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PubMedDate not supplied

Interstitial cystitis in persistent posthysterectomy chronic pelvic pain.

OBJECTIVES: Hysterectomies may be performed unnecessarily in women with chronic pelvic pain if the diagnosis of interstitial cystitis is not considered. The objectives of this study were to investigate the prevalence of interstitial cystitis in patients with posthysterectomy chronic pelvic pain and to evaluate the efficacy of various therapies for interstitial cystitis. METHODS: A study was performed of 111 patients with chronic pelvic pain whose pain persisted after hysterectomy. Patients were screened with the Pelvic Pain and Urgency/Frequency symptom scale, and underwent Potassium Sensitivity Testing. Patients were treated with dietary changes alone or in combination with cystoscopic hydrodistention or oral pentosan polysulfate, or both of these, for 3 to 6 months. RESULTS: Of the 111 patients enrolled, 79% (n=88) were diagnosed with bladder dysfunction consistent with interstitial cystitis. For patients treated with dietary modification alone (n=33), the mean score on the Pelvic Pain and Urgency/Frequency questionnaire improved 15.4%, from 13.18 at baseline to 11.15 at follow-up. For patients treated with pentosan polysulfate or cystoscopic hydrodistention, or both, plus diet changes (n=78), Pelvic Pain and Urgency/Frequency scores improved 34.2%, from 15.01 to 9.87. CONCLUSION: In this study, nonsurgical treatment for interstitial cystitis resulted in a marked improvement in symptoms that had not improved with surgery. Without determining the origin of bladder pain, gynecologists should not proceed to hysterectomy in patients with chronic pelvic pain.

Chronic Disease↗
PubMed1992

[Renal pelvic tumor associated with contralateral renal cyst--a case report].

A 74-year-old female presented with a two years history of malaise, weakness and intermittent gross hematuria. Two years earlier, left renal cyst had been diagnosed by excretory urography, abdominal sonography and computed-tomography. Initially she was treated conservatively with oral antibiotics, however medical management had not been successful in improving her condition. Finally she was transfer to our ward for further evaluation and treatment. Cystoscopic examination demonstrated no abnormality, except for bloody urine efflux from the right ureteric orifice. Right retrograde pyelograms confirmed a solitary filling defect in the upper calyx of right kidney. Because of immediate concern for right renal pelvic tumor and contralateral renal cyst, a midline transperitoneal exploration was made. The right nephroureterectomy with cuff of bladder was removed and left unroofing of cyst was carried out. Convalescence was uneventful. The pathologic examination revealed moderately differentiated transitional cell carcinoma of right kidney with a simple renal cyst of left kidney. We suggest that cases with a clinical diagnosis of renal cyst based on the presence of gross hematuria, a normals excretory urogram and computed tomogram, generally require further evaluation especially by cystoscope and retrograde pyelogram to determine the source of bleeding.

Aged↗
PubMedDate not supplied

[Follow up of urinary bladder cancer--a task for the urology nurse?].

The introduction of the flexible cystoscope has simplified the examination for both the patient and the examiner. With an attached video camera to the cystoscope it showed that the assistent nurse fastly learned to interpret any finding in the bladder. In an article from England it was shown that a trained nurse cystoscopist had the same accuracy in detecting bladder tumors as a consultant urologist. The present study addresses the question if the same is valid in our department. After a period of training we started the study. 50 consecutive patients with known bladder cancer were first examined by the nurse who recorded any relapses of bladder tumor. Then the urologist examined the bladder unaware of the nurse's finding. Any discrepancy was reexamined together. 23 relapse cases of tumor were found, all which were diagnosed by the nurse. The urologist was un-able to detect 2 small grade 1 tumors. The result strengthened us to initiate a nurse-led follow up of patients with known bladder tumor. Until now about 100 cystoscopies have been done by a nurse with only good experience.

Clinical Competence↗
PubMedDate not supplied

[A retrospective analysis of morphological tests in patients with interstitial cystitis].

Cystoscopy, hydrobougieurage and biopsy of the urinary bladder were made in 80 female patients with interstitial cystitis (IC) aged 23-68 years. Endoscopic changes were estimated by an original scale. The analysis of the endoscopic findings revealed a correlation between duration of the process, cystoscopic picture and histopathological evidence. Clinical and cystoscopic pictures provide significant information on morphological changes in the wall of the urinary bladder depending on the disease stage. Histological study of urinary bladder biopsies in IC is used rather for excluding other diseases of the urinary bladder with similar clinical symptoms (primarily cancer and tuberculosis).

Adult↗
PubMed2006

[Papillary cystadenocarcinoma in a Müllerian duct cyst: report of a case with literature review].

OBJECTIVE: To study the diagnosis and treatment of Müllerian duct cysts and their involvement with malignancy. METHODS: A 44-year-old male patient with papillary cystadenocarcinoma involving a Müllerian duct cyst was presented. The presentation treatment, and pathological and radiological appearances were retrospectively analysed and discussed with literature review. The main manifestation was intermittent episode of hemospermia accompanying terminal hematuria and infertility for 15 years. Final diagnosis was determined by the findings of transrectal ultrasound scan, CT scan, MRI imaging, cystoscopic examination and biopsy. RESULTS: Exploratory laparotomy was performed through a suprapubic retrovesical approach. The finding that a duct-like wedge of tumor tissue passed through the prostate near cyst neck to the posterior urethra without affecting the adjacent prostatic tissue during tylectomy confirmed that it arises from Müllerian duct system. Pathohistologic examination disclosed a papillary cystadenocarcinoma and it infiltrated the wall of the cyst. Both seminal vesicles and ejaculatory duct had no carcinoma invasion. CONCLUSION: Müllerian duct cyst involving with malignancy is exceedingly rare, the diagnosis is based on the findings of transrectal ultrasound scan, CT scan, MRI imaging, cystoscopic examination. The final diagnosis depends on the pathohistologic examination. Lumpectomy is effective and have a good outcome.

Adult↗
PubMed1991

[Prognostic factors in 243 transitional carcinomas of the bladder (I): clinical and macroscopic parameters of the tumor].

A retrospective study was undertaken in 243 cases of transitional cell carcinoma of the bladder to determine the correlation of clinical parameters (sex, age, symptoms and duration of the disease) and tumor gross anatomic features (cystoscopic aspects, tumor number, size and site) with survival. The study comprised 148 superficial carcinomas and 95 infiltrating carcinomas of the bladder. The following clinical parameters were observed to influence survival of patients with superficial or deep tumors: patient age (worse prognosis for those over 60 years) and initial symptoms (better prognosis for those whose presenting symptom was hematuria). With regard to tumor gross anatomic features, a correlation was observed between the cystoscopic aspects of the tumor and type of infiltration in 80% of our series (1 error out of 5 cystoscopies). A worse prognosis was observed for multiple lesions only in those with superficial tumors. Tumor site and size did not influence survival in this series of 243 transitional cell carcinoma of the bladder.

Adult↗
PubMed1991

[Two cases of urachal cyst].

Case 1: A lower abdominal large painful mass was recognized by palpation, CT scan and ultrasonography in a 64-year-old house wife. Urine cytology was negative. The mass at the dome of bladder was covered with normal epithelium cystoscopically. Aspiration cytology of the lower abdominal mass demonstrated no malignancy and total excision of urachal remnant with a portion of bladder wall was carried out. Histologically, the mass was an urachal cyst with granulomatous change infected with C group beta-streptococcus. Case 2: A 46 year-old male engineer complained of asymptomatic hematuria. Cystoscopic examination revealed a small bleeding lesion at the dome of bladder. Urine cytology was negative. CT scan and ultrasonography revealed a tiny cystic mass lesion with irregular density. Biopsy or aspiration cytology appeared difficult because of the size and localization of the mass. En bloc segmental resection of urachal remnant was carried out. Since intraoperative rapid histological examination of the specimen confirmed no malignancies, dissection of pelvic lymph node was not performed. Urachal cysts presented above were suspicious of malignant degeneration from findings of imaging examination. Either preoperative or intraoperative histological examination in such cases appears to be indispensable to avoid unnecessary extensive operation as well as to perform radical operation required for malignant lesions.

Cytodiagnosis↗
PubMed1990

Toxicity of intravesical recombinant human tumor necrosis factor in cynomolgus monkeys.

Six groups of two cynomolgus monkeys were treated with escalating intravesicular doses of recombinant human tumor necrosis factor (rHuTNF) for a 6 week interval. The doses of rHuTNF ranged from 10 ng to 1 mg and were instilled weekly. Two monkeys had instillation of saline only and served as controls. The monkeys were weighed and temperatures determined before, immediately after, and 2 days following each treatment. Cystoscopic examination was performed 2 days after each treatment and blood samples were obtained. At the conclusion of the study, animals were killed and necropsy was performed. There was no observable toxicity from treatment with rHuTNF. There was no difference between treated and control monkeys with respect to temperature, weight, or blood measurements. No drug-induced alteration in bladder morphology was found by either cystoscopic or microscopic pathologic examination.

Administration, Intravesical↗
PubMed1989

[Urine cytology as a supplement to cystoscopy and biopsy in the control of bladder tumors].

Throughout the years several investigations have either recommended or discredited exfoliative urine cytology because of high incidence of false negative or false positive results. Most authors agree that high grade bladder tumors are diagnosed with fairly high certainty (80-87%) by using exfoliative urine cytology whereas the value of urine cytology of low grade bladder tumors is uncertain. This investigation, including 200 patients who came for cystoscopic control of bladder tumors, revealed 87% accordance between cystoscopic biopsy and exfoliative urine cytology of high grade tumors while there were 47% false negative and no false positive of low grade tumors. On this background, it must be concluded that exfoliative urine cytology is an important investigation in diagnosing and controlling patients with bladder tumors, but the method can not always stand alone.

Aged↗
PubMedDate not supplied

[Cystoscopy and endovesical biopsy in renal tuberculosis].

Cystoscopy and endovesical biopsy of the bladder wall were performed at early stages of investigation prior to the onset of tuberculostatic treatment in 77 patients with destructive renal tuberculosis, verified both bacteriologically and histologically. Cystoscopy proved to be valuable in 83.2% of the cases, particularly so where the destruction focus communicated with the renal calyx-pelvis system. Cystoscopic symptoms of renal tuberculosis occurred at the following rates: tubercles in 6.5%, focal hyperemia, in 18.2%, erosion and ulcer, in 9.1%, bullous edema of the ureteral opening, in 11.6%, all kinds of changes of ureteral opening, in 37.6%. There were no visible changes of vesical mucosa in 16.8%. The pattern of mucosal changes correlated with the markedness of X-ray morphological changes in the kidney. Endovesical biopsy was positive in 52%, its results, being significant in cases of open destructive developments and ureteral affection. The value of endovesical biopsy increased where it was performed at the peak of clinical and cystoscopic symptoms, at early stages of disease, before the onset of tuberculostatic treatment. False-negative results of endovesical biopsy do not exclude renal tuberculosis. High value of cystoscopy and endovesical biopsy makes them up-to-date diagnostic tests for renal tuberculosis.

Adult↗
PubMed1988

The impact of laparoscopy on modern urologic practice.

The original concept of laparoscopy developed as a branch of cystoscopy. Since the use of the Nitze cystoscope at its inception, laparoscopy has kept pace with the innovations in our cystoscopic inventory. The recently emerging interest of urologists in utility of the laparoscope for a variety of urologic surgery is a welcome renascence of this procedure, which has been used mainly by our gynecologic colleagues, in part because of our own lack of pursuit in its development. Laparoscopy should now become an integral part of our urologic teaching and practice.

Abdominal Neoplasms↗
PubMed1988

[A case of transitional cell carcinoma of the bladder with heterotopic bone formation].

A 85-year-old woman consulted our clinic due to asymptomatic macrohematuria on January 6, 1987. In the cystoscopic examination, solitary and pedunculated bladder tumor was revealed. This tumor was located on the retrotrigonal region near the right ureteral orifice. On January 20, transurethral resection of bladder tumor was planned but the base of the tumor was stony hard, so complete resection was not performed. On February 10, transurethral resection of bladder was performed repeatedly. At that time, the cystoscopic finding showed that the tumor size had increased and transurethral bladder ultrasonography showed invasion into the deep muscular layer. On February 17, total cystectomy and ileal conduit was done. Histological examination revealed poorly differentiated TCC with osteoid, bone and cartilage. This patient was discharged in good condition on March 27. Heterotopic bone formation in the bladder tumor is rare. Ten cases were collected from the literature. We report a case of heterotopic bone formation and discuss the mechanism of the etiology.

Aged↗
PubMed1988

168 double J (pigtail) ureteric catheter insertions: a retrospective review.

The medical records of 116 patients who had 168 ureteric double J (pigtail) catheters inserted over a 6-year period between 1981 and 1987 were reviewed. Eighty-five patients had pigtails inserted for benign conditions and 31 for malignant disease. The pigtail catheters were inserted cystoscopically in 88 patients, percutaneously in 7 patients and by open surgery in 21 patients. Of 168 pigtail catheters used, 147 were soft (silicone, multilength) and 21 hard (polyurethane). No mortality was attributable to the use of these catheters but certain complications were commonly encountered. Loin discomfort occurred after 32 (19%) insertions; 27 of 147 (18%) soft catheters and 5 of 21 (24%) hard catheters. Trigonal irritation, confirmed cystoscopically was reported in 26 of 147 (18%) insertions of soft catheters and in 6 of the 21 (29%) with hard catheters (chi 2, P = 0.37). Urinary tract infection (confirmed by urine microscopy and culture) occurred after 46 (31%) soft catheter insertions and after 13 of 21 (61%) hard catheter insertions (chi 2 test, P = 0.01). Stent migration occurred in five patients and obstruction in two. Pigtail catheters are safe ureteric stents which are easy to insert and their use is supported by this study. The complications of associated infection, trigonal irritation and loin discomfort are relatively common and still occur even with soft catheters. Careful monitoring of all patients with pigtail catheters in position is recommended.

Adult↗
PubMed1987

[Adenomatous polyps with prostatic type epithelium: a report of two cases].

Two cases of adenomatous polyps with prostatic type epithelium are reported. The first case was of a 62-year-old male suffering from asymptomatic hematuria. Cystoscopic findings showed an urethral tumor in the prostatic urethra. He was treated by transurethral resection of the prostate. The second case was of a 47-year-old male with complaints of hematuria and doubtful findings in urinary cytology. Cystoscopic findings showed that he had an urethral tumor in the prostatic urethra as well as bladder tumor. Both were resected transurethrally. Histological examination revealed that both urethral tumors were papillary adenoma of the prostatic urethra, corresponding to the adenomatous polyps with prostatic type epithelium in the classification of AFIP. The peroxidase-antiperoxidase complex method was performed using the anti-prostatic acid phosphatase antibody and anti-prostatic-specific antigen antibody, and positive reactions were obtained which confirmed that the tumors originated in the prostatic tissue. Benign urethral tumor in males is not common and description of adenomatous polyps with prostatic type epithelium is very rare. We could find only 11 cases in the Japanese literature.

Humans↗
PubMed1987

[A case of vesical malacoplakia diagnosed by randomized biopsy of the urinary bladder].

Vesical malacoplakia is a relatively rare disease and commonly diagnosed by characteristic cystoscopical findings and histological determination using biopsy specimen. We report here a case of a 53-year-old housewife, with atypical cystoscopical findings, which looked like carcinoma in situ, and in which randomized biopsy helped to make the final diagnosis. This case was successfully controlled by anti-bacterial agents.

Biopsy↗
PubMed1985

Management of superficial bladder cancer in a community setting.

Over the past four or five years, the urologist in private practice has gained experience using mitomycin in the treatment of superficial bladder cancers. Indications for use of mitomycin include carcinoma in situ (CIS), more than two or three recurrences on successive cytoscopic examinations of superficial transitional cell carcinomas, the presence of multiple transitional cell carcinomas at the time of initial examination when it was believed that all tumor could not be removed cystoscopically, and prophylaxis. The regimen for mitomycin has changed over time; currently the standard regimen is 40 mg mitomycin in 40 cc sterile water given intravesically once a week for eight weeks followed by routine cystoscopic examinations every three months and maintenance therapy, if indicated, of 40 mg mitomycin once a month. Results following use of this regimen in private practice have been most encouraging. Complications have been minimal. Only 1 patient had to discontinue therapy because of side effects, and 1 patient underwent radical cystectomy for recurrent disease after partial cystectomy and mitomycin therapy. Patients still receiving treatment include 1 patient who had not responded after initial treatment and who is being followed up for possible recurrence. Mitomycin therapy appears to be effective in controlling superficial bladder cancer and, possibly, carcinoma in situ, with minimal side effects and good patient compliance.

Administration, Topical↗
PubMedDate not supplied

Instrumentation for urologic laser surgery.

Carbon dioxide, neodymium:yttrium-aluminum-garnet, ruby, and argon lasers are the only commercially available lasers with wavelengths suitable for laser surgery. Consequently, researchers have attempted to make the tool fit the clinical need. A pediatric #6 bronchoscope was fitted to a carbon dioxide laser endoscopic coupler to form a modified cystoscopic laser delivery system. This instrument was able to vaporize small condylomata of the distal male urethra. However, the restricted visibility of this crude adaptation represents an inferior solution compared with the endless possibilities of sophisticated fiberoptic technology. Future prospects in infrared optical fiber technology portend a breakthrough for transurethral carbon dioxide laser surgery. Adapting the Nd:YAG laser for urologic surgery is attractive because it can be easily incorporated into conventional cystoscopes. The argon laser's capacity to absorb blood and traverse water suggests future importance for transurethral surgery. Investigation is needed to develop a surgical laser adaptable to both open and transurethral urologic surgery.

Argon↗
PubMed1983

[Fundamental studies on intravesical instillation of carboquone for treatment of urinary bladder tumors--on the effects of intravesical instillation of carboquone in normal beagle dogs].

The effects of intravesical instillation of Carboquone at the clinically used doses of 5 and 10 mg on the normal mucosa of female beagle dogs was compared with that of 10 mg Mitomycin C used as the control drug. Intravesical instillation for 48 hours of 10 mg carboquone/20 ml phosphate buffer solution (PBS) after bilateral cutaneous uretrostomies produced severe inflammatory changes in all layers of the bladder wall. However, no secondary effects were observed in blood laboratory examinations or histological examinations of the whole organ after autopsy. Phosphate buffer solution produced no remarkable secondary effects in animals. Five milligrams carboquone per 20 ml PBS was instilled intravesically once a week for 3 weeks in normal animals. Cystoscopically , the bladder mucosa recovered normally. Blood laboratory examinations showed no abnormal results, but the bladder epithelium had regenerative epithelial hyperplasia and slightly inflammatory changes in the submucosal layers. Two of the three control animals given instillation of 10 mg of Mitomycin C/20 ml PBS had slight leucopenia at 7 days after the last intravesical instillation, but leucocyte count was normal at the end of the experiment. Cystoscopic and histological examination of the epithelium of the urinary bladder revealed severe inflammatory changes in 2 of the 3 animals.

Administration, Topical↗