period was 5.4 years. Intraoperative endoscopy (IOE) was performed at the time of cyst excision using a pediatric cystoscope, which identified IHBD debris in 11/42 (26.2%), and massive debris in 4/42 (9.5%). In all cases, IHBD debris was successfully washed out with normal saline through the cystoscope. There was no postoperative IHBD stone formation or cholangitis except for one case of cholangitis in a patient undergoing chemotherapy for acute myelocytic leukemia. Debris left in the IHBD during cyst excision is probably one of the primary causes of postoperative IHBD stone formation and can be prevented by washing during IOE.

Bile Ducts, Intrahepatic↗
PubMed2006

The role of the surgeon in the evolution of flexible endoscopy.

Several cultures, including the Egyptians, Greeks, Romans, and Arabs, made attempts to view accessible human body cavities using a variety of instruments such as spatulas and specula. The first endoscope was created in 1806 when Phillip Bozzini, a German-born urologist, constructed the lichtleiter, which used concave mirrors to reflect candlelight through an open tube into the esophagus, bladder, or rectum. Maximilian Carl-Friedrich Nitze, another German urologist, produced the first usable cystoscope in 1877 by using series of lenses to increase magnification. He was also the first to place light inside the organ of interest to aid visualization. In 1880 Mikulicz made the first gastroscope using a system similar to Nitze's cystoscope. Modern endoscopy was born with the introduction of the fiberoptic endoscope in the late 1950s. Over the ensuing 50 years endoscopy revolutionized many aspects of the surgeon's practice. Endoscopy can now be used to diagnose and often treat gastrointestinal cancer, hemorrhage, obstruction, and inflammatory conditions. This review was initiated by the SAGES Flexible Endoscopy Committee to chronicle the role of the surgeon in the development and introduction of flexible endoscopy into clinical practice, historically and in contemporary surgery. Flexible endoscopy evolved out of surgeons' need to overcome diagnostic and therapeutic challenges. There have been many recent technological advances that facilitate endoluminal therapies, and flexible endoscopy is now traversing new ground. Surgeons have been major contributors in the development of all aspects of endoscopy. There is a continually expanding list of therapeutic options available to patients. The difficult questions of which procedure, on which patient, and when can be answered best by the surgeon versed in endoscopic, laparoscopic, and open surgical techniques.

Endoscopy↗
PubMed1979

Correlation of cytology and cystoscopy.

A total of 152 patients had cytology and cystoscopy performed for either initial or recurrent bladder tumors and postoperative control examinations. Positive cytology was found in 97 per cent of patients with pathologically proved bladder tumors. However, 23 per cent of the patients with negative cytology had positive cystoscopic and pathologically proved findings. Without cystoscopic examination a significant number of recurrent tumors may be missed because of a negative cytology.

Cystoscopy↗
PubMed1980

Nephrogenic adenoma of urinary bladder associated with malakoplakia.

A case of nephrogenic adenoma occurring in a twelve-year-old black female child, associated with recurrent Escherichia coli urinary tract infection is described. The patient was followed for over six years and treated with repeated cystoscopic examinations and fulgurations of the lesion. Five years after the initial diagnosis, malakoplakia of the bladder developed in association with nephrogenic adenoma. There was no evidence of invasion of the bladder by the lesion during these six years. Electron microscopic study of nephrogenic adenoma indicated its origin from the urothelium. Nephrogenic adenoma of the bladder is to be considered as a benign metaplastic lesion of the urothelium and is to be treated with repeated cystoscopic fulgurations.

Adenoma↗
PubMed1985

Nephrogenic adenoma: benign proliferative lesion of urothelium.

Three new cases of a rare benign proliferative lesion of the urothelium (nephrogenic adenoma) are hereby added to the existent 58 reported cases. All 3 lesions occurred in the bladder. Two of the 3 cases presented with a history of surgical interventions on the bladder, and the third patient had a history of chronic cystitis and pyelonephritis, and was on chronic dialysis. Diagnosis was made on histologic examination of cystoscopic biopsy of the lesions. Transurethral resection and/or fulguration was the treatment of choice. There was no recurrence of the lesions on follow-up cystoscopic examination.

Adenoma↗
PubMed1991

Urinary symptom and quality of life questions indicative of obstructive benign prostatic hyperplasia. Results of a pilot study.

In a pilot study of a urinary symptom and health-related quality-of-life questionnaire for benign prostatic hyperplasia (BPH), responses from 64 Mayo Clinic patients with cystoscopic evidence of obstructive BPH were compared with those of 14 men with no cystoscopic evidence of BPH and a community sample of 64 comparably aged men with no medical history of prostate enlargement. Questions which best discriminated between the groups were those dealing with urinary symptom frequency, bother due to urinary symptoms, and worry and concern about urinary problems. The results suggest that urinary-symptom-bother and worry due to urinary symptoms may be important additions to the more usual questions asked about urinary frequency in the identification of men with BPH. These findings are preliminary, however, and will be verified in an ongoing natural history study of BPH.

Humans↗
PubMed1995

Combined laparoscopic and transurethral neodymium: yttrium-aluminum-garnet laser treatment of invasive bladder cancer.

OBJECTIVES: The feasibility and efficacy of combined cystoscopic and laparoscopic neodymium: yttrium-aluminum-garnet (Nd:YAG) laser coagulation of invasive bladder cancer were investigated. METHODS: Five patients with extensive Stage T2-T3a bladder cancer who were not candidates for radical cystectomy were treated by Nd:YAG laser irradiation. All patients also underwent transperitoneal laparoscopic mobilization of the intestine away from the bladder with continuous monitoring of the laser treatment. In 2 cases, laser therapy of the serosal surface of the bladder at the site of tumor was also administered. RESULTS: The procedure was completed without complications in all 5 patients. A mean of 58,607 joules (J) of energy was delivered transurethrally with an additional 8000 to 10,000 J utilized via laparoscopy in 2 cases. Local disease recurrence was noted within 1 to 4 months in 4 of the 5 patients. Distant metastases were detected within 1 to 9 months postoperatively in 3 of 5 patients. No perioperative bowel or bladder perforation occurred. CONCLUSIONS: The use of laparoscopy allows for the safe delivery of large amounts of laser energy to the bladder. However, in this small group of patients with extensive bladder tumors, effective palliation of local disease could not be reliably achieved. Further study is necessary to determine whether treatment modifications or selection of patients with less extensive tumors will lead to better results with combined laparoscopic and cystoscopic laser therapy.

Aged↗
PubMed2004

Nine episodes of anaphylaxis following cystoscopy caused by Cidex OPA (ortho-phthalaldehyde) high-level disinfectant in 4 patients after cytoscopy.

BACKGROUND: Ortho-phthalaldehyde (OPA) is a high-level disinfectant commonly used for processing heat-sensitive medical devices. OBJECTIVE: We report 4 patients who experienced 9 episodes of anaphylaxis following cystoscopy after a urology practice switched from using Cidex (glutaraldehyde [GTA]) to OPA for disinfecting their cystoscopes. METHODS: Allergic evaluations consisted of: skin testing to saline, histamine, glycerin, lidocaine, latex, GTA, and OPA and blood tests for total immunoglobulin E (IgE) and latex specific IgE. FINDINGS: The 4 patients were evaluated after 3 of them had experienced 2 episodes of anaphylaxis and one of them 3 episodes following outpatient cystoscopy for ongoing evaluation of bladder cancer. Skin testing of subjects and controls to lidocaine, latex, latex specific IgE, and GTA was negative. Skin testing to OPA resulted in immediate wheal and flare reactions in all 4 patients within 20 minutes and late reactions at 24 hours but negative reactions in controls. Subsequent to the testing, 3 of the patients returned for repeat cystoscopy in which GTA but not OPA was used to disinfect the cystoscopes and tolerated the procedure. CONCLUSIONS: OPA solution should be considered a cause of anaphylactic/allergic reactions following cystoscopy and possibly following instrumentation with other medical devices disinfected by this material.

Aged↗
PubMed2006

Venacavoscopy during nephrectomy for renal cell carcinoma with inferior vena caval thrombus.

PURPOSE: Renal cell carcinoma with inferior vena caval thrombus remains a complex challenge for the urologist. Aggressive surgery to remove all tumor can result in long-term survival. Liver transplant techniques, assistance from cardiac surgeons and bypass techniques can yield optimal vascular control but there is still a blind element inside the inferior vena cava when the thrombus is evacuated. We present data on a technique using a flexible cystoscope to evaluate the lumen of the intrahepatic and suprahepatic inferior vena cava after nephrectomy and tumor thrombectomy. MATERIALS AND METHODS: Seven patients underwent radical nephrectomy and tumor thrombectomy for renal cell carcinoma with inferior vena caval thrombus. During surgery and after removal of the tumor thrombus a flexible cystoscope was inserted into the venacavotomy for direct inspection of the inferior vena caval lumen. Any residual tumor was manipulated out of the lumen and removed. Patient records were reviewed for data on the time of this procedure, estimated blood loss, residual tumor, postoperative complications and survival. RESULTS: Venacavoscopy required an average additional 5.6 minutes and residual tumor was found in 3 of 7 patients. Average estimated blood loss was 1,170 cc and it was not affected by venacavoscopy. One patient experienced acalculous cholecystitis, possibly as a result of this procedure. Mean followup was 17.6 months with 5 of 7 patients alive. CONCLUSIONS: Venacavoscopy is a safe, reliable method of intraoperative inspection of the inferior vena cava that uses equipment and techniques familiar to every urologist. This can help prevent incomplete thrombectomy and disastrous pulmonary embolus.

Aged↗
PubMed2005

Correlation of office-based cystoscopy and cytology with histologic diagnosis: how good is the reference standard?

OBJECTIVES: To evaluate the accuracy of cystoscopy and cytology in predicting the histopathologic features of suspicious cystoscopic lesions. METHODS: We reviewed the bladder biopsy records at two institutions from July 2001 to July 2004. Intraoperative biopsies were performed for positive (papillary or sessile) (n = 155) and equivocal (n = 101) lesions found during office cystoscopy. The specimens were submitted for histopathologic analysis, and the results were correlated with the preceding office-based cystoscopy and cytology findings. RESULTS: Malignancy was found in 27 (26.7%) of 101 equivocal lesions and 128 (82.5%) of 155 sessile or papillary lesions. Of the 72 biopsies performed for equivocal lesions in patients with a history of transitional cell carcinoma (TCC), 24 (33%) had malignancy compared with 3 (10.3%) of 29 biopsies performed in patients without a history of TCC. For patients with no history of TCC and equivocal lesions, cytology was able to identify all neoplasms (100% sensitivity) and negative cytology always predicted a normal biopsy result (100% negative predictive value). However, for patients with a history of TCC and equivocal lesions, cytology had a sensitivity and negative predictive value of 81.8% and 88.2%, respectively. CONCLUSIONS: Our findings suggest that patients without a history of TCC who have an equivocal lesion at cystoscopy may avoid an unnecessary operation if they have normal cytology findings. A large number of patients with equivocal cystoscopic findings undergo unnecessary biopsies in the operating room, and future studies should be performed to assess the value of other bladder markers in predicting oncologic status in this setting.

Cystoscopy↗
PubMed2006

Development of glomerulations in younger women with interstitial cystitis.

OBJECTIVES: To evaluate the consistency of cystoscopic findings with hydrodistension in younger women with a clinical diagnosis of interstitial cystitis. METHODS: A retrospective chart review was conducted of patients aged younger than 26 years old at the time of initial cystoscopy and hydrodistension at a single institution. Data included approximate duration of symptoms, development of visible terminal hematuria, presence of ulcers, and semiquantitive evaluation of degree of glomerulations (negligible, moderate, diffuse), and bladder capacity under anesthesia. RESULTS: Eighteen women aged 15 to 25 years old (mean, 17.5 years) were identified. The mean duration of symptoms was 38 months, with an estimated mean age of onset of 16 years. No patient had Hunner's ulcers, and 13 had visible terminal hematuria with moderate-to-diffuse glomerulations. Ten women had repeat cystoscopies, and the mean time to repeat cystoscopy was 17 months. Three women underwent repeat cystoscopy and initially had a relatively normal bladder mucosa, with none or only rare glomerulations, but moderate-to-diffuse glomerulations were seen on the subsequent cystoscopy in addition to the development of terminal hematuria. One patient, conversely on subsequent cystoscopy, showed resolution of glomerulations. CONCLUSIONS: Interstitial cystitis symptoms can develop before an age where adult urologists or primary care physicians familiar with the diagnosis and treatment are usually involved with care. The cystoscopic appearance of the bladder wall after hydrodistension may not be constant over time, and the absence of initial findings of glomerulations or terminal hematuria does not preclude further development of these hallmarks of the disease on subsequent evaluation.

Adolescent↗
PubMed2003

Performance characteristics of multiple urinary tumor markers and sample collection techniques in the detection of transitional cell carcinoma of the bladder.

BACKGROUND: The optimal management of bladder cancer requires early detection of both primary tumor as well as recurrences. This study compared the methodologies of the following tumor markers and diagnostic tools: telomerase, bladder tumor-associated analytes (BTA stat), nuclear matrix protein 22 (NMP22), the hemoglobin (Hb) dipstick and chemiluminometric red cell assays, and determined their respective sensitivity and specificity in detection of bladder cancer along with urine cytology. METHODS: Different sample collection techniques were used including bladder tissue from radical cystectomy or transurethral resection, voided and cystoscopically collected urine and bladder washes. Results of these techniques were compared for some of these markers. RESULTS: The first study utilizing cystoscopically collected urine and bladder washes, the sensitivity of telomerase in detecting bladder cancer was 92% and 87%, respectively, whereas for bladder tissue it was 93%. The sensitivities of cytology, NMP22 and original BTA, however, were 62%, 54% and 49%, respectively. In the second study using first single voided urine from patients with bladder cancer and non-bladder cancer controls, the greatest sensitivity (overall 77%) and specificity (overall 98%) was exhibited with telomerase. The combined sensitivity of telomerase with that of either the hemoglobin dipstick or chemiluminometric red cell assays, showed that the overall sensitivity was increased to 89% and specificity to 98%. CONCLUSIONS: The sensitivity and specificity of telomerase activity in conjunction with chemiluminometric red cell or hemoglobin dipstick assay may be considered as an alternative to urinary cytology. It can also supplement cystoscopy for monitoring recurrence of bladder cancer.

Antigens, Neoplasm↗
PubMed1987

The operative management of posterior urethral valves.

The surgical management of posterior urethral valves remains controversial. To examine the effects and results of operative treatment in boys with proven posterior urethral valves, a retrospective study was undertaken. The case records of 33 male children who presented with posterior urethral valves over a 10-year period were reviewed. Two patients died prior to definitive treatment and one died postoperatively. Following resuscitation and diagnostic procedures, the remaining patients had eradication of the posterior urethral valves by electrothermic fulguration. In 14 patients this was performed using the Innes-Williams diathermy hook under control of contrast enhanced radiography. In 16 patients the valves were fulgurated under direct cystoscopic visualization. All surviving patients had an uneventful postoperative recovery. However, of those undergoing cystoscopic fulguration, four developed symptomatic urethral strictures necessitating repeat cystoscopy and urethral dilatation. No cases developed strictures following the use of the diathermy hook. One patient from each treatment group developed dribbling. The Innes-Williams diathermy hook has been proven to be a safe, simple, and inexpensive technique. This has specific application in the neonate and small infant where cystoscopy poses technical problems because of anatomic size and where potentially traumatic urethral instrumentation should be avoided.

Child↗
PubMed2003

Urethral stricture repair with an off-the-shelf collagen matrix.

PURPOSE: In select patients with urethral strictures in whom genital skin is insufficient alternative tissues are needed for urethral reconstruction. We explored the feasibility of using a bladder submucosa collagen based inert matrix as a free graft substitute for urethral stricture repair. MATERIALS AND METHODS: A total of 28 patients 22 to 61 years old with a diagnosis of urethral stricture underwent reconstructive surgery using a collagen based inert matrix for urethral repair. The inert collagen matrix was trimmed to size as needed for each patient and the neourethra was created by anastomosing the matrix in an onlay fashion to the urethral plate with continuous 6-zero absorbable sutures. The size of the created neourethra ranged from 1.5 to 16 cm. A voiding history, physical examination, retrograde urethrography, uroflowmetry and cystoscopic examinations were performed preoperatively and postoperatively. Random urethral biopsies were also performed. RESULTS: After a 36 to 48-month followup (mean 37) 24 of the 28 patients had a successful outcome. The remaining 4 patients had a slight caliber decrease at the anastomotic sites on urethrography. A subcoronal fistula developed in 1 patient which closed spontaneously 1 year after repair. Mean maximum urine flow rate increased from the preoperative value of 9 +/- 1.29 to 19.7 +/- 3.07 ml. per second postoperatively. Cystoscopic studies revealed adequate caliber conduits and normal appearing urethral tissues. Histological examination of the biopsy specimens showed the typical urethral stratified epithelium. CONCLUSIONS: Use of an off-the-shelf collagen inert matrix appears to be beneficial for patients with urethral strictures and obviates the need for obtaining an autologous graft, thus eliminating donor site morbidity.

Adult↗