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PubMed1983

[Eosinophilic cystitis: a report of 2 cases].

Two patients with eosinophilic cystitis are presented in this report. The first case was a 39-year-old man who was admitted to our clinic with complaints of pollakisuria, pain on urination and hematuria for a month, which had not been relieved by antibiotic therapy. He had both a family and a personal past history of allergy. Excretory urograms showed a mild bilateral hydroureter and small bladder with irregular filling defects. Cystoscopic examination revealed velvety, ulcerated areas in the bladder mucosa, and we diagnosed these changes as eosinophilic cystitis after bladder biopsy. Steroid and antihistaminic therapy improved these symptoms. The second case was a 67-year-old woman who visited our clinic complaining chiefly of hematuria for 2 months. There was no predisposition to allergy, but she had a past history of uterine cancer which had been treated with irradiation. Cystoscopic examination disclosed a large amount of intravesical coagula, and erythematous and edematous areas with petechiae of the bladder mucosa. Bladder biopsy revealed hemangioma and eosinophilic cystitis. There was no recurrence of cystitis after the removal of the coagula without any other treatment.

Adult↗
PubMed1982

[Various methods of spread of bladder tumours (author's transl)].

The authors undertake a complete review of the literature concerning the various methods of spread of bladder tumours. They successively consider spread through the thickness of the bladder wall, surface extension, direct implantation of exfoliated cells, lymphatic spread, and venous dissemination both in the bladder wall as well as to the viscera by metastases. It is difficult to give a brief analysis of such an exhaustive review. However, a number of facts are worthy of emphasis: --the frequency of invasion of the seminal vesicles and the prostate; --the reliability of combined clinical, radiological and endoscopic findings, which may be used to differentiate deep tumours and superficial tumours in more than 80% of cases; --the importance of methods which await development, such as the scanner and, above all, ultrasound techniques; --the importance of study of the vesical mucosa at a distance from the tumour itself, both by fluorescent cystoscopic methods, as well as by distant biopsies (30 to 50% of premalignant cell changes found in cystoscopically normal zones); --the frequency if invasion of the terminal portions of the ureters (10% on average) and of the urethra (12 to 15%); --the prognostic gravity of tumour emboli in the intraparietal lymph vessels, the presence of which reduces the chances of cure at 5 years by two thirds; --the usual limitation of the first lymph node spread to the external iliac and hypogastric vessels with the exception of tumours of the bladder neck, where the first lymph node spread occurs to the aortic bifurcation; --the gravity of the presence of emboli in the parietal veins which reduces chances of survival at 5 years by half; --finally, the recently recognized frequency of secondary bone tumours; --and the supposed frequency of infraclinical metastases which would be a considerable argument in favour of complementary chemotherapy in therapeutic protocol for carcinomas of the bladder.

Humans↗
PubMed1982

Xenografts of human bladder cancer in immune-deprived mice.

Human bladder cancer from cystoscopic biopsies and from established cell lines was transplanted into mice that were immune suppressed by thymectomy plus sequential treatment with 1-beta-D-arabinofuranosylcytosine and whole-body irradiation. Each of four established human bladder cancer cell lines generated transplantable tumors in these mice, and some of the mice developed pulmonary metastases. Eight of 33 cystoscopically obtained biopsies of transitional cell carcinoma and one from a metastatic site led to xenografts that grew progressively, and some of these have been transplanted and/or have generated cell lines in vitro. Xenografts grew after a lag period of 0 to 32 weeks and had doubling times of 9 to 30 days. All of those examined histologically were consistent with transitional cell carcinoma, but some of the xenografts became more or less well differentiated in first and subsequent passages. The immune-deprived mouse is an alternative host to the nude mouse for generation of human tumor xenografts and may be a useful model for study of biological properties and therapeutic response of human bladder cancer.

Animals↗
PubMed1978

[Value of cystoscopy in the study of the urogynecological patient].

The results of 350 cystoscopic studies, are presented. In 85.7%, urinary incontinence was present, and in 72% one or more of the following symptoms were present: urgency, dysuria, urinary frequency, vesical tenesmus and nycturia. The following were analyzed: age, parity, uroculture and its relation to cystoscopic findings. Most of the patients (64.5%) were 40 to 60 years old, 54% had seven or more deliveries. Most frequent diagnoses were: urethritis alone or with trigonitis (66.8%) and urethral stenosis (meatus) in 31.4%. Uroculture was done in 96% and it was positive in 20% and negative 76%. In 88% of the patients with a negative uroculture, there were other lesions shown by urethrocytoscopy. From 300 patients with urinary incontinence, only in 155 it was confirmed objectively.

Adult↗
PubMed1996

Discrimination between the ulcerous and the nonulcerous forms of interstitial cystitis by noninvasive findings.

PURPOSE: We determined whether the classification of interstitial cystitis cases into ulcer and nonulcer categories from cystoscopic findings could be corroborated with epidemiological data relating to demographics, risk factors, symptoms, pain and psychosocial factors. MATERIALS AND METHODS: We surveyed 565 interstitial cystitis patients (111 with and 454 without ulcer), and from univariate analyses we found 10 noninvasive variables to be significantly associated with the presence of Hunner's ulcers. The 3 multivariate statistical methodologies of discriminant analysis, logistic regression and recursive partitioning were used to classify ulcer versus nonulcer cases from these variables. The retrospective and prospective performances from each methodology were also analyzed. RESULTS: Retrospectively, resubstitution error rates of all 3 methodologies were small, with overall misclassification rates of 19.1% with linear discriminant, 14.7% with logistic regression and 8.0% with recursive partitioning. Prospectively, the overall misclassification rates increased slightly to 20.0% with linear discriminant, 15.8% with logistic regression, and 15.9% with recursive partitioning. CONCLUSIONS: The classification of interstitial cystitis into distinct categories of Hunner's ulcer (classic interstitial cystitis) and nonulcer based on cystoscopic findings can be corroborated with epidemiological evidence. The 2 categories may represent different manifestations of the underlying disease pathophysiology.

Adult↗
PubMed1979

Unilateral essential hematuria.

At the Mayo Clinic between 1961 and 1975, 54 patients presenting with gross hematuria had "essential hematuria" of unilateral origin diagnosed. Criteria for this diagnosis included normal findings on excretory urogram, unilateral bleeding demonstrated at cystoscopic examination, the absence of infection, and a negative history for bleeding diathesis, analgesic abuse, renal surgery, or trauma. Of these patients, 52 responded to follow-up inquiry; 2 died of unrelated causes. Ancillary studies such as renal arteriography, renal biopsy, and repeated excretory urography and cystoscopic examinations were not helpful in establishing a cause, and no explanation for the hematuria was ever found in any of these patients. Although contributing no information as to the cause of unilateral essential hematuria, the study suggests that the patient who fulfills the above criteria need not undergo an extensive workup beyong excretory urography and cystoscopy and that repeated examinations are unnecessary and unrewarding. Most patients continue to do well despite intermittent or persistent hematuria. Essential unilateral hematuria probably is a benign condition that seldom requires surgical intervention.

Adolescent↗
PubMed1995

The relationship among multiple recurrences, progression and prognosis of patients with stages Ta and T1 transitional cell cancer of the bladder followed for at least 20 years.

A retrospective study was done on 176 patients with primary stages Ta and T1 bladder cancer treated between 1963 and 1972. One patient was lost to followup after 6 years, while the remainder were followed to death or for at least 20 years. In 1993, 13 patients had no evidence of disease, 39 died of bladder cancer and 123 died of intercurrent disease. Of 77 patients with a primary noninfiltrating tumor and 99 with a primary lamina propria invasive tumor 9 (11%) and 30 (30%), respectively, died of bladder cancer. Recurrences were noted on 10 or more cystoscopic studies in 16 patients and 10 died of bladder cancer 3.5 to 19 years after the primary transurethral resection. A total of 14 patients received repeated thiotepa instillations, all continued to have recurrences and 10 subsequently died of bladder cancer. Only 1 upper tract tumor was diagnosed on routine followup excretory urography. Invasive transitional cell carcinoma of the bladder developed in only 1 of 59 patients who had been tumor-free for 5 years. The results indicate that patients with recurrences on 10 or more cystoscopic studies will continue to have recurrences until death or cystectomy. Recurrence more than 4 years after the primary tumor operation is another ominous sign. Repeated thiotepa instillations did not influence the course of the disease in patients with a history of multiple recurrences. Followup cystoscopy may be discontinued 5 to 10 years after the last recurrence, at least in patients with a solitary low grade primary tumor. Routine followup urographic studies are neither cost-effective, clinically indicated nor justified in patients with superficial bladder cancer.

Carcinoma, Transitional Cell↗
PubMed1993

Percutaneous rotational lithotripsy of urinary bladder stones. Clinical results with the Rotolith lithotriptor.

Mechanical rotational lithotripsy of urinary bladder stones, up to 20 mm in diameter, was performed in 6 male patients with the Rotolith lithotriptor. The lithotriptor was introduced through a 10 F (OD 3.3 mm) suprapubically inserted sheath, and the procedure was performed under intermittent fluoroscopy and inspection through a transurethral cystoscope. In 3 patients, the bladder stones were fragmented to pieces small enough to be evacuated through the cystoscope. The instrument, which is designed for lithotripsy of gallbladder stones, was less efficient for fragmentation of urinary bladder calculi, primarily due to the large volume of the human urinary bladder, and possibly because of the higher gravity of bladder stones. There was no substantial damage to the mucosa of the urinary bladder.

Aged↗
PubMed1996

Transitional cell carcinoma of the bladder in the pediatric patient.

PURPOSE: We report on 5 boys with transitional cell carcinoma of the bladder, describe the identifying characteristics, review the literature, and define the issues of diagnosis, treatment and followup in this rare disease in pediatric patients. MATERIALS AND METHODS: Five boys 11 to 18 years old were identified with transitional cell carcinoma of the bladder. Preoperative imaging and urinary cytology were correlated with cystoscopic and biopsy findings. RESULTS: In all patients evaluation was prompted by gross hematuria. Low grade lesions, definitive cystoscopic management and a low recurrence rate were uniform findings. Preoperative imaging identified the tumor in all cases and bladder ultrasound was the most sensitive scan with 4 of 4 cases identified. CONCLUSIONS: While rare, transitional cell carcinoma of the bladder in children presents a challenge in diagnosis and followup since cystoscopy typically requires general anesthesia in this age group. Bladder ultrasound was found to be extremely sensitive in identifying lesions, and it may be a valuable and minimally invasive surveillance tool.

Adolescent↗
PubMed1997

Clinical evaluation of cats with nonobstructive urinary tract diseases.

OBJECTIVE: To identify the underlying cause of clinical signs in cats with nonobstructive diseases of the bladder and urethra. DESIGN: Prospective case series. SAMPLE POPULATION: 109 cats examined by the urology service of The Ohio State University's veterinary teaching hospital because of stranguria, hematuria, pollakiuria, or urination in inappropriate locations. PROCEDURE: History was obtained and a CBC, serum biochemical analyses, serologic tests for FeLV and feline immunodeficiency virus, urinalysis, bacterial culture of urine, and contrast radiography or urethrocystoscopy (females only) were performed. RESULTS: 16 cats had cystic calculi: 8 had struvite uroliths, 7 had calcium oxalate uroliths, and 1 had a urolith of unknown composition in conjunction with an anatomic defect. Anatomic defects, including diverticulae, urethral strictures, and a malpositioned urethra, were identified in 12 cats. A urinary tract infection was identified in 1 cat, and neoplasia was diagnosed in 2. One of the cats with neoplasia also had a struvite urolith. The remaining 80 cats did not have an anatomic defect, urolith, or tumor. Ten of these cats also did not have radiographic or cystoscopic abnormalities and were presumed to have a behavioral disorder. The remaining 70 cats had radiographic or cystoscopic abnormalities, and idiopathic cystitis was diagnosed. In 14 of the cats with idiopathic cystitis, results of a urinalysis were normal. Cats with idiopathic cystitis were significantly more likely to eat dry food exclusively (59%) than were cats in the general population (19%). CLINICAL IMPLICATIONS: Results suggest that idiopathic cystitis occurs commonly in cats with stranguria, hematuria, pollakiuria, or inappropriate elimination and is associated with consumption of dry foods. Contrast radiography or cystoscopy is necessary for differentiating idiopathic cystitis from behavioral disorders in some cats.

Animal Feed↗
PubMed1997

Endoscopic treatment of continent urinary reservoir calculi.

Formation of calculi is a late complication of continent urinary diversions. The techniques of percutaneous and transstomal treatment of these stones are described. Three patients underwent percutaneous placement of a rigid nephroscope into three different types of continent reservoirs and fragmentation of stones (2-5 cm in size) using ultrasonic lithotripsy. Preoperative CT scan of the abdomen and pelvis with oral and intrareservoir contrast was essential in finding the safest location for percutaneous access. One patient, with small stones, underwent placement of a flexible cystoscope through the continent efferent limb and Holmium laser lithotripsy. There were no instances of reservoir perforation. There was minimal blood loss, with an average operative time of 165 min. Ultrasonic lithotripsy of large stones through a percutaneous approach and Holmium laser lithotripsy for smaller stones via a flexible cystoscope placed through the efferent limb are safe and effective ways to treat calculi within continent urinary diversions.

Adolescent↗
PubMed1997

[Bladder hemangioma in a child: a case report].

We report a case of bladder hemangioma in a child. An 8-year-old girl was referred to our hospital for the evaluation of painless hematuria. Neither pyuria nor bacteriuria was detected. She had no dysuria. Intravenous pyelography showed deformity of the bladder without dilation of the upper urinary tract. Voiding cystourethrography revealed a filling defect of the bladder. Reddish blue masses were seen cystoscopically at the right wall and the dome of the bladder. Partial cystectomy was performed. From the histological findings, the diagnosis was cavernous hemangioma of the urinary bladder. Her postoperative course was uneventful and no recurrence was seen at the cystoscopical examination 3 months postoperatively. This is the 15th case of bladder hemangioma in children reported in Japan.

Child↗
PubMed1998

[Interstitial cystitis in case of primary Sjögren's syndrome].

A 53-year-old woman who had xerostomia for ten years was admitted to our hospital because of refractory lower abdominal pain and pollakisuria of five years duration. Although she had undergone surgical treatments including cholecystectomy, ovarian cystectomy and groin hemiorrhaphy, she still suffered from abdominal symptoms. A diagnosis of interstitial cystitis was confirmed by hydraulic distention during a cystoscopic examination and by histopathological examination of the bladder. Her symptoms disappeared soon after the cystoscopic procedure, which also had a therapeutic effect of interstitial cystitis. Laboratory findings revealed hypergammaglobulinemia, a high titer of rheumatoid factor, positive anti-nuclear antibody, and positive anti-SS-A/Ro antibody. She was diagnosed as having primary Sjögren's syndrome based on the results of a gum test (8.5 ml/ 10 min), sialography (Stage II), and a positive minor salivary gland biopsy. Starting one month after the hydraulic distention, her abdominal symptoms gradually reappeared along with elevation of her serum IgG level. These features were markedly improved with 30 mg/day of oral prednisolone, which was then successfully tapered. These results suggested that interstitial cystitis in this case was caused by immunological abnormalities associated with Sjögren's syndrome.

Cystitis, Interstitial↗
PubMed1995

Phase I clinical study of the recombinant oncotoxin TP40 in superficial bladder cancer.

Transforming growth factor alpha-Pseudomonas exotoxin-40 (TP40) is a hybrid fusion protein that selectively binds to cancer cells that express the epidermal growth factor receptor. TP40 is then internalized and kills these cells by virtue of its Pseudomonas exotoxin-derived domains. We studied the safety and short-term antitumor activity of intravesical TP40 in 43 patients with refractory superficial bladder cancer. These patients had resected Ta/T1 disease (n = 19), visible Ta or T1 lesions (n = 11), or carcinoma in situ (n = 13). Patients were treated with increasing dose levels of TP40 at 0.15, 0.3, 0.6, 1.2, 2.4, 4.8, or 9.6 mg/week for 6 weeks and evaluated by comparing pretreatment and posttreatment cystoscopic examinations, cytology, and histopathology. All TP40 doses were well tolerated. No evidence of antitumor activity was seen in any of the patients with Ta or T1 lesions. However, 8 of 9 patients with evaluable carcinoma in situ were judged by histopathology of multiple biopsy specimens to exhibit clinical improvement following TP40 therapy. In most of these responsive patients, cystoscopic examination supported the histopathological findings, although cytology of urine and bladder washings persistently demonstrated malignant cells. Therefore, TP40 appears to be a well-tolerated biological agent that may prove to have utility in treating carcinoma in situ of the bladder.

Aged↗
PubMed1995

Spectroscopic diagnosis of bladder cancer with elastic light scattering.

BACKGROUND AND OBJECTIVES: Recently, significant progress has been made toward the development of optical, noninvasive medical diagnostics. The goal of this study was to evaluate elastic scatter measurements as a tool for diagnosing bladder cancer. STUDY DESIGN/MATERIALS AND METHODS: In vivo measurements on 10 patients with suspected bladder cancer were made with the optical biopsy system (OBS) developed at Los Alamos National Laboratory. Elastic-scatter spectra over the wavelength range 250-800 nm were obtained using a fiber-optic probe through one of the lumens of a urological cystoscope. Measurements were made on putatively normal areas and areas of uncertain abnormality, as well as those suspected to be cancerous. After measurements were made with the OBS, biopsy samples were taken at the measurement sites. Comparisons of the histopathology and the optical spectra were then made. RESULTS AND CONCLUSIONS: A diagnostic algorithm for distinguishing malignant from nonmalignant tissue based on the values of the slopes over the wavelength range 330-370 nm has a sensitivity of 100% and specificity of 97% for the limited number of patients in this study.

Absorption↗
PubMed2005

Use of resectoscope to aid in bladder stone extraction.

We describe a modified technique of standard cystoscopic manipulation to facilitate bladder stone extraction. This technique decreases the overall time required for stone manipulation by allowing larger size stone fragments to be removed from the urethra under direct visualization.

Adult↗
PubMed1990

Corporeal perforation or undersized prosthesis? The role of corpus cavernosum endoscopy.

At the time of revision for a unilaterally short penile prosthesis it sometimes is difficult to differentiate between an originally undersized implant and a proximal corporeal perforation. Intraoperative inspection of the corpus cavernosum with a cystoscope was performed in 2 instances and appears to be a simple diagnostic method to differentiate a proximal corporeal perforation from an undersizing of unequal corporeal bodies.

Aged↗