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At least 73 records · Page 4Linked to original sources
PubMed1999

Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy.

OBJECTIVE: To review the frequency of lower urinary tract injuries after major gynecologic surgery and the role of routine intraoperative cystoscopy during major gynecologic surgery in the detection of lower urinary tract injuries. DATA SOURCES: We combined a MEDLINE search for reports from 1966 to October 1998, using the terms "urinary tract injury," "ureter/ureteric/ureteral obstruction/fistula/injury," "bladder fistula/injury," and "vesico-vaginal fistula," with a second search for all reports of gynecologic surgical procedures. Additional references were obtained from relevant articles and review articles. METHODS OF STUDY SELECTION: Included were all English language articles on the frequency of unintentional urinary tract injuries identified during or after benign gynecologic surgery. There were 22 reports on the frequency of lower urinary tract injuries after gynecologic surgery and eight on the use of routine cystoscopy during gynecologic surgery to diagnose unsuspected injuries. TABULATION, INTEGRATION, AND RESULTS: In the reports of studies not involving routine cystoscopy, the frequency of ureteral injury varied from 0 to 14.6 injuries per 1000 operations, with an overall frequency of 1.6 per 1000. The frequency of bladder injury varied from 0.2 to 19.5 per 1000, with an overall frequency of 2.6 per 1000. Only 11.5% of ureteral injuries and 51.6% of bladder injuries were identified and managed intraoperatively. In the reports of studies involving routine cystoscopy, the frequency of ureteral injury varied from 0 to 26.8 per 1000, with an overall frequency of 6.2 per 1000. The frequency of bladder injury varied from 0 to 29.2 per 1000, with an overall frequency of 10.4 per 1000. Up to 90% of unsuspected ureteral injuries and 85% of unsuspected bladder injuries were identified with the use of cystoscopy and were managed successfully intraoperatively. In 69% of the unsuspected ureteral and bladder injuries, the intraoperative management consisted of removing and replacing sutures or repairing unintentional cystotomies. CONCLUSION: Use of routine intraoperative cystoscopy during major gynecologic and urogynecologic surgery might prevent sequelae from lower urinary tract injuries.

Cystoscopy↗
PubMed2003

Intraoperative and postoperative morbidity associated with cystoscopy performed in patients undergoing gynecologic surgery.

OBJECTIVE: The purpose of this study was to evaluate the role of cystoscopy during major gynecologic surgery and to describe an interesting and rare complication that was encountered. STUDY DESIGN: This was an observational descriptive study. A retrospective review was performed. Data collected included intraoperative lower urinary tract injuries, injuries that were related directly to cystoscopy, and postoperative morbidity. RESULTS: One hundred one cases were evaluated. Eight lower urinary tract injuries were noted, 4 of which were detected at cystoscopy and 3 of which (2.97%) were detected intraoperatively before cystoscopy. There was one complication that was linked directly to cystoscopy. There were nine postoperative urinary tract infections. Total cost per case excluding anesthesia time was $54.42. CONCLUSION: Liberal use of cystoscopy in gynecologic surgery is recommended. The procedure is safe, easily learned, and inexpensive to perform.

Adult↗
PubMed2001

Flexible cystoscopy: is the volume and content of the urethral gel critical?

PURPOSE: To determine whether volume (10 or 20mL) or the presence of 2% lidocaine (lignocaine) in the gel used for urethral lubrication alters the discomfort felt during flexible cystoscopy. PATIENTS AND METHODS: A randomized double-blind trial was performed in men attending for flexible cystoscopy. Patients were assigned to one of four groups: 10 mL of gel with or without lidocaine and 20 mL with or without lidocaine. Gel was retained for 10 minutes prior to cystoscopy. Pain felt during both the instillation of the gel and the cystoscopy itself was evaluated using a visual analog scale (0-10). RESULTS: Interim analysis after 147 patients had been recruited revealed a significant difference between the groups in terms of the pain felt on instillation of the gel, leading to an early termination of the trial. There was a significant reduction in pain on cystoscopy in patients receiving 20 mL of gel if this contained lidocaine. CONCLUSION: The least pain on cystoscopy occurred in patients receiving 20 mL of gel containing lidocaine.

Aged↗
PubMed2005

Randomized double-blind comparison of lidocaine gel and plain lubricating gel in relieving pain during flexible cystoscopy.

PURPOSE: To compare the pain induced by outpatient flexible cystoscopy in men having local lidocaine jelly application or plain lubricant. PATIENTS AND METHODS: We performed a randomized, double-blind study to compare the anesthetic effect of intraurethral 2% lidocaine gel (N = 45) and plain lubricant (N = 46) in men undergoing outpatient flexible cystoscopy. The age, prostate size, and examination time were similar in the two groups. Before cystoscopy, we filled the urethra with 20 mL of gel, which was held for 15 minutes. A 15.5F flexible cystoscope was then used for examination. A 10-point visual analog pain scale (1 = least to 10 = most painful) and a four-point pain grade (grade 1 = least to grade 4 = most painful) were used to measure the pain perception. The amount of postoperative analgesic used and willingness to adopt the same anesthesia for future cystoscopy were also recorded. RESULTS: The mean pain scores for the lidocaine and plain gel groups were 2.8 +/- 1.1 and 2.5 +/- 1.1, respectively (P = 0.06), while the pain grades for the lidocaine gel and plain gel groups were 1.6 +/- 0.6 and 1.8 +/- 0.7, respectively (P = 0.19). In both groups, many patients (42.2% in the lidocaine gel group and 37% in the plain lubricant group) felt the external sphincter and prostatic urethra were the most uncomfortable areas during cystoscopy. Postcystoscopic analgesics were requested by 12 of 45 patients in the lidocaine group, but only 6 of 46 of the plain-gel group (P = 0.103). When patients were asked if they would desire general anesthesia for better pain control in future examinations, five of the lidocaine group responded positively, while three of the plain-gel group said they would (P = 0.62). The cost of lidocaine gel is about thrice that of the plain gel. CONCLUSION: Using plain lubricant is cheaper and faster than applying lidocaine gel. The pain score, pain grade, postcystoscopic analgesic requirement, and anesthetics requested for the next cystoscopy were similar in the two groups. However, a larger investigation will be needed to achieve more significant statistical power.

Aged↗
PubMed1988

Urethral dilatation compared with cystoscopy alone in the treatment of women with recurrent frequency and dysuria.

The relative merits of cystoscopy alone and cystoscopy plus urethral dilatation were compared in a randomised study of women with recurrent frequency and dysuria. One hundred women were studied before and at least 6 months after operation. A detailed questionnaire was completed, the severity of the symptoms was scored and patients underwent urodynamic investigation. Forty-eight patients underwent cystoscopy alone and 52 underwent urethral dilatation. The two groups were well matched with regard to age, parity, menopausal status, previous gynaecological surgery and severity of symptoms. A significant improvement in symptoms was observed in both groups after treatment: 30% had no residual symptoms, 50% were improved and 20% were no better. However, no difference in final outcome was observed between those who had undergone cystoscopy alone and those who had undergone urethral dilatation. Furthermore, 7 patients who underwent urethral dilatation experienced transient stress incontinence of urine, a complication not observed in women who underwent cystoscopy alone. No benefit was observed from the addition of urethral dilatation to cystoscopy alone in women with recurrent frequency and dysuria.

Adult↗
PubMed1991

Flexible cystoscopy compared with ultrasound in the detection of recurrent bladder tumours.

A combination of transrectal and transabdominal ultrasound was compared with flexible cystoscopy as a means of detecting recurrent bladder tumours. The study group comprised 50 patients who had previously had rigid cystoscopy. They underwent combination ultrasound in the out-patient department 1 week before flexible cystoscopy. Combination ultrasound identified 25 patients with recurrent tumours and flexible cystoscopy identified 26. Thirty-four patients (68%) preferred ultrasound, 10 (20%) preferred flexible cystoscopy, 3 (6%) preferred general anaesthesia and rigid cystoscopy and 3 (6%) had no preference. The main objection to ultrasound was the use of the transrectal probe.

Aged↗
PubMed2005

Urine cytology after flexible cystoscopy.

OBJECTIVE: To correlate urine cytology findings before and after flexible cystoscopy. PATIENTS AND METHODS: A total of 153 patients undergoing surveillance for bladder tumour provided voided urine for cytology before and immediately after flexible cystoscopy. RESULTS: Of the 153 patients, 116 had negative urine cytology before and after (96%) a visibly normal cystoscopy and 37 had positive urine cytology before and after cystoscopy that showed recurrent tumour. CONCLUSIONS: Urine cytology immediately after flexible cystoscopy correlates well with results of urine cytology before cystoscopy.

Adult↗
PubMed1997

Virtual cystoscopy: early clinical experience.

Virtual cystoscopy was performed in 13 patients with hematuria and abnormal findings at conventional cystoscopy. Perspective volume-rendering algorithms were applied to helical computed tomographic data to generate interactive, intraluminal views of the bladder mucosa after insufflation of room air. At conventional cystoscopy, 29 masses appeared to arise from the bladder mucosa and two were hypertrophied median lobes of the prostate. At virtual cystoscopy, 30 masses arose from the bladder (one prostate mass was misinterpreted as an intrinsic bladder mass). Results at virtual cystoscopy were comparable to those at conventional cystoscopy but were obtained without the associated risks.

Aged↗
PubMedDate not supplied

Evaluation of nonlinear optimization for scheduling of follow-up cystoscopies to detect recurrent bladder cancer. The Bladder Cancer follow-up Group.

Standard recommendations for patients who have had superficial bladder cancer are inspection by cystoscopy quarterly for a year or two after tumor removal, then half-yearly and yearly. The authors assessed the potential for improvement in scheduling cystoscopies according to probabilistic optimization techniques. Eight hypothetical practices were created, based on retrospective analysis of 918 bladder-cancer-patient charts. Standard and alternative recommendations for the interval to next cystoscopy were compared. The alternatives were derived from patient-specific predictions of future tumor risks (based on the patient's prior recurrence rate and tumor stage and grade) and a nonlinear optimization approach to allocation of the same number of cystoscopies as were available for standard follow-up. The optimization proposed longer intervals between visits for low-risk patients and shorter intervals for high-risk patients. Overall, optimization reduced expected tumor detection delays by 30%, from 12.6 to 8.7 weeks. When optimization intervals were shorter than standard, cancer was found more often at subsequent cystoscopies (34% vs 27%, p less than 0.05), suggesting that the optimization was a better predictor of cancer recurrence. If reduction in tumor-detection delay is the goal of follow-up for recurrent cancers, then urologists can improve monitoring by using probabilistic optimization methods for scheduling cystoscopies. Further understanding of the accuracy of predictive models for bladder-cancer recurrence rates is desirable. Subsequently, the optimization method developed here may be tested prospectively.

Aftercare↗
PubMed2005

Comparison of virtual cystoscopy, multiplanar reformation, and source CT images with contrast material-filled bladder for detecting lesions.

OBJECTIVE: The objective of our study was to compare the diagnostic accuracy of virtual cystoscopy, multiplanar reformation, and source CT images for lesion detection in the contrast material-filled bladder. SUBJECTS AND METHODS: Two observers independently evaluated 47 patients (28 men and 19 women; mean age +/- SD, 59 +/- 16 years) with virtual cystoscopy, multiplanar reconstruction, and source CT images acquired with contrast material-filled bladder using an MDCT scanner (detector array, 4 x 1.25 mm; beam pitch, 0.75). Agreement between the two observers was evaluated for the three reconstruction methods using kappa statistics. Using the conventional cystoscopic findings as a reference, we compared the results of the three reconstruction techniques both by bladder site and by patient using the McNemar test. RESULTS: The interobserver agreement for the number of positive sites was excellent for virtual cystoscopy (kappa = 0.816), fair for multiplanar reconstruction (kappa = 0.461), and good for source CT images kappa = 0.676). For both observers, the sensitivity for lesion detection by bladder site was significantly greater with virtual cystoscopy (observer 1, 95%; observer 2, 90%) than with multiplanar reconstruction (78% and 60%) and source CT (68% and 65%) images (p < 0.05), whereas the specificity by bladder site and the sensitivity and specificity by patient did not differ with the three methods (p > 0.05). For determining the presence or absence of lesion at each site, virtual cystoscopy was more accurate than multiplanar reconstruction and source CT images for both observers (p < 0.05). CONCLUSION: Virtual cystoscopy is more accurate than multiplanar reconstruction and source CT images for the detection of lesions in the bladder.

Adult↗
PubMed2006

[Clinical significance of cystoscopy in transrectal prostate biopsy].

The clinical significance of cystoscopy in patients with benign prostatic hyperplasia or prostate cancer remains open to discussion. We have always performed cystoscopy with prostate biopsy and have discovered bladder cancer in some patients. The present study investigated the clinical significance of performing cystoscopy with prostate biopsy. Subjects were 458 patients who underwent cystoscopy and ultrasound-guided transrectal prostate biopsy from January 1998 to December 2004. Mean age of subjects was 71.3 years (range, 52-93 years). Prostate biopsy was performed modified Eskews systematic 5-region prostate biopsy (12 core). Some abnormalities were found in 43 of the 458 patients (9.3%). Among these 43 patients, bladder cancer was found in 11 patients (2.4%), and transurethral resection bladder tumor (TUR-Bt) was performed on all 11 patients. Pathological staging of bladder cancer was pT1 and G2 in all cases. Bladder stones were seen in 13 patients (2.8%), benign bladder tumor in 5 patients (1.1%), urethral polyp in 7 patients (1.5%), urethral stenosis in 6 patients (1.3%) and ureteral stones associated with ureterocele in 1 patient (0.2%). Appropriate examinations and treatments were performed for all cases. Cystoscopy may be needed at the time of prostate biopsy because: the above-mentioned abnormalities were first discovered on cystoscopy; and the frequency of bladder cancer was 2.4% for the total patient population, and endoscopic surgery was performed.

Aged↗
PubMed1990

Disinfecting effect of a disposable lubricant during cystoscopy.

To study the disinfecting effect of the lubricant Instillagel for the urethra in children, bacteriologic tests of the urethra were performed immediately before and after cystoscopy in 100 children. In addition urine cultures were taken during and after cystoscopy. The culture of the urethra before cystoscopy was positive in 75 children. For 46 of these children the second culture after cystoscopy plus Instillagel appeared to be sterile while in 20 children a considerable reduction in the number of bacteria was found. Out of 92 children with an initially sterile urine culture, the culture of the urine voided immediately after the cystoscopy appeared to be contaminated in 2 while several weeks later an infected urine was found in 5 children. From this study we may conclude that during cystoscopy Instillagel has a good disinfecting effect for the urethra in children.

Child↗
PubMed2001

Microsatellite analysis--DNA test in urine competes with cystoscopy in follow-up of superficial bladder carcinoma: a phase II trial.

BACKGROUND: It has been shown that microsatellite analysis (MA) is able to detect bladder carcinoma in urine. Relatively small groups of patients often with high stage and grade disease were investigated. However, greater than 85% of cystoscopies are performed for follow-up of superficial bladder carcinoma. The authors evaluated this DNA-based method in a group of consecutive patients in follow-up after transurethral resection of superficial disease. METHODS: Matched blood and urine samples from 109 patients were obtained before cystoscopy and subjected to MA. The BTA stat test (Bard Diagnostic Sciences, Inc., Redmond, WA) and cytology were used for comparison. RESULTS: Sixteen patients were excluded: the DNA was of insufficient quality for 7 patients and leukocyte abundance rendered the result of MA unreliable for 9 patients. For the remaining 93 patients, MA detected 18 of the 24 recurrent tumors. The six undetected tumors were small pTaG1 lesions for which immediate surgery was not necessary. Conversely, 5 of 9 patients with a positive MA and a negative cystoscopy had a tumor recurrence within 6 months after urine collection. In contrast, a recurrence occurred in only 7 of 60 patients who were negative in both MA and cystoscopy (P = 0.006). The MA (74%) appeared more sensitive than the BTA stat test (56%) or urine cytology (22%). CONCLUSIONS: Microsatellite analysis is a DNA test in urine that reliably signals the presence of recurrent bladder carcinoma, sometimes even before cystoscopic evidence of the disease. This noninvasive diagnostic tool has the potential to replace cystoscopy in many cases. The authors' results warrant the need for randomized trials.

Aged↗
PubMed2005

[Virtual multislice computed tomography cystoscopy for evaluation of urinary bladder lesions].

The introduction of multislice computed tomography (MDCT) with the possibility of acquiring isotropic datasets has been an ideal prerequisite for development of virtual MDCT cystoscopy. Remarkable technical progress regarding post-processing of high-resolution 3D datasets as well as a considerable reduction of the time required for post-processing made it possible to introduce virtual MDCT cystoscopy into the clinical routine. 3D post-processing that often required 7-8 h when virtual endoscopy techniques were first developed can now be performed in less than 5 min after transfer of data to the 3D workstation. With the limitations and contraindications of conventional cystoscopy in mind, virtual MDCT cystoscopy may be seen as a valuable alternative to conventional cystoscopy for evaluation of hematuria.

Cystoscopy↗
PubMed2003

Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery.

Our objective was to review our experience and attempt to identify risk factors for ureteral injury during gynecologic surgery for benign conditions. A retrospective chart review was performed of all cases of ureteral injury during gynecologic surgery for benign conditions, at Temple University Hospital, from January 1992 to September 2002. We analyzed hospital records to determine whether the injury was diagnosed intraoperatively, with postprocedure cystoscopy, or if cystoscopy was ineffective in diagnosing the injury. There were nine ureteral injuries during the study period. Of these, two were diagnosed during the procedure, two were discovered by immediate postprocedure cystoscopy, and the other five were discovered during the postoperative period. Of these five, three patients had immediate postprocedure cystoscopy and the injuries were not detected. Risk factors associated with ureteral injury included: a large uterus (5), high-grade cystocele (3), ectopic insertion of the ureter into the bladder (1), and previous surgeries (4). Our conclusion was that negative cystoscopy cannot be solely relied on to rule out ureteral injury, as cases with partial obstruction and ureteral patency can be missed.

Adult↗
PubMed2006

The incidence of ureteral obstruction and the value of intraoperative cystoscopy during vaginal surgery for pelvic organ prolapse.

OBJECTIVE: The objective of the study was to determine the incidence of ureteral obstruction during vaginal surgery for pelvic organ prolapse and the accuracy and efficacy of intraoperative cystoscopy. STUDY DESIGN: The study was a retrospective review of 700 consecutive patients who underwent vaginal surgery for anterior and/or apical pelvic organ prolapse with universal intraoperative cystoscopy. RESULTS: Thirty-seven patients (5.3%) had no spillage of dye from 1 or both ureters intraoperatively. The false-positive and negative cystoscopy rates were 0.4% and 0.3%, respectively. Thus, the true incidence of intraoperative ureteral obstruction was 5.1%. Intraoperative cystoscopy was accurate in 99.3% of cases, with a sensitivity and specificity of 94.4% and 99.5%, respectively. Suture removal relieved ureteral obstruction in 88% of cases. Six subjects (0.9%) had true ureteral injuries. CONCLUSION: Vaginal surgery for anterior and/or apical pelvic organ prolapse is associated with an intraoperative ureteral obstruction rate of 5.1%. Intraoperative cystoscopy accurately detects ureteral obstruction and allows for relief of obstruction in the majority of cases.

Aged↗
PubMed1996

Cystoscopy and biopsy of the feline lower urinary tract.

Cystoscopy is rapidly developing as a diagnostic and therapeutic technique for application in feline practice. Instruments are currently available that provide transurethral access to the lower urinary tract in most cats with prepubic percutaneous cystoscopy allowing evaluation when transurethral cystoscopy is not applicable. Cystoscopy is indicated for assessment of chronic cystitis, hematuria, tenesmus, increased frequency of urination, urinary incontinence, alteration of urinary stream, trauma, and cystic and urethral calculi. The vagina, urethral opening, urethra, bladder, and ureteral openings can be effectively assessed and samples can be collected for histopathology, cultures, and stone analysis. Cystoscopy provides easy access to diagnostic information that can be difficult to obtain with any other technique.

Animals↗
PubMed2001

Does cystoscopy correlate with the histology of recurrent papillary tumours of the bladder?

OBJECTIVE: To correlate the cystoscopic appearance of recurrent papillary bladder tumours with the histology after transurethral resection, and thus ascertain whether cystoscopy can reliably identify low-grade, noninvasive papillary tumours suitable for outpatient fulguration. PATIENTS AND METHODS: In all, 150 recurrent papillary tumours of the bladder identified at outpatient flexible cystoscopy were classified as either low-grade and noninvasive (TaG1), high-grade and noninvasive (TaG3), or invasive (TIG3) tumours, and correlated with urine cytology and histology of tumour stage and tumour grade after transurethral resection. RESULTS: Cystoscopy classified 84 of the 150 papillary tumours as TaG1 and 66 as either TaG3 or T1G3. Cystoscopy correctly predicted the histology of 78 of 84 (93%) TaG1 tumours, 71 of 72 (98%) TaG1 tumours associated with a negative urine cytology, and 92% of TaG3 or T1G3 tumours. CONCLUSIONS: A skilled urologist can identify noninvasive, low-grade recurrent papillary bladder tumours on follow-up cystoscopy that do not require biopsy and that may be treated by outpatient fulguration alone.

Adenocarcinoma, Papillary↗