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PubMed1996

[Development of a new technique to detect the laterality of microscopic hematuria by means of gas cystoscopy].

BACKGROUND: We developed a new technique to determine the laterality of microscopic hematuria by means of gas cystoscopy. METHODS: An originally designed catheter system consisted of two catheters. On the tip of an inner catheter, a urine dipstick for blood was attached, with a cap on the tip of an outer catheter to keep the dipstick dry. In order to react a dipstick with the urine coming out from a ureteral orifice in the bladder, CO2 was insufflated into the bladder through a cystoscope (gas cystoscopy). The laterality of microscopic hematuria was determined in the bladder, based on the color reaction on the dipstick. RESULT: This technique was performed successfully in 14 (88%) of 16 cases with microscopic hematuria. The laterality of microscopic hematuria was determined to be ipsilateral in 6 patients, which coincided with the side of a urological upper urinary tract disorder. In contract, bilateral microscopic hematuria was confirmed in 8 patients with glomerular disorders. CONCLUSION: The diagnostic process in patients with microscopic hematuria remains unsolved for urologists and nephrologists. This technique may provide a new approach in diagnosing microscopic hematuria.

Adult↗
PubMed2004

Neodymium:YAG laser incision of congenital obstructive posterior urethral membrane in boys with urinary incontinence and low uroflow.

BACKGROUND AND PURPOSE: Congenital obstructive posterior urethral membrane (COPUM) is associated with sub-clinical lower urinary tract symptoms in boys. Urethral stricture following cystoscopic fulguration of the membrane and a relatively small urethral caliber make the treatment of this condition difficult. METHODS: Fifteen boys (mean age, 10.0 years) with COPUM were treated with neodymium:YAG (Nd:YAG) contact laser incision of the membrane through a cystourethroscope (n = 7) or a ureteroscope (n = 8). RESULTS: Presenting symptoms were bedtime incontinence in 15, frequency/urgency in 10, daytime incontinence in 7, lazy bladder in 3 and urinary tract infection in 2. All patients had an obstructive urinary flow pattern with a maximal flow rate (Q(max)) < 15 mL/s. The mean follow-up period was 10.5 months. After the surgery, the number of wet nights per week reduced > 90%, 50-90% and < 50% in 9 (60%), 5 (33.3%), and 1 (6.7%), respectively. Mean (Q(max)) increased from 11.3 to 14.9 mL/s (p = 0.003). CONCLUSION: Nd:YAG laser incision of COPUM with the aid of a ureteroscope or a cystourethroscope is a safe and effective method for improving urinary flow and bedtime incontinence.

Adolescent↗
PubMed1990

[Laser lithotripsy with the neodymium YAG laser].

Laser-induced shock wave lithotripsy (LISL) with a Q-switched neodymium-YAG laser depends on the generation of a laser-induced breakdown in the fluid surrounding the stone. An oscillating plasma bubble is created, directing shock waves towards the stone. These cavitational effects fragment the calculus into small particles. A new bifunctional laser is introduced: this allows both nanosecond pulses for shock wave generation and disintegration of urinary calculi and millisecond pulses for biliary stones and tissue coagulation. It can be supplied with 320-, 400-, and 600-micron fibers. We have treated 189 ureteric stones in 185 patients with laser lithotripsy utilizing flexible ureteroscopes (n = 26) or rigid ureteroscopes (n = 159). It proved possible to fragment 179 stones into small pieces. In eight patients LISL was not successful. A rigid cystoscope that can be dismantled into an upper and lower hemisheath for the introduction of flexible endoscopes into the ureter without prior dilatation of the ureteral orifice was used in 15 patients.

Cystoscopes↗
PubMedDate not supplied

[The efficacy of rigid and flexible endoscopes in the diagnosis of bladder diseases].

A comparative assessment of the efficiency of rigid and flexible endoscopes used for the diagnosis of bladder diseases (cystitis, papilloma, carcinoma in a total of 250 patients) is reported. Cystoscopy made use of a rigid catheter in 101 patients and of a flexible one, in 149. With rigid cystoscope procedure, the diagnosis was correct in 72.2%, doubtful in 13.9%, and erroneous in 13.9%. Major causes of the failure of cystoscopy in this group of patients were bleedings small volume of the bladder, tumor disintegration incontinence, prostatic adenoma, fistula, the tumor outside rigid endoscope's visibility range, or grave condition of the patient. Fiber cystoscopy made use of 6 mm endoscopes, corresponding to No 18 by Charrière's scale. Flexible endoscope procedure proved effective in 98.7% of the patients, including 11 patients after a failure with rigid cystoscopy. Principal advantages of vesicle fibroscopy are that the method is absolutely atraumatic, painless, quick, has no dead zones and makes possible complete examination of the mucosa of diverticula or any exophytic formation, and target biopsy.

Cystoscopes↗
PubMed1985

[Cryoprostatectomy of prostatic tumors].

Since 1968, we have carried out cryoprostatectomy on prostatic hypertrophy and prostatic cancer patients. As for the method of monitoring during cryoprostatectomy, digital examination only was carried out at the beginning in order to confirm the range of freezing and to determine the freezing time. In 1972, we developed a cryoprostatectomy method under direct intravesicular observation using the Trocar Cystoscope and furthermore in 1980, we developed echoguided cryoprostatectomy using the transrectal linear electronic scanner. These new developments ensure the safety of cryoprostatectomy and furthermore, cryoprostatectomy can now be easily carried out. The above-mentioned procedures are described.

Aged↗
PubMed1997

Randomized, prospective, double-blind study of the effects on pain perception of lidocaine jelly versus plain lubricant during outpatient rigid cystoscopy.

PURPOSE: There is no clear evidence that intraurethral lidocaine jelly decreases pain and/or makes rigid cystoscopy more tolerable for patients. Since lidocaine jelly is significantly more expensive than plain lubricant, we attempted to assess the true benefit of this agent. MATERIALS AND METHODS: We performed a randomized, prospective, double-blind study to compare the anesthetic effects of intraurethral 2% lidocaine jelly versus plain lubricant in patients undergoing rigid cystoscopy. Unlike previous studies, we ensured adequate urethral filling by using 30 cc of each agent and we waited 20 minutes after instillation of the agent before performing cystoscopy to allow adequate absorption. Cystoscopy was performed using a 17 to 21F rigid instrument. A total of 189 patients was entered into the study but 10 were excluded from analysis due to incomplete questionnaires. A 10-point scale (1-least to 10-most painful) was used to measure pain perception. RESULTS: In men pain perception was significantly decreased when lidocaine jelly was used (mean plus or minus standard error 3.00 +/- 0.21 versus 4.36 +/- 0.37 points, p = 0.002). In women there was no observed difference in pain perception when lidocaine jelly or plain lubricant was used (3.21 +/- 0.38 versus 3.11 +/- 0.30 points, p = 0.823). Patient race, performance of a related procedure, cystoscope size or history of cystoscopy did not significantly affect reported pain scores. There was a slight decrease in pain perception with increasing age (-0.23 +/- 0.10 points per decade, p = 0.021). The level of patient anxiety before cystoscopy was also significantly associated with pain perception (p < 0.001). CONCLUSIONS: Lidocaine jelly offers no advantage over plain lubricant in regard to pain control during rigid cystoscopy in women. However, when used in adequate amounts and allowed to dwell in the urethra for 20 minutes before cystoscopy, lidocaine jelly can significantly decrease pain in men.

Adult↗
PubMed1995

Retrieval of ureteral stents in children.

An endoscopic technique to remove ureteral stents in children is described. The technique is simple and reproducible. A snare or lasso is created by looping a polypropylene suture through a ureteral catheter. The snare is advanced under vision through the working channel of a pediatric cystoscope. The loop of the suture is placed over the intravesical portion of the indwelling ureteral stent. It is tied to create a noose, thus securing the stent. The stent can then be removed easily.

Child↗
PubMed1997

[Infectious risks of outpatient cystoscopy in men with sterile urine].

OBJECTIVE: To prospectively assess the inherent risk of infection associated with outpatient cystoscopy performed in men with sterile urine without antibiotic prophylaxis. MATERIAL AND METHODS: 298 cystoscopies were performed in men corresponding to these criteria, with the exclusion of patients at risk of bacterial endocarditis. The equipment consisted of three cystoscopes prepared according to the recommendations of the Société Française d'Hygiène Hospitalière. The disease justifying the examination was specified for each patient. The sterility of the urine was verified during the week preceding the examination and 48 hours later by urine culture. RESULTS: Out of 281 evaluable patients, an infection was observed in 22 cases (7.8%), and was symptomatic in only one case. Escherichia coli was the organism most frequently isolated (50%) and no multiresistant bacteria were detected. A particularly high infection rate was observed in enterocystoplasty patients (21.7%). CONCLUSION: The infectious risk of cystoscopy in the presence of sterile urine, performed according to recommendations, appears to be higher than previously reported. This risk appears to be significantly higher in the case of enterocystoplasty than for other diseases.

Ambulatory Care↗
PubMed2005

Relevance of urine telomerase in the diagnosis of bladder cancer.

CONTEXT: The identification of new molecular markers is one of the most challenging goals for the early detection of bladder cancer because available noninvasive methods have neither sufficient sensitivity nor specificity to be acceptable for routine use. OBJECTIVE: To develop a relatively simple, inexpensive, and accurate test that measures telomerase activity in voided urine to apply to large-scale screening programs for bladder cancer detection. DESIGN, SETTING, AND PARTICIPANTS: Case-control study conducted in 218 men (84 healthy individuals and 134 patients at first diagnosis of histologically confirmed bladder cancer), frequency matched by age and recruited between March 2003 and November 2004 in Italy. Urine telomerase activity was determined using a highly sensitive telomeric repeat amplification protocol (TRAP) assay. Urine samples were processed for cytological diagnosis and TRAP assay. The diagnosis of bladder cancer was based on bioptic and cystoscopic examinations. The performance of the TRAP assay to detect urine telomerase activity was compared with urine cytology as an aid to early cancer detection. Quantification of urine telomerase activity was conducted in a blinded manner. MAIN OUTCOME MEASURE: Sensitivity and specificity of TRAP to detect bladder cancer. RESULTS: Using a 50 arbitrary enzymatic unit cutoff value, we validated the results obtained in the pilot study. In the overall series, sensitivity was 90% (95% confidence interval [CI], 83%-94%) and specificity was 88% (95% CI, 79%-93%). Specificity increased to 94% (95% CI, 85%-98%) for individuals aged 75 years or younger. The same predictive capacity of telomerase activity levels was observed for patients with low-grade tumors or with negative cytology results. CONCLUSIONS: The present validation study demonstrated the ability of urine telomerase activity levels to accurately detect the presence of bladder tumors in men. This test represents a potentially useful noninvasive diagnostic innovation for bladder cancer detection in high-risk groups such as habitual smokers or in symptomatic patients.

Adult↗
PubMed1999

Laser ablation of urethral hair.

BACKGROUND AND OBJECTIVE: Two separate cases involving laser ablation of hair follicles in the neourethra are described. STUDY DESIGN/MATERIALS AND METHODS: Urethral hair developed secondarily to free-flap urethroplasty for congenital urethral defects. In both cases, cystoscopic depilation with electrocautery fulguration was attempted on multiple occasions. RESULTS: No improvement was seen; therefore, laser ablation was employed. Both patients remain free of regrowth at greater than one year of follow-up.

Adult↗
PubMed1999

The accuracy of urinary cytology in daily practice.

BACKGROUND: Most studies of urinary cytology have been research analyses designed to test the method itself, and many claim that the high diagnostic yields in these studies cannot be achieved in daily practice. The authors examined the clinical and pathologic records in three hospital pathology practice settings--academic, community, and cancer referral settings--to determine the diagnostic yield of urinary cytology under daily clinical conditions. METHODS: Records of consecutive urinary cytology specimens from 1672 patients reported from the years 1990-1994 were reviewed and correlated with histologic and clinical information. Initial analyses were based on the records themselves, without review of pathologic specimens. Subsequently, a subset of specimens was reviewed to determine reasons for noncorrelations. RESULTS: Results confirmed that the diagnostic sensitivity and specificity of urinary cytology for high grade transitional cell neoplasms, as reported in the daily practice of pathology, are very high (79% and >95%, respectively). Disaggregated cells from low grade transitional cell neoplasms usually lack recognizable features of neoplasia, and attempts to classify such lesions cytologically result in low diagnostic yield, with an overall sensitivity of 26%. Of these 1672 patients, 707 had insufficient clinical information for analysis, despite diligent and persistent efforts to acquire it. CONCLUSIONS: The diagnostic yield of consultations based on urinary cytology in the daily practice of pathology is high, regardless of whether the practice setting is referral-based or community-based. The available information indicates that in approximately 79% of patients with high grade transitional cell neoplasms, the neoplasms can be detected using urinary cytology. Conversely, a negative result is predictive of no cancer in more than 90% of cases. Sensitivity for detecting low grade urothelial lesions is low; however, most of these are easily detected cystoscopically. The authors' inability to acquire sufficient information to determine diagnostic yield in a large percentage of their cases was disturbing to them. Not only did this deficiency render their analyses incomplete, but lack of easily accessible follow-up and the apparent low priority for quality assurance activities among pathologists in all types of practice settings is likely to significantly reduce the feedback required for pathologists to acquire and maintain expertise in this very difficult area.

Carcinoma, Transitional Cell↗
PubMed2000

Atypical nephrogenic metaplasia of the urinary tract: a precursor lesion?

BACKGROUND: Nephrogenic metaplasia with cytologic atypia (atypical nephrogenic metaplasia) is occasionally encountered and its biologic potential is uncertain. METHODS: The authors describe 18 cases of atypical nephrogenic metaplasia characterized by the presence of prominent cytologic atypia, including nuclear enlargement, nuclear hyperchromasia, and enlarged nucleoli. DNA ploidy analysis by digital image analysis and immunostaining for high-molecular-weight cytokeratin (34betaE12), cytokeratin 7, cytokeratin 20, carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), p53, and MIB-1 were performed in 9 cases. RESULTS: The mean patient age was 62 years (median, 65 years; range, 39-84 years). The male-to-female ratio was 2.6:1. Two patients had a history of noninvasive papillary urothelial carcinoma. The typical clinical presentation was hematuria (8 patients) and voiding symptoms (5 patients). Cystoscopic findings were suspicious for neoplasm in 7 of 13 cases. The neoplastic cells were positive for high-molecular-weight cytokeratin, cytokeratin 7, and EMA, and were usually negative for cytokeratin 20 and CEA. p53 nuclear accumulation and increased MIB-1 labeling index were seen in 4 cases. DNA ploidy analysis showed aneuploid pattern in 2 of 9 cases. The mean patient follow-up was 3.5 years (range, 0.5-10.6 years); 2 patients had recurrent nephrogenic metaplasia, and the remainder were alive without recurrence or urothelial carcinoma. CONCLUSIONS: Atypical nephrogenic metaplasia is benign; it occasionally displays substantial cytologic abnormalities of no apparent clinical significance. Awareness of the spectrum of cytologic changes within this entity is critical to prevent overdiagnosis of cancer and avoid unnecessary treatment. There is no direct evidence that links atypical nephrogenic metaplasia to cancer.

Adult↗
PubMed1998

Bladder tissue biopsies in spinal cord injured patients: histopathologic aspects of 61 cases.

It was the aim of this histopathologic study to examine and compare results of bladder tissue biopsies in spinal cord injured (SCI) patients. The study group consisted of 61 SCI patients who received treatment at the Swiss Paraplegic Centre in Nottwil, near Lucerne, Switzerland. The mean age of the study group was 41 years (range, 17-73) and the mean duration of spinal cord lesion was 10 years and 4 months (range, 5 months to 44 years). The male:female ratio was 57:4. Bladder infections had occurred in each patient one to six times per year (median, 3.2). All samples were taken from the trigone of the bladder during endoscopic urologic procedures with a flexible cystoscope. Histopathologic analysis showed abnormal alterations of bladder tissue in 56 SCI patients (91.8%). Forty-six SCI patients (75.4%) had a chronic type and 10 SCI patients (16.4%) a subacute type of inflammation. Normal bladder tissue was found in five cases (8.2%). Further observation revealed the presence of fibrosis (34.4%), edema (9.8%), and lymphoid hyperplasia (6.6%). A t-test for independent samples showed a lack of significant correlation between the number of clinical bladder infections per year, the duration of injury, the neurologic level of the spinal cord lesion, and histopathologic types of infections.

Adolescent↗
PubMed1981

BCG immunotherapy of bladder cancer: inhibition of tumor recurrence and associated immune responses.

Fifty-one patients with confirmed bladder cancer have enrolled in a prospective evaluation of BCG immunotherapy. Following resection of existing tumors, patients were stratified according to tumor grade and number of previous recurrences and randomly assigned to control or BCG treatment groups. Immunotherapy consisted of six weekly administrations of Pasteur strain BCG using 120 mg intravesically and 5 mg percutaneously. Immunotherapy side effects were minimal and no patient required postponement of BCG treatments. Eleven control (46%) compared with five (22%) BCG-treated patients had tumor recurrence (P = 0.078, chi 2). Prolongation of the disease-free interval with BCG treatment was significantly at the P = 0.016 level by Wilcoxon analysis. Four control and two BCG-treated patients had multiple recurrences. Comparing total episodes of recurrence, nineteen of 79 (24%) control and eight of 85 (7%) BCG group cystoscopic examinations revealed tumor (P = 0.006, chi 2). Immunologic correlates of response to immunotherapy were not statistically significant since only five BCG-treated patients had tumor recurrence. However, four of these five patients evidenced impaired LIF response to PPD at the time of tumor recurrence, and impairment of skin test reactivity and BCG humoral antibody response were more commonly seen in this subgroup of patients.

Antibody Formation↗
PubMed1982

Intravenous cisplatin for superficial bladder tumors.

Cisplatin, 1.25 mg/kg IV QM, was administered to 15 patients with recurrent flat carcinoma in situ and/or bladder tumors confined to the mucosa and lamina propria. All patients had a history of multiple transurethral resection and 4 had received prior irradiation and two prior intravesical thiophosphoramide. Response was evaluated by urinary cytologic findings, cystoscopy and biopsy. Of 14 adequately treated cases, four (28%) had disappearance of all visible lesions, cystoscopically, for a median of eight months (range, 8-18), and six exhibited transiently a greater than 50% decrease in the number of tumors. However, no patient demonstrated a complete remission--all had persistently positive urinary cytologies. Nausea and vomiting, even at this dose level, was significant and at times, severe. Cisplatin, in the dose and schedule used, was found to be ineffective in controlling low-stage bladder tumors.

Adult↗
PubMed1983

Prognostic factors in local surgical treatment of invasive bladder cancer, with special reference to the presence of urothelial dysplasia.

Thirty-three patients with bladder cancer of categories pT1 or pT2 were treated by transurethral resection alone. At the initial diagnosis random preselected site mucosal biopsies were obtained to demonstrate the presence or absence of concomitant urothelial dysplasia. A statistically significant (P less than 0.01) relationship was found between the presence or absence of concomitant urothelial dysplasia and the development of new occurrence or the absence of recurrence at cystoscopic follow-up. Four of six patients with concomitant carcinoma in situ developed invasive bladder cancer within 6 months demonstrating the serious prognostic significance of this entity. Thus, the presence or absence of concomitant urothelial dysplasia at the initial diagnosis of invasive bladder cancer seems to be an important prognostic factor for future new occurrences.

Adult↗
PubMed1985

Endoscopic diagnosis and treatment of upper-tract urothelial tumors. A preliminary report.

The technique of transurethral ureteropyeloscopy allows many standard cystoscopic procedures to be extended into the upper urinary tract. This endoscopic method was used to evaluate 31 patients suspected to have urothelial malignancies of the ureter or renal pelvis. Twenty-eight of the patients had the procedure successfully completed (90%), 11 of whom were found to have urothelial tumors. Diagnostic ureteroscopic biopsy in three of these patients revealed high-grade, multifocal tumors and was followed by nephroureterectomy (two patients) or partial ureterectomy (one patient). However, in eight patients, ureteroscopy and biopsy revealed apparently localized, low-grade tumors which were treated by ureteroscopic fulguration or resection. The latter patients have undergone endoscopic surveillance every 3 months (average follow-up, 21 months). The technique of ureteropyeloscopy permits endoscopic access into the ureter and renal pelvis, enabling tissue diagnosis and better preoperative cancer staging without surgical exploration. Although follow-up is short, selected patients with low-grade tumors may be treated primarily by endoscopic means.

Aged↗