SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A retrograde pyelogram was performed on 2 men with the flexible choledochonephroscope and a 5F whistle-tip ureteral catheter. The procedure was done on an outpatient basis with topical anesthesia and patient tolerance was good. The technique is simple and is a useful alternative to the classical rigid cystoscopic technique.
A 50-watt carbon dioxide continuous laser coupled to a Zeiss surgical microscope was used to study the characteristics of laser-induced lesions on the exteriorized canine bladder. The relationship of energy to the depth of the lesion created by the laser was evaluated. Healing, vertical temperature transmission and hemostasis were studied. A prototype carbon dioxide laser cystoscope then was constructed and used endoscopically to create surgical lesions in the intact canine bladder.
Cardiopulmonary bypass, temporary cardiac arrest, and exsanguination have facilitated the surgical resection of renal tumors with intracaval thrombi that extend above the hepatic veins or into the atrium. The bloodless field provided by this approach enables the surgeon to utilize a flexible cystoscope to ensure that the caval thrombus has been removed entirely from the hepatic veins.
The purpose of this investigation was to determine the safety and efficacy of subtrigonal, periureteral injections of autogenous fat grafts for the treatment of vesicoureteral reflux. Seven patients (12 renal units) with vesicoureteral reflux were treated with subtrigonal autogenous fat injection. Fat harvesting was obtained from abdominal and thigh subcutaneous tissue. Approximately 2 ml of fat was injected beneath each ureteral orifice with a modified 10 Fr needle through a 23.5 Fr rigid cystoscope. Two of the seven patients experienced durable (six months) resolution of reflux. In three patients, reflux resolved but recurred within three months and another developed recurrent reflux within six months. In one patient with a periureteral diverticulum, proper positioning of the needle tip for effective fat injection was not possible, resulting in persistent reflux. Two of the five patients with persistent reflux demonstrated a diminished grade of reflux on follow-up cystography. Neither complications nor ureteral obstruction have been encountered. The subtrigonal injection technique can be used with autogenous adipose tissue to treat vesicoureteral reflux. Anatomic variation may determine those patients less likely to enjoy durable results. Clinical success and reabsorption of the fat cannot be predicted or controlled at the present time. The ideal periureteral bulking agent for the treatment of vesicoureteral reflux remains to be determined.
An assessment of the prototype Olympus Flexible Cystoscope in routine urological practice is presented. The results show that the instrument compares favourably in all respects with standard rigid equipment and has the advantage that cystoscopy can be performed supine and under local anaesthesia with ease. Biopsies may be taken; small lesions fulgurised and ureteric catheterisation can be performed without general anaesthesia.
The use of cystoscopy is advocated as an aid to the early differential diagnosis of disease of the canine bladder. Techniques are described for carrying out urethroscopy and cystoscopy in both male and female dogs using modern medical diagnostic instruments. Males were examined with flexible paediatric bronchofibrescopes, which permitted urethroscopy and cystoscopy, but to obtain extensive biopsies or undertake cauterisation of the bladder surface with rigid endoscopes, a simple perineal urethrostomy was necessary. The bladder of females, on the other hand, was examined by cystoscopy and biopsied using standard rigid cystoscopes and resectoscopes.
An intraoperative technique for deep brain biopsy is described. It features the use of an integrated surgical support system for the instruments and a rod that provides external topographical maintenance of the coordinates established ultrasonographically. A cystoscope, when supported mechanically by this system, permits multiple entries of the biopsy forceps to the lesion without further disturbance of the brain, as well as irrigation, coagulation, and visualization, if desired. When used in conjunction with real time intraoperative ultrasonography, the surgeon may view the entire procedure and be certain that the biopsy sample has been obtained from the lesion, major deep blood vessels have been avoided, and the biopsy site is stable after the procedure. The advantages of this technique include simplicity, low cost, accuracy, stability, and availability to every neurosurgeon in every hospital.
The availability of extended-length, small-caliber endoscopes allows the use of many cystoscopic techniques in the ureter and renal pelvis. Although the instruments are rigid, they can be passed transurethrally in both male and female patients to allow the urologist to diagnose and treat many lesions of the upper urinary tract. The success of our series demonstrates the utility and safety of the technique, which often eliminates the need for surgical exposure of the lesions.
Forty-nine patients underwent preoperative cystoscopy prior to surgical resection for adenocarcinoma of the rectum. There were 30 men and 19 women ranging in age from 26 to 78 years, with a median age of 59 years. Surgical resections consisted of abdominoperineal resection, posterior exenteration, or total pelvic exenteration. Twenty patients had positive findings on preoperative cystoscopy while 29 had negative findings. Of the 20 patients with positive cystoscopic findings, eight (40%) had either urologic symptoms or abnormal microscopic findings on urinalysis; however, only one of these eight patients had tumor invasion of the bladder wall at cystoscopy, while the remaining seven had associated benign conditions. In the 29 cystoscopy procedures in which findings were negative, only three patients (10%) had urologic symptoms or abnormal results of urinalysis, none of which were secondary to the rectal carcinoma. We conclude that urinary symptoms can be misleading and unreliable when predicting neoplastic involvement of the bladder by carcinoma of the rectum because of the high incidence of associated benign disorders of the bladder. Therefore, cystoscopy does not have a useful role in staging patients undergoing surgery for rectal carcinoma in terms of local tumor extension.
Two cases of rupture of the urinary bladder following cystoscopic clot evacuation are presented. Both patients had hemorrhagic cystitis (HC) secondary to cyclophosphamide therapy. The bladder injuries were not immediately recognized. Computed tomography (CT) demonstrated the bladder rupture in both patients.
As the general experience with extracorporeal shock wave lithotripsy (ESWL) for renal calculi broadens, it is increasingly evident that the clearance of stone fragments in lower pole calices needs to be improved. The stone-free rate after treatment for lower caliceal stones is consistently less than that for other upper tract locations. Use of a cystoscopically placed cobra catheter for directed irrigation during ESWL resulted in an increase of our lower caliceal stone-free rate at 1 and 3 months of followup to 71% (15 of 21) compared to 33% (8 of 24) of randomly selected controls at 1 month and 54% (13 of 24) at 3 months. We conclude that pre-ESWL placement of a cobra catheter into the lower pole calix and intermittent irrigation during the procedure are potentially useful adjuncts in the successful treatment of lower caliceal calculi.
BACKGROUND: Most fistulas communicating with the bladder are large enough to be diagnosed easily, or small enough to close spontaneously without clinical sequel. A vesicocervical fistula is an uncommon event and may be difficult to diagnose. TECHNIQUE: During an operative cystourethroscopy procedure, suspicious areas of the bladder can be probed with a cone tip catheter and injected with contrast dye to visualize the suspected fistula communicating with the bladder. EXPERIENCE: This technique was employed when a double dye test, an intravenous urogram, a cystogram, a computed tomography scan, and a hysterogram failed to localize the fistulous tract in a patient who was 3 weeks postpartum after a repeat cesarean with complaint of persistent urinary incontinence. CONCLUSION: Cystoscopic catheterization of suspicious lesions in the bladder may visualize an otherwise elusive fistulous tract.
BACKGROUND: Urinary amylase (UA) remains the most common biochemical parameter to detect rejection in bladder-drained pancreas allografts. With the development of the cystoscopic transduodenal pancreas transplant biopsy technique, tissue samples of the pancreas graft are now frequently obtained. A definitive correlative analysis between UA activity and biopsy results has not been done in the three different pancreas transplant categories (simultaneous pancreas-kidney, pancreas transplant alone, and pancreas after kidney). METHODS: We studied 66 pancreaticoduodenal biopsy specimens obtained for hypoamylasuria. Rejection was defined as a greater than 25% decrease from stable posttransplantation baseline on two consecutive measurements at least 12 hours apart. To perform biopsies we used our newly developed 14- and 16-gauge core-cut needles (50 cm long). Biopsy specimens were considered positive if either pancreatic or duodenal rejection was found. To assess the quality of UA activity we studied 13 biopsy specimens from patients with stable UA levels; these 13 specimens were negative for rejection. RESULTS: Acute rejection was diagnosed in 36 biopsy specimens (55%). The mean decrease in UA levels was 67% +/- 8% (range, 28% to 99%) for the positive biopsy results, and 57% +/- 16% (range, 22% to 92%) for the negative biopsy results (p = 0.147). Within 1 month, UA levels returned to baseline in 19% of our patients with positive biopsy results versus 97% with negative results; postbiopsy 1-year graft survival was 64% versus 97% (p < or = 0.05). In assessing the test quality of our biopsy specimens (including 13 obtained for reasons other than hypoamylasuria), we found a sensitivity of 100% (stable UA levels mean no rejection) and a specificity of 30%. The predictive value of a positive test was 53%; of a negative test it was 100%. By performing biopsies we avoided antirejection treatment in 47% of the patients studied. We found no biopsy-related complications. CONCLUSIONS: Stable UA levels reliably rule out rejection; a decrease is a marker for acute rejection but is unspecific. Performing biopsy is currently the only way to reliably diagnose rejection in solitary pancreas recipients (pancreas transplant alone and pancreas after kidney) and in simultaneous pancreas-kidney recipients with isolated hypoamylasuria. The procedure is safe and should always be attempted to avoid unnecessary rejection treatment.
We developed the technique of retrograde perfusion sphincterometry to troubleshoot the AMS 800 device. We implanted artificial urinary sphincters in men who were incontinent after prostatectomy and performed intraoperative retrograde perfusion sphincterometry. Retrograde perfusion sphincterometry using a flexible cystoscope is simple and allows early recognition of intraoperative urethral injury and mechanical malfunction.
OBJECTIVES: To determine whether urethral injection of anesthetic and lubricating agent before outpatient flexible cystoscopic examination is worthwhile regarding patient tolerance of pain. METHODS: A randomized prospective study was conducted. A total of 133 consecutive men scheduled to undergo flexible cystoscopy were randomized to receive 11 mL of 0.2% oxybuprocaine hydrochloride gel (group 1), 11 mL of plain lubricating gel (group 2), or no gel injection (group 3). In every group, 2% lidocaine gel was applied to the fiberscope. Patients recorded the level of pain during gel instillation, scope insertion, and intravesical observation separately on a 100-mm visual analog self-assessment scale. RESULTS: Pain scores for gel instillation were approximately two thirds those for scope insertion and intravesical observation in groups 1 and 2. No significant difference was noted in the pain score of each group during either scope insertion or intravesical observation. CONCLUSIONS: Pain during intraurethral gel instillation is significant. Anesthetic gel instillation has no advantage compared with no-gel injection in men when lubricating gel is applied to a flexible fiberscope.
We describe an alternative method of double J stent placement for ureteral transection following the failure of traditional antegrade and retrograde approaches. Cystoscopically, a guidewire was placed across the distal ureteral segment and was advanced into a urinoma cavity at the level of the transected ureter. Subsequently, an antegrade approach was used to place a gooseneck snare through the proximal ureteral segment into the urinoma cavity. The guidewire was grasped with the snare and pulled through the percutaneous access site. A double J ureteral stent was then placed using the typical antegrade method.
Periurethral injection of collagen is widely used for treatment of stress urinary incontinence. It has been shown to be an effective, low risk, minimally invasive surgical procedure to treat carefully selected patients with intrinsic sphincter deficiency. Adverse reactions and complications from this technique are rare. We report an unusual complication following cystoscopic injection of collagen.
Urinary bladder xanthoma (UBX) is an infrequent lesion that has been very rarely referred to in medical literature. We describe a case of UBX that was associated with a low-grade transitional cell carcinoma of the urinary bladder. The cystoscopic aspect of this lesion was so characteristic that diagnosis could be suggested at cystoscopy, while histological examination confirmed this.