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At least 55 records · Page 3Linked to original sources
PubMed2006

Combining hand assisted laparoscopic nephroureterectomy with cystoscopic circumferential excision of the distal ureter without primary closure of the bladder cuff--is it safe?

PURPOSE: We have previously described our technique of combining HAL-NU using early ureteral ligation with simultaneous cystoscopic circumferential excision of the distal intramural ureter without primary closure of the bladder cuff. We report the oncological sequelae in patients who underwent HAL-NU using our technique of complete ureteral removal. MATERIALS AND METHODS: We retrospectively evaluated all patients who underwent HAL-NU from April 1999 through July 2004. Cystograms were performed 1 week postoperatively in all patients. Pathological findings were reviewed. Cystoscopy was performed every 3 months to assess bladder recurrences. Upper tract imaging was performed postoperatively and then annually. The locations of recurrence and need for adjuvant treatment were assessed. RESULTS: A total of 49 patients with an average age of 67 years underwent HAL-NU. Gravity cystography confirmed that bladder defects had completely sealed at 1 week in all patients. Mean followup was 10.6 months (median 10, range 1 to 52). Of the patients 20 (49%) had bladder tumors postoperatively. Two patients were found to have advanced stage disease, leading to chemotherapy with radiation therapy in 1 and radical cystectomy in the other at 4 and 14 months, respectively. A total of 25 patients had postoperative pelvic imaging. Four patients with pathological stage T2 (1) and T3 (3) had metastatic disease at followup. One patient was known to have pulmonary metastases preoperatively and HAL-NU was performed for refractory hematuria. Two patients were noted to have distant metastases to the liver, lung and bone at 1 and 3 months postoperatively, respectively. One patient was found to have distant metastases to the liver and retroperitoneal lymph nodes 2 years after surgery. No patients were found to have local pelvic or peritoneal metastases. CONCLUSIONS: HAL-NU with cystoscopic excision of the distal ureter is feasible, safe and effective for upper tract transitional cell carcinoma. Oncological sequelae are comparable to results after open surgery. There is no evidence to suggest pelvic or peritoneal tumor seeding since no cases of pelvic or abdominal recurrence were discovered after surgery, while allowing the bladder defect to close spontaneously with catheter drainage. Our technique of ureterectomy ensures complete removal of the entire ureter, eliminating the possibility of ureteral stump recurrences. Early ligation of the ureter prevents tumor migration during renal manipulation, minimizing the risk of local tumor recurrences postoperatively.

Adult↗
PubMed1997

Primary lymphoma of the bladder: a unique cystoscopic appearance.

Primary lymphoma of the bladder is a rare disorder that occurs in the fifth to seventh decades, with a female preponderance. Although computed tomographic scanning is the best diagnostic imaging study, cystoscopic biopsy and immunoperoxidase staining are needed to make the diagnosis. Primary lymphoma of the bladder has a good prognosis and responds to a variety of therapeutic modalities. Throughout the literature, authors have described primary lymphoma of the bladder as a submucosal tumor, smooth, nonulcerative, edematous, friable, or even hemorrhagic. We present what we believe to be the first photographic image of the cystoscopic appearance of primary lymphoma of the bladder.

Aged↗
PubMed1997

Associations among cystoscopic findings and symptoms and physical examination findings in women enrolled in the Interstitial Cystitis Data Base (ICDB) Study.

OBJECTIVES: To determine if specific symptoms or physical findings were associated with findings on cystoscopic examination under anesthesia in patients participating in the Interstitial Cystitis Data Base (ICDB) Study. METHODS: Subjects entering the ICDB Study completed symptom questionnaires and underwent physical examinations. Additionally, at the discretion of study investigators, 150 women underwent cystoscopy under anesthesia following a specific protocol of bladder distension at 70 to 80 cm irrigating fluid height and reinspection after capacity was reached and the irrigant drained. RESULTS: Statistically significant (p < 0.01) associations between bodily pain and urinary urgency with the presence of a Hunner's patch, and urinary frequency and urgency with a reduced bladder capacity under anesthesia were seen. Neither the findings of bloody irrigating fluid nor glomerulations were strongly associated with any symptom, and except for an association of urethral tenderness with Hunner's patch, no physical examination finding was associated with any cystoscopic findings. CONCLUSIONS: The strong associations of Hunner's patch and reduced bladder capacity under anesthesia with severe pain and urinary urgency, and urgency and frequency, respectively, indicate not only the importance of these findings in diagnosing interstitial cystitis, but also their potential utility in subclassifying this disease.

Cystitis, Interstitial↗
PubMed1997

Associations among cystoscopic and urodynamic findings for women enrolled in the Interstitial Cystitis Data Base (ICDB) Study.

OBJECTIVES: Interstitial cystitis is a symptom complex characterized by pelvic pain, urinary urgency, urinary frequency, and nocturia. Patients with these symptoms, at the 5 clinical centers participating in the National Interstitial Cystitis Data Base (ICDB) Study, have been evaluated with history and physical exams, questionnaires, and urodynamic studies. METHODS: Of the 388 female subjects entered in the study as of December 31, 1995, 150 women have undergone cystoscopy with hydrodistension. The data from the endoscopic procedures and the urodynamic studies were analyzed. The associations among cystoscopic and urodynamic findings were reviewed. RESULTS: Patient demographics of this subgroup show a predominance of Caucasians 139/150 (92.7%), with the average age being 43 (+/-13.2) years. Of the total, 17 patients (11.3%) had a Hunner's patch (HP). The prevalence by center varied from a low of 2/38 (5.3%) to a high of 3/9 (33.3%). Bloody effluent following hydrodistension was present in 113/150 (75.3%). Glomerulations appeared in varying degrees (mild, moderate, severe) in 91.3% of the 150 patients. There was a strong inverse relationship (P < 0.001) between bladder capacity under anesthesia and the presence of a HP (mean of 845 cc with HP absent versus a mean of 531 cc when present). The incidence of HP varied from 67.6% among women with a bladder capacity at hydrodistension of < 400 cc to 3.8% for those with a bladder capacity of at least 800 cc. The presence and increasing severity of glomerulations was positively associated (P < 0.003) with the presence of HP, ranging from 0/13 (0%) when glomerulations were not present to 6/31 (19.4%) when glomerulations were graded as severe. Of the patients with HP, 17/17 (100%) had glomerulations after hydrodistension. HP is more closely associated with the moderate to severe range of glomerulations (P < 0.01). Nearly half of the patients with HP or 8/17 (47.1%) had "moderate" glomerulations, while 6/17 (35.3%) had "severe" glomerulations. The volume at first sensation to void on urodynamics (mean 87 cc without HP versus 34.7 cc with HP) was highly inversely associated (P = 0.002) with the presence of HP, but not with any of the other cystoscopic findings. Of patients with HP, 94% had a volume at first sensation to void of < or = 50 cc where only 36% of patients without HP had a volume at first sensation to void of < or = 50 cc. The volume at maximum capacity on urodynamics was positively associated with the volume at hydrodistension (P < 0.001). CONCLUSIONS: Overall, patients with HP had lower bladder capacities, lower volumes at first sensation to void, and more severe glomerulations. Thus, the presence of HP would imply a more severe case of interstitial cystitis. Logically, a higher bladder capacity on cystometrogram is associated with a higher volume at the time of hydrodistension, and bloody effluent is associated with more severe glomerulations.

Adult↗
PubMed2002

Hand-assisted laparoscopic nephroureterectomy with cystoscopic en bloc excision of the distal ureter and bladder cuff.

Various hand-assisted and purely laparoscopic nephroureterectomy techniques have been described in the urologic literature. We describe a technique of hand-assisted laparoscopic nephroureterectomy with cystoscopic en bloc excision of the distal ureter and bladder cuff that duplicates open surgical excision of these structures and obviates bladder trocar placement and midprocedural patient repositioning. The patient is placed in a modified dorsal lithotomy position with the tumor side elevated 30 degrees. Allen stirrups are utilized to allow simultaneous access to the urethra. A transperitoneal hand-assisted laparoscopic nephrectomy is performed. The technique is modified in that the ureter is clipped prior to the kidney dissection to avoid distal migration of tumor cells during kidney manipulation. After the kidney is isolated, the intact ureter is liberated distal to the intramural hiatus. The remaining dissection is completed intravesically under cystoscopic guidance. While the surgeon's intra-abdominal hand places the ureter on tension, the cystoscopist transurethrally excises the bladder cuff and intramural ureter with a Collings knife. The complete surgical specimen is removed en bloc through the hand port. The bladder is not closed. A urethral catheter connected to straight drainage remains until the seventh postoperative day, when a cystogram is performed; if it is normal, the catheter is removed.

Carcinoma↗
PubMed2000

Proposal for changes in cystoscopic follow-up of patients with low-grade pTa bladder tumor.

OBJECTIVES: The cystoscopic follow-up of superficial bladder cancer accounts for a considerable workload for urologists and is also an invasive procedure with high costs. There is a potential benefit both to the urologist and the patient if unnecessary cystoscopies can be avoided. METHODS: The recurrence and progression rates of 120 patients with pTa G1 or G2 and small (<4 cm) transitional cell carcinoma were evaluated retrospectively. RESULTS: The recurrence rate was 6.5% (8/120) at 3 months. The recurrence rates at 6 and 9 months were 6.7 (8/119) and 3.6% (4/112), respectively. However, when the third month (first check) was clear, the recurrence rates at 6- and 9-month cystoscopy were 4.3 (5/116) and 2.7% (3/111), respectively. The recurrence rate at 12 months was 8% (8/99). For G1 tumors, the recurrence rates at 3, 6, 9 and 12 months were 6 (5/84), 5 (5/83), 2.5 (2/80) and 7% (5/71), respectively. The same results for G2 tumors were 8 (3/36), 8 (3/36), 6 (2/32) and 10.5% (3/28), respectively. The progression rate for the first year was lower than 1%. The difference between G1 and G2 tumors according to recurrence rate within the first year was not statistically significant (p>0. 05). CONCLUSIONS: This study supports the proposal that for patients with small and welldifferentiated pTa tumors at diagnosis, if the first control cystoscopy is clear, it is appropriate to perform the second check cystoscopy 1 year from initial resection and subsequent controls yearly. One should note that the study group included the most suitable patients for cystoscopic follow-up according to size and multiplicity of the tumor. This change in policy is further supported by the fact that progression occured in less than 1% in this group of patients.

Carcinoma, Transitional Cell↗
PubMedDate not supplied

Cytology of grade 1 papillary transitional cell carcinoma. A comparison of cytologic, architectural and morphometric criteria in cystoscopically obtained urine.

OBJECTIVE: To assess the diagnostic criteria for grade 1 papillary transitional cell carcinoma (TCC) in cystoscopically obtained urine. STUDY DESIGN: We compared the sensitivity, specificity and positive predictive value of cytologic, architectural and morphometric (primarily architectural) criteria in 177 specimens with corresponding biopsy follow-up. RESULTS: Sensitivities ranged from 22% to 44%, specificities from 69% to 85% and positive predictive values from 59% to 66%. CONCLUSION: The currently described cytologic, architectural and morphometric criteria are inadequate for the identification of grade 1 papillary TCC, and the cytologic diagnosis of grade 1 papillary TCC in cystoscopically obtained urine remains unreliable.

Biopsy↗
PubMed1986

Are cystometric and cystoscopic examinations of any value for disabled incontinent elderly?

According to assessments made by the personnel and patients' own reports 42% of males and 54% of females aged 65 years or over and attending the day hospital in the town of Tampere were found to be incontinent. Incontinence was related to the frequency of urinating in the daytime. All incontinent patients of the day hospital were referred to the urologist at the University Hospital. Only about one third of these patients participated in the cystometric and cystoscopic examinations. The main reasons for non-attendance were unwillingness of the patient, referral of the patient to another place of care and resistant urinary infection. Urinary retention and small bladder capacity were common findings by cystometry and cystoscopy. A surgical management was recommended to seven per cent and conservative management to 93% of the patients. The concordance rates between the classification of the incontinence by anamnestic questions and the classification made by the urologist were not very high: the overall percentage of agreement was 40%. It is concluded, that not all incontinent elderly patients should be sent for cystometric and cystoscopic examination. Residual urine should be measured, if urinary retention is thought to be associated with incontinence. Furthermore, the classification of incontinence cannot be made only by using anamnestic questions.

Aged↗
PubMed2000

Improvement of transperineal implant dosimetry by intraoperative cystoscopic confirmation of prostate anatomy.

PURPOSE: A simple, inexpensive method to aid in the accurate placement of permanent seeds for prostate brachytherapy is described. The effect of identifying the prostate base and apex cystoscopically relative to registration seeds placed at the beginning of the implant is discussed. MATERIALS AND METHODS: At the beginning of each implant procedure a pair of marker seeds are first placed in the prostate, including 1 seed at the base and 1 at the apex. Using a cystoscope, the urologist identifies the prostatic base and apex, and a fluoroscopic record is obtained. The positions of the base and apex relative to the marker seeds are monitored throughout the case via fluoroscopy to aid in needle and seed placement for the implant. RESULTS: Use of this method significantly improved coverage of the prostate apex, reduced overall dose variance in the prostate base and improved overall gland dosimetry by 22% as measured by the D90 quality metric (minimal dose which covers 90% of the prostate volume). CONCLUSIONS: While the clinical efficacy of improved target coverage on local control and survival awaits further clinical investigation, we encourage others to adopt this easy technique to ensure better, more consistent interstitial implants.

Brachytherapy↗
PubMed2001

A technique for resection of small bladder tumors using a flexible cystoscope on an outpatient basis: bladder tumor resection with newly designed hot cup forceps.

PURPOSE: We describe a technique for resecting small papillary superficial bladder tumors using a new device and flexible cystoscope. MATERIALS AND METHODS: In a 79-year-old man 3 small recurrent papillary bladder tumors were resected transurethrally on an outpatient basis. The procedure was performed using a flexible cystoscope and a newly designed type of cup forceps with the patient under topical anesthesia. No urethral catheter remained indwelling after surgery and the patient was discharged home the same day. RESULTS: Bladder tumor resection using this technique was tolerable to the patient and postoperative bladder hemorrhage was not noted. Resected specimens were adequate for pathological tumor evaluation, which revealed grade 1 stage Ta superficial transitional cell carcinoma of the bladder. CONCLUSIONS: This easy technique seems to be tolerated well by the patient. Resected specimens should be adequate for evaluating the pathological grade and depth of stage Ta or T1 superficial bladder cancer. This technique may be an alternative to standard transurethral resection for removing small recurrent bladder lesions in select patients who prefer outpatient management of bladder tumors.

Aged↗
PubMed2003

Hypobaric bupivacaine spinal anesthesia for cystoscopic intervention: the impact of adding fentanyl.

BACKGROUND AND OBJECTIVE: Addition of fentanyl to hyperbaric bupivacaine spinal anesthesia prolonged the duration of sensory block. This study seeks to test the hypothesis that adding fentanyl to small dose hypobaric spinal anesthesia will improve intraoperative patients and surgeon satisfaction without delay in recovery. METHODS: Patients (n = 80) subjected to minor cystoscopic surgery were randomly assigned to have spinal anesthesia with either 5 mg bupivacaine 0.1% or 5 mg bupivacaine 0.1% mixed with 20 micrograms fentanyl. The main outcome measures included intraoperative patient and endoscopist satisfaction, sedative/analgesic supplementation, postoperative side effects and time to ambulation. RESULTS: Patients in the bupivacaine group needed more analgesic supplementation. Analgesia was more adequate in the bupivacaine-fentanyl group. Pruritus was the main side effect in the bupivacaine fentanyl group. Ambulation and discharge of patients were nearly the same in both groups. CONCLUSIONS: Spinal anesthesia with small dose (5 mg) hypobaric (0.1%) bupivacaine mixed with fentanyl (20 micrograms) produced adequate anesthesia for short cystoscopic procedures with minimal side effects and without delay in ambulation.

Adult↗
PubMed1991

[Initial clinical experience with video-cystoscope].

The endoscopic image processing system which has a very small change coupled device (CCD) at the distal tip of an endoscope, can give us a quite different imaging information from the conventional optical endoscopes, of which the main functions were just to "see inside the human body". The advantage of this endoscopic image processing system has been well recognized but, since the scope diameter could not be made smaller due to the size limitations of the CCD chip itself, the system has not been utilized in the field of Urology. In cooperation with Olympus Optical Co., we have studied a system called Urological Video Information System (UVIS) in order to utilize the image processing system for Urology. In our system a special light source with RGB light output is utilized together with a conventional optical cystoscope and a video converter is connected to the eyepiece of the scope in order to observe endoscopic images on the monitor. Endoscopic images can be stored in an image filing system when necessary. The image quality of UVIS is inferior to that of the conventional cystoscopes at the moment and there are several other technical problems to solve but, as witnessed in the field of Gastroenterology, it is expected that this kind of electronic system will become much more important in the future. This report covers the current problems and some considerations of them as an initial study.

Acute Disease↗
PubMed1990

A cystoscopically directed biopsy technique developed in canine pancreaticoduodenal transplantation.

Present methods of monitoring for allograft dysfunction in pancreaticoduodenal transplantation (urinary amylase, scintigraphy) give indirect evidence and do not consistently allow recognition of early, potentially reversible rejection from other causes of allograft dysfunction. For better diagnosis of allograft dysfunction, adequate tissue specimens must be obtained without trauma to the allograft. We devised a cystoscopically directed needle biopsy technique to obtain tissue from the canine pancreaticoduodenal allograft. This technique is made feasible by a duodenocystostomy similar to that in human pancreaticoduodenal transplantation. The duodenum acts as a port of entry for the biopsy instruments, providing access to the pancreas. A 24F side-viewing nephroscope is used to view the duodenum. The tissue specimen is obtained with an 18-gauge, 350 mm Menghini aspiration needle inserted by way of the nephroscope through the duodenum and into the pancreas. Pancreaticoduodenal allotransplantation with a duodenocystostomy for exocrine drainage was performed in 18 dogs. Of 59 serial biopsy specimens obtained, 41 (69.5%) were adequate for pathologic evaluation. The principal complication associated with the technique was minimal bleeding at the biopsy site, occurring in 22 of the 59 biopsy procedures. This cystoscopically directed biopsy technique appears to be safe, often obtains adequate tissue for diagnosis, and may be directly applicable for distinguishing causes of allograft dysfunction in human pancreaticoduodenal transplantation.

Animals↗
PubMed1988

[Morbidity due to bilharziasis caused by S. haematobium. Relationship between the bladder lesions observed by ultrasonography and the cystoscopic and anatomo-pathologic lesions].

Twenty-seven patients with proved urinary schistosomiasis and echographic bladder lesions were selected for cystoscopic examination and biopsy. All patients had specific lesions at cystoscopic investigation. Histologic examination confirmed diagnosis 26/27 cases. Ultrasonography appears as a very efficient method for detection of schistosomiasis bladder pseudo-tumors.

Biopsy↗
PubMed1980

Development of a carbon dioxide laser cystoscope.

CO2 laser lesions were created at varying power densities on the exteriorized canine bladders. A 50-watt carbon dioxide continuous laser coupled to a Zeiss surgical microscope was used. A schematic power curve was developed indexing depth of bladder penetration by the laser against laser energy output. Once the optimal power settings for the carbon dioxide laser were established, vertical heat transmission, hemostasis, and healing were studied. A prototype carbon dioxide laser cystoscope was then constructed that allowed endoscopic delivery of the CO2 laser beam into the intact canine bladder. The beam was focussed by a germanium lens and directed out the end of the endoscope, using a movable mirror. Eight dogs were then endoscopically studied in vivo.

Animals↗
PubMed2005

Sterile disposable sheath system for flexible cystoscopes.

Flexible cystourethroscopy is an accepted routine procedure in urology. The sterilization of instruments is time consuming and may damage flexible instruments. However, it must be performed to prevent contamination of the endoscopes. This study is the first to document experience using a flexible cystoscope with a disposable sheath in a urologic setting.

Cystoscopes↗