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At least 649 records · Page 36Linked to original sources
PubMed2006

[Novel NMP22 quick qualitative analysis (BladderChek NMP22) for the diagnosis of urothelial tumor].

PURPOSE: The BladderChek NMP22 test was studied to determine whether it could be a useful diagnostic tool for urothelial tumor. MATERIALS AND METHODS: During the period from April to May 2004, a total of 50 patients who visited Nagano Municipal Hospital were subjected to analysis with the BladderChek NMP22 test. They consisted of 25 patients with microscopic or gross hematuria and 25 patients with urothelial tumor who were being followed after surgery. The clinical diagnosis was made by cystoscopy, abdominal CT scanning, ultrasonography or intravenous urography. BladderChek NMP22 was used in all of the patients and the test was judged to be positive when a line appeared on the glass at 30 minutes after a drop of urine was added to the sample well. Cytological examination of the urine was also done. It was defined as negative if the result was I, II or III, while it was positive if the result was IV or V. RESULTS: Seven patients who were not eligible were excluded and the remaining 43 patients were studied. Eleven of the 43 patients were diagnosed as having urothelial tumor. The sensitivity, specificity, and accuracy of BladderChek NMP22 for making a correct diagnosis was 63.6%, 62.5%, and 62.7%, respectively (p = 0.1703). As for urine cytology, the sensitivity, specificity, and accuracy was 36.3%, 100%, and 83.7%, respectively (p = 0.0027). BladderChek NMP22 was positive in all the patients whose urine cytology was positive and in three patients with low-grade, low-stage, and small tumors, although urine cytology was negative. On the other hand, false-positive BladderChek NMP22 results were obtained in patients undergoing follow-up after removal of urothelial carcinoma and in patients with urinary stones. The sensitivity of BladderChek NMP22 was superior to that of urine cytology, but its specificity was inferior. CONCLUSION: The combined use of BladderChek NMP22 and cystoscopy may be useful for the diagnosis and follow-up of urothelial tumor. On the other hand, the results obtained with BladderChek NMP22 need to be interpreted carefully because the test can yield a false-positive outcome in the presence of marked hematuria, pyuria or cytolysis of normal urotherium. When the result of BladderChek NMP22 in the monitoring of recurrent urotherial tumor following surgery was positive in spite of negative findings of cystoscopy, it is necessary to consider the presence of a tumor in the upper urinary tract or a high tendency toward tumor recurrence. In such a case, careful followup may be necessary.

Adult↗
PubMed2000

Evaluation of two new urinary tumor markers: bladder tumor fibronectin and cytokeratin 18 for the diagnosis of bladder cancer.

Our objectives were to evaluate the diagnostic value of two new urinary tumor markers, cytokeratin 18 (CK18) and bladder tumor fibronectin (BTF), for the detection and monitoring of bladder cancer. The study comprised 931 urine samples belonging to 402 subjects: 112 individuals under suspicion for a primary bladder tumor (group 1); 104 bladder cancer patients under scheduled follow-up (group 2); 109 bladder cancer patients receiving intravesical instillations (group 3); 45 patients with other urological diseases (group 4); and 32 healthy subjects (group 5). Voided urine samples were collected before cystoscopies, between them and before intravesical instillations. CK18 and BTF tests were measured by chemiluminescent immunoassays. Optimal receiver operating characteristic cutoffs of 7.4 microg/L for CK18 and 52.8 microg/liter for BTF rendered overall sensitivities of 66.2% for CK18 and 80.0% for BTF at specificities of 88.4 and 74.7%, respectively. Urinary cytology provided a sensitivity of 29.2% at a specificity of 99.1%. Sensitivities were 80.8, 74.2, and 82.3% for BTF and 71.1, 77.4, and 64.7% for CK18 for groups 1 to 3, respectively. False positive rates were higher for BTF in all groups of patients. Elevated urinary tumor markers during the monitoring of patients with bladder cancer could detect recurrence sooner than scheduled cystoscopies. Persistence of negative markers was greatly indicative of free of disease status in follow-up. CK18 and BTF in urine may eventually prove to be of benefit for specific patients with bladder carcinoma given its higher sensitivity compared with cytology. In selected patients, namely those with persistent negative urinary CK18 and BTF, the number of cystoscopies could be reduced.

Adult↗
PubMedDate not supplied

[ALA fluorescent diagnosis of bladder cancer].

Application of 5-aminolauvulin acid (ALA) fluorescence allows to detect not only exophytic tumors of the bladder but also flat, small tumors-satellites and preneoplastic changes of the bladder. 175 biopsies were performed in 53 patients with suspected superficial tumor of the bladder. 3 hours before surgery all the patients were intravesically instilled 50 ml 3% ALA solution. Cystoscopy employed white and blue light. Visual registration of exophytic masses and red fluorescence of the suspected sites was registered and consequently compared to the histological findings. 96 of 100 sites with malignancy/dysplasia showed red fluorescence. In 13% patients cancer and mucosal dysplasia were detected only under the blue light and were missed by standard cystoscopy. Residual red fluorescence of the resection margins was observed in 41% patients after TUR. Sensitivity of ALA-fluorescent detection reached 96%, specificity 52%. ALA-induced fluorescent diagnosis is more effective than standard cystoscopy. It is most effective in diagnosis of dysplasias, carcinoma in situ, flat, small, multiple superficial tumors of the bladder during primary TUR.

Adult↗
PubMed2000

National guidelines for nurse cytoscopy.

There is a growing demand for flexible cystoscopy, and nurse involvement can help meet this. Support for nurse cystoscopy from the UKCC depends on nurses' professional accountability and competence. It is important that national guidelines are adhered to if nurses are to undertake flexible cystoscopy safely.

Cystoscopy↗
PubMed2003

[Value of the uCyt+ test for the detection and followup of bladder tumors].

INTRODUCTION: Superficial bladder tumours are common tumours that frequently relapse, generally with deterioration of the grade. Cystoscopic surveillance is unpleasant for the patient and is associated with considerable morbidity, while urine cytology, although very easy to poor, has a low sensitivity. According to the literature, the uCyt+ test is very effective for the detection of urothelial tumours. This immunofluorescent technique detects desquamated tumour cells previously labelled by specific antibodies. MATERIAL AND METHOD: This prospective study was conducted in 92 patients undergoing screening or follow-up cystoscopy. Voided urine was collected prior to cystoscopy to perform standard cytology and a uCyt+ test. These examinations were interpreted independently under blinded conditions. RESULTS: The sensitivity and specificity of uCyt+ were 68.7% and 81.7%, versus 40.6% and 96.7% for cytology. The sensitivity of uCyt+ was higher for low-grade tumours (87.5%), in contrast with cytology (37.5%). The results of uCyt+ were comparable to those of cytology for high-grade tumours (80%). CONCLUSION: The uCyt+ test presented better performances than standard cytology. It would allow less frequent surveillance cystoscopy examinations, especially in patients with low-grade lesions.

Cystoscopy↗
PubMed2003

Multimodal spinal anesthesia.

BACKGROUND AND OBJECTIVES: Cystoscopy and extracorporeal shock wave lithotripsy (ESWL) are common urologic procedures in the treatment of ureteral calculi. Spinal anesthesia with local anesthetics is the anesthetic technique of choice for these procedures. Sufentanil and/or clonidine have been combined with local anesthetics to provide effective and safe neuroaxial anesthesia. Our objectives were to review the efficacy and safety of combining both sufentanil and clonidine with reduced doses of intrathecal lidocaine in patients undergoing cystoscopy and ESWL. METHODS: We reviewed the medical records of 12 patients who underwent such urologic procedures using an intrathecal mixture consisting of 20 mg of lidocaine, 10 micrograms of sufentanil, and 50 micrograms clonidine from May 1st, 1998 to December 31st, 1998. Patients' demographics, intraoperative analgesia and adverse side effects as well as recovery times were reviewed. RESULTS: All 12 patients tolerated their urologic treatments using this combination of drugs without requiring conversion to another anesthetic technique or significant supplementation with intravenous analgesics. Motor power returned to normal by the end of the procedure. The systolic blood pressure dropped 26 +/- 8% intra-operatively and 25 +/- 9% postoperatively. The incidences of other adverse side effects were low. Time spent in recovery area was short, 45 +/- 15 minutes (mean +/- standard deviation). CONCLUSIONS: Intrathecal admixtures of sufentanil 10 micrograms, clonidine 50 micrograms, and lidocaine 20 mg can provided effective and prolonged analgesia in patients undergoing cystoscopy and ESWL. Patients had recovery of their motor power in their lower extremities by the end of the procedure. No urinary retention was noted. Mild hypotension was the most common adverse side effect and was the main confounding factor for the prolongation of the discharge time.

Adult↗
PubMedDate not supplied

Urine cytology in the follow-up of patients with transitional cell carcinoma of the urinary bladder: is that enough as a single method?

There were studied 130 patients with Ta, T1 and T2 transitional cell carcinomas of the urinary bladder, all treated by transurethral resection. After transurethral resection the follow-up was performed in 48 cases by cystoscopy and urine cytology and in 82 cases by cytology alone. In the first group there were 27 recurrences; cystoscopy failed to identify recurrences in 3 cases and cytology in one of them; all 3 patients with apparently false positive cytology recurred at 4, 9 and 11 months from the cytodiagnosis. From 82 patients of the second group 42 developed recurrences. Urine cytology was positive in 80.9%, suspect in 14.2% and false negative in 4.7% of cases. There were only 2 unsuspected recurrences with a consecutive delay in the correct diagnosis of recurrence in another one. Our results suggest that urine cytology can replace cystoscopy only when it exists a good correlation between its results with pathological findings (over 80% real positive results).

Carcinoma, Transitional Cell↗
PubMed2005

Trans-vaginal sonographic evaluation of vesicovaginal fistula.

OBJECTIVE: To determine the sensitivity of transvaginal ultrasound (TVUS) in the detection of vesicovaginal fistula (VVF). METHODS: The study included 15 patients with urinary incontinence suspected or diagnosed to be due to vesicovaginal fistula that were originally referred to the department for intravenous urography (IVU). Complimentary TVS was done with consent. Cases with stress incontinence and co-existent rectovaginal fistulae were excluded. Findings were compared against the cystogram, cystoscopy and surgical findings for determining the sensitivity, the last being taken as the gold standard. RESULTS: The fistula was visualized as a jet of echoes in real time from bladder to the vagina in all 15 cases. The location number and size corresponded with the surgical findings. The sensitivity of trans-vaginal scanning in diagnosing WF was 100%, that of cystoscopy- 93% and of cystography- 60%. CONCLUSION: In this series, the trans-vaginal scan findings correlated well with the surgical findings. It was less invasive and more tolerable than cystoscopy.

Adolescent↗
PubMed2005

[Fluorescence endoscopy in the diagnosis and treatment of superficial bladder neoplasms].

AIM: The results of a clinical investigation on neoplasm and bladder dysplasia detection by 5-aminolaevulinic acid (5-ALA)-induced fluorescence are reported. In this paper the authors report their experience with 5-ALA in the diagnosis, treatment and follow-up of bladder neoplasms after chemotherapy and endocavitary immunotherapy. METHODS: The 5-ALA was instilled in the bladder 2 h before bladder transurethral resection. This method has been used since December 2000 on 163 patients and a total of 266 biopsies were histologically examined. RESULTS: One-hundred and four benign and 92 malignant/dysplastic areas were biopsied; 46 malignant/dysplastic lesions were not detected during routine white-light cystoscopy but were identified with fluorescence cystoscopy. Sensitivity was 99% but specificity was low (20%). CONCLUSIONS: ALA-based fluorescence cystoscopy is a safe and simple technique that enhances the detection of flat and papillary urothelial neoplasms.

Adult↗
PubMed1991

Value of urologic investigation in a targeted group of women with recurrent urinary tract infections.

According to the conclusions of clinical studies, excretory urography and cystoscopy are of no value in managing the majority of women who have a history of recurrent urinary tract infection (UTI). Of 475 women with recurrent UTIs, 186 were prospectively targeted for evaluation by cystoscopy and ultrasonography or excretory urography from selection criteria based on the degree of complicating factors, to determine the value of urologic investigation. Thirty-nine patients had significant detectable abnormalities, and 20 of them required surgical intervention. Definite indications for urologic evaluation include hematuria (gross hematuria and persistent microscopic hematuria between infections), pyelonephritis and a presentation that is not typical for simple uncomplicated UTIs (obstructive symptoms, infection with urea-splitting bacteria, clinical impression of persistent infection or urinary calculi). Diabetes itself does not warrant urologic evaluation. The findings from this study suggest that cystoscopy and upper urinary tract evaluation do play a role in the management of a selected group of women with UTIs.

Adult↗
PubMed1991

[Suprapubic bladder ultrasonography and urinary cytology: indications and limits in the follow-up of superficial bladder tumors].

139 patients underwent urinary cytology and bladder sonography in follow-up of superficial bladder cancer (Ta G1-3) alternatively or at the same time of cystoscopy. Medium follow-up was 27.2 mos. In 7.91% there was progression to T1 o T2 but no case escaped this protocol. In 9% urinary cytology and bladder sonography were both falsely negative: tumors were smaller than 0.5 cm and low grade. In 76 patients with Tar bladder cystoscopy rate was 1/5.2 mos. before this study and 1/7.2 mos. after this study. In our opinion this protocol reveals the recurrence of superficial bladder tumor, reduce cystoscopy rate with no risk of ignored progression.

Carcinoma in Situ↗
PubMed1990

[Diagnosis and follow-up of superficial bladder tumors using non-invasive techniques].

The discomfort caused by cystoscopy to the patient with superficial bladder tumor has led to the routine use of other less invasive but similarly reliable procedures. We performed a two-year comparative study of cystoscopy versus abdominal ultrasonography/cytology in 90 patients. Two hundred procedures were performed for each method of evaluation. Together, the sensitivity and specificity of both procedures were 61% and 98%, respectively. The positive and negative predictive values were 94% and 87%, respectively. These good results have permitted us to change the follow-up protocol of these patients such that currently ultrasonography and cytology are performed once every 6 months, and cystoscopy is used only for those cases with clinical features suggestive of recurrence and a negative work up of those with a negative scan and positive cytology.

Cystoscopy↗
PubMed1990

A study to assess the efficacy of chemoprophylaxis in the prevention of endoscopy-related bacteraemia in patients aged 60 and over.

Five hundred and fifteen patients aged 60 and over (mean age 74.7; 278 men and 237 women) underwent routine endoscopic procedures (gastroscopy, bronchoscopy and cystoscopy). Alternate patients were given antibiotics before the procedure, as currently recommended, and blood was taken for culture from all patients within five minutes of completion of the procedure. Of 74 patients who underwent bronchoscopy, only one culture, from one of 37 controls was positive. Of 262 who underwent gastroscopy, cultures were negative in the 130 who received antibiotics but positive in 13 of the 132 controls (9.8 per cent p less than 0.001). Cystoscopy was performed in 179; one culture was positive in the 88 given antibiotics (1.1 per cent) compared to 25 in the 91 controls (27.5 per cent; p less than 0.001). Bacteraemia rates appear to be low following bronchoscopy (less than 5 per cent) but higher with gastroscopy (10 per cent) and cystoscopy (28 per cent). Chemoprophylaxis was effective in reducing these rates in this patient group.

Aged↗
PubMed1989

Anterior spread of gynaecological neoplasias: reliability between some diagnostic procedures.

The Authors report their experience regarding the comparison between pre-surgical clinico-instrumental staging and intra-operative staging in 134 patients with gynaecological neoplasias, particularly considering the spread to the lower urinary tract. The analysis of the results shows the moderate reliability of the cystoscopy in routinely evaluating extension of gynaecologic malignant diseases. The association of cytological urinary sediment examination with cystoscopy improves the possibility of a better evaluation. On the contrary, vesical biopsy, performed on the indications of cystoscopy and urinary cytology, and standard excretory urography prove to be insensitive indicators in diagnosing the spread of gynaecological malignancies.

Cystoscopy↗
PubMed1987

[Diagnostic value of flow cytometry of bladder lavage in the surveillance of bladder tumors].

DNA index and proliferation index (% greater than 2 n) of 125 bladder washings were studied with flow cytometry. Cystoscopy was positive in 49 patients and negative in 56 patients with a previous history of bladder cancer. There were 20 control patients with a normal bladder. Flow cytometric data was compared with cystoscopic and cytologic data. In the group of 49 patients with a positive cystoscopy, conventional cytology was suspicious or positive in 70% (34/49) whereas flow cytometry was positive in only 43% of the cases (21/49). The diagnostic sensitivity of flow cytometry increased with grade elevation: 7% of grade 1 tumors, 43% of grade 2 and 77% of grade 3 had a positive flow cytometric examination. In the group of 56 patients with a negative cystoscopy, flow cytometry was positive in 36% of the cases and cytology in 6% of the cases. The diagnostic sensitivity of flow cytometry was rather disappointing in the study on bladder washings. Flow cytometric follow-up of bladder washings should be reserved preferentially to patients with a poor prognosis, i.e., superficial bladder cancer with an aneuploid DNA content.

Cystoscopy↗
PubMed1987

Routine pretreatment evaluation of patients with gynecologic cancer.

We evaluated the usefulness of the routine pretreatment performance of a chest x-ray, intravenous pyelogram (IVP), cystoscopy, barium enema, and sigmoidoscopy in patients presenting with endometrial and cervical carcinoma by reviewing the results of these tests in 231 patients. In no patient with cervical or endometrial carcinoma was tumor involvement of the large bowel mucosa found by the use of sigmoidoscopy and barium enema. Two percent of the cervical patients and none of the endometrial patients had bladder mucosal involvement discovered by using cystoscopy. Ureteral obstruction was seen by the IVP in 9% of the cervical patients and 1% of the endometrial patients. All of the women with cervical carcinoma who had bladder mucosal invasion or ureteral obstruction were already stage III before these tests. The chest x-rays showed a 0.7 and 3% incidence of tumor involvement in cervical and endometrial patients, respectively. The final stage differed from the initial stage in seven of the cervical patients and in two of the endometrial patients, but only in three of these nine were the changes based on the findings of the routine pretreatment evaluation. We conclude that routine cystoscopy, barium enema, and sigmoidoscopy in all patients with early stage cervical or endometrial carcinoma is not necessary, that a routine chest x-ray is still indicated in all patients with these malignancies, and that IVP should be performed routinely in all patients with cervical carcinoma but only if clinically indicated in patients with endometrial carcinoma.

Barium Sulfate↗
PubMed1985

Mitomycin for patients who have failed on thiotepa. The National Bladder Cancer Group.

The National Bladder Cancer Group undertook a study to determine the effectiveness and toxicity of mitomycin in patients who failed on thiotepa. A total of 117 patients with residual superficial transitional cell bladder cancer (Ta, T1, Tis) who had previously failed on intravesical thiotepa were treated with 40 mg of mitomycin instilled intravesically weekly for eight weeks. Four to six weeks after the last treatment, tumor response was evaluated by cystoscopy, biopsy of the site of the index lesion, and cytology. In 57 patients (48.7%), visible tumor had been ablated. Results of cystoscopy, biopsy, and cytology were negative in 32 (27.4%) patients. Eleven patients (9.4%) had no visible tumor and negative cytology unconfirmed by biopsy. In 14 patients (12%) who had complete destruction of the tumor at cystoscopy, and biopsy specimen was negative for tumor, cytology was positive, indicating a partial response. Six patients (5.1%) withdrew from the study before the first evaluation because of local toxicity (cystitis).

Administration, Topical↗
PubMed1996

Detection of early bladder cancer by 5-aminolevulinic acid induced porphyrin fluorescence.

PURPOSE: We determined whether the sensitivity of detecting dysplasia or early bladder cancer can be improved by 5-aminolevulinic acid induced porphyrin fluorescence. MATERIALS AND METHODS: A 3% 5-aminolevulinic acid solution was instilled intravesically before cystoscopy in 104 patients. The 5-aminolevulinic acid induced porphyrin fluorescence was excited by violet light from a krypton ion laser (wavelength 406.7 nm.). RESULTS: The sensitivity of the fluorescence cystoscopy (96.9%) was significantly (p < 0.0001) greater than that of white light cystoscopy (72.7%). There was no impact on specificity. CONCLUSIONS: Due to the high sensitivity of the procedure fluorescence guided biopsies are recommended instead of random biopsies.

Administration, Intravesical↗