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PubMed1988

The diagnosis of neoplasia in patients with asymptomatic microscopic hematuria: a decision analysis.

Clinical decision analysis and a computer model were used to evaluate the performance of alternative strategies for the diagnosis of neoplasia in adults with asymptomatic microscopic hematuria. Strategies consisted of sequences of diagnostic tests, including ultrasound, excretory urography, angiography, computerized tomography and cystoscopy. The strategies have a sensitivity of 98 to 100 per cent for bladder cancer and 90 to 94 per cent for renal carcinoma, and a specificity of 99 per cent. The cost per carcinoma diagnosed is $75,000 to $86,000 at 1 per cent prevalence and $5,000 to $5,800 at 15 per cent prevalence. Strategies using cystoscopy or ultrasound as the initial diagnostic test minimized cost and morbidity while maintaining diagnostic accuracy. Excretory urography does not add significantly to diagnostic accuracy but it does add to cost and morbidity.

Adult↗
PubMed1984

Transabdominal dynamic ultrasonography in detection of bladder tumors.

The accuracy of dynamic transabdominal ultrasonography in the detection of bladder tumors is examined. Of 49 bladder tumors 34 between 2 mm. and several centimeters in size could be demonstrated ultrasonographically. Ultrasound failed to visualize tumors less than 5 mm. in size in 14 patients. Dynamic transabdominal ultrasonography cannot replace cystoscopy in the diagnosis or followup of patients with bladder tumors but it may be used instead of cystoscopy in some selected cases.

Adult↗
PubMed1982

Flow cytometry followup of patients with low stage bladder tumors.

A total of 98 urologic outpatients with a history of conservatively treated low stage bladder tumors underwent 325 examinations during a 2-year interval, each comprising conventional cytology, cystoscopy and automated flow cytometry. The flow cytometry results agreed with cystoscopic findings and conventional cytology in 80 per cent of the examinations, while cystoscopy and cytology agreed in 75 per cent. Assuming cystoscopic findings were entirely accurate, the false negative rate for flow cytometry was 8.3 per cent and the false positive rate was 5.8 per cent. On occasion, flow cytometry diagnosis of bladder tumors antedated the development of visible tumor by up to 12 months. Flow cytometry provided an objective and quantitative assay of epithelial abnormalities and, in the absence of skilled, conventional cytology, it appears to be a valuable new tool for the urologist in the diagnosis, management and followup of patients with bladder tumors or a history of bladder tumor.

Carcinoma, Transitional Cell↗
PubMed2003

Bladder tumor found by tension-free vaginal tape procedure.

BACKGROUND: Tension-free vaginal tape (TVT) is thought to be a most effective therapy against stress urinary incontinence. It is rare to find a bladder tumor by the TVT procedure. CASE: A 76-year-old woman with stress urinary incontinence underwent a TVT procedure. Cystoscopy performed in conjunction with the TVT procedure detected a papillary tumor. Transurethral resection of the bladder tumor was performed after the TVT procedure. CONCLUSION: Taking the possible presence of bladder tumors into consideration, TVT-related cystoscopy procedures should be performed carefully. Moreover, the case reported here suggests, at least in the short term, not only that the TVT device does not adversely affect the operability of transurethral resection of the bladder tumor, but also that the transurethral resection of the bladder tumor procedure does not lead to increased levels of urinary incontinence.

Aged↗
PubMed2001

Significance of hematuria in patients with interstitial cystitis: review of radiographic and endoscopic findings.

OBJECTIVES: Hematuria may be found in up to 30% of patients with interstitial cystitis (IC). However, few studies have described its etiology based on the findings of a complete evaluation. We reviewed the clinical significance of hematuria in the setting of IC. METHODS: We retrospectively reviewed the records of 148 patients fulfilling the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases inclusion criteria for IC. Patients with gross or microscopic hematuria were identified. Evaluation consisted of urine culture and cytology, cystoscopy, and intravenous urography (or retrograde pyelography plus renal ultrasound). Patients with urinary tract infections were excluded. RESULTS: Of 148 patients, 60 (41%) were found to have had at least one episode of hematuria during a mean follow-up of 18 months. Of 56 patients who agreed to be evaluated, 8 (14%) had positive urologic findings. Of these, none were highly significant; five were simple renal cysts (8.9%), one was a renal stone (1.8%), one was reflux nephropathy (1.8%), and one was medullary sponge kidney (1.8%). Cystoscopy, cytology, and bladder biopsy did not demonstrate malignancy in any patient. No statistically significant differences were found in age (49.9 versus 46.7 years), sex (90% versus 91% female), bladder capacity (792 versus 808 mL), and the presence of Hunner's ulcers (5% versus 2.4%), glomerulations (60% versus 59.9%), or detrusor mastocytosis (55% versus 47.6%) between patients with hematuria and those without (P >0.05). CONCLUSIONS: The incidence of hematuria in patients with IC may be higher than previously reported. Nevertheless, although many of these patients present with pelvic pain and irritative voiding symptoms, the hematuria evaluation is unlikely to reveal a life-threatening urologic condition.

Adult↗
PubMed2001

Interstitial cystitis: current issues and controversies in diagnosis.

Current tests for the diagnosis of interstitial cystitis (IC) are reviewed, including clinical assessment, urodynamic testing, cystoscopy, bladder biopsy, and urinary markers. A MEDLINE search was performed of all studies dealing with the diagnosis of IC. These studies were critically reviewed with the goal of arriving at a utilitarian approach to IC diagnosis. IC is being diagnosed with increasing frequency. However, the diagnostic criteria are nonuniform and there is significant overlap between chronic pelvic pain syndromes in men and women and IC. Diagnosis of IC can be made clinically and by cystoscopy and hydrodistention. The sensitivity and specificity of urinary markers have not been prospectively studied. Individual practitioners continue to use the various diagnostic tests. There is a clear need for uniform diagnostic criteria for clinical diagnosis as well as epidemiologic and research studies.

Biomarkers↗
PubMed1994

Relationships between bladder inflammation and other clinical features in interstitial cystitis.

OBJECTIVES: Interstitial cystitis (IC) has been considered possibly to represent more than one disease process. If so, patients would be expected to form distinct subgroups. The degree of mononuclear inflammation on bladder biopsy can be objectively quantified and might be a useful parameter for subgroup division. The hypothesis of this study was that patients with mild versus severe inflammation would differ with regard to other clinical features of IC. METHODS: Sixteen patients who met the original National Institute of Diabetes, Digestive and Kidney Diseases criteria for IC underwent cystoscopy with bladder distention and biopsy. The degree of mononuclear inflammation on bladder biopsy was classified as mild, with less than 100 mononuclear cells/high power field (HPF), or severe (100 or more mononuclear cells/HPF or lymphoid aggregates). Associations were sought between degree of inflammation and other subjective and objective clinical features. RESULTS: Five patients had severe inflammation and 11 had mild inflammation. The major finding was that the patients with severe inflammation experienced better symptom relief after cystoscopy with bladder distention under anesthesia. This difference was highly significant (Fisher's exact test, p = 0.0014). For the other clinical features studied, these two groups did not differ significantly. CONCLUSIONS: Two distinct IC patient groups were identified by bladder biopsy findings. These two groups had significantly different treatment responses. If this difference is confirmed with a larger number of patients, it would suggest that these two patient groups may have different underlying disease processes.

Adult↗
PubMed1994

Intravesical instillation of 5-aminolevulinic acid: the fluorescent metabolite is limited to urothelial cells.

OBJECTIVES: For photodynamic therapy 5-aminolevulinic acid is an attractive compound, since it is a physiologic endogenous substance, and its application in excess results in the accumulation of the metabolite protoporphyrin IX, a very effective photosensitizer. The topical application of 5-aminolevulinic acid in the urinary bladder led to pronounced fluorescence in neoplasias when excited with violet laser light during cystoscopy. The aim of this study was the determination of the transmural distribution of protoporphyrin IX in order to estimate potential efficacy and side effects of a therapeutic application of 5-aminolevulinic acid. METHODS: 5-Aminolevulinic acid was instilled prior to cystoscopy and biopsies were taken of lesions that were either fluorescing or nonfluorescing. Fluorescence distribution was analyzed by fluorescence microscopy on cryostat sections prepared from 72 biopsy specimens. In addition, multicellular spheroids grown from tumor cells and fibroblasts were exposed to 5-aminolevulinic acid and analyzed accordingly. RESULTS: Biopsy preparations showed that the fluorescence of protoporphyrin IX was limited to normal and neoplastic urothelial cells. Clinical findings were supported by the in vitro data, which showed negative protoporphyrin IX fluorescence in fibroblasts. CONCLUSIONS: Thus, 5-aminolevulinic acid might be superior in selective accumulation to conventional sensitizers known to localize also in endothelial cells of the tumor stroma. The data appear to hold great promise for 5-aminolevulinic acid in photodynamic diagnosis and therapy in bladder cancer, as phototoxicity will be limited to mucosal lesions. Bladder shrinkage due to photodamage of subepithelial structures even in case of high light doses is not expected.

Administration, Intravesical↗
PubMed1998

Spectroscopic measurement of diffuse reflectance for enhanced detection of bladder carcinoma.

OBJECTIVES: To assess the diagnostic potential of diffuse reflectance spectroscopy for the detection of bladder carcinoma during cystoscopy. Our hypothesis is that neovasculature in neoplastic (dysplastic and malignant) regions will lead to a blood absorption "signature" that is different from that of normal tissue. METHODS: Diffuse reflectance measurements have been performed in 14 patients undergoing mucosal biopsies or transurethral resection of a bladder tumor. A quartz optical fiber was advanced through the working channel of a cystoscope and placed in gentle contact with the bladder surface. A standard cystoscopy xenon light source was used for illumination and the reflectance spectra were recorded using an optical multichannel analyzer (OMA) system. From the spectra, the relative concentrations of hemoglobin (Hb), oxyhemoglobin (HbO2), oxygen saturation (HbO2%), and the total amount of blood (arbitrary units) were calculated to assess their usefulness in differentiating between neoplastic and benign bladder areas. RESULTS: The spectra of 26 bladder areas (9 malignant areas including 4 carcinomata in situ, 2 dysplastic lesions, and 15 benign areas) have been analyzed. Only the total amount of blood was a useful parameter for the differentiation between neoplastic and benign bladder areas. The sensitivity, specificity, and positive and negative predictive values of this method for neoplastic tissue were found to be 91%, 60%, 63%, and 90%, respectively. CONCLUSIONS: The measurement of diffuse reflectance is a fast, simple, and noninvasive method which allows in vivo determination of bladder blood perfusion. The total blood concentration was increased in neoplastic bladder tissue, making it a tool for tissue diagnosis. The relatively low specificity is a result of inflammatory areas also exhibiting an increased total blood concentration. This pilot study encourages further studies to assess the usefulness of reflectance measurements for enhanced detection of bladder cancer.

Aged↗
PubMed2000

Comparison of the monoclonal UBC-ELISA test and the NMP22 ELISA test for the detection of urothelial cell carcinoma of the bladder.

OBJECTIVES: To compare the diagnostic value of two enzyme-linked immunosorbent assay (ELISA) tests, the nuclear matrix protein 22 (NMP22) test and a newly developed urinary bladder cancer (UBC) test, in patients having symptoms suggestive of urothelial cell carcinoma (UCC) and patients under follow-up after transurethral resection (TUR). METHODS: Two hundred forty patients with a mean age of 65.8 years (range 22 to 92) were included in this retrospective study. The tests were performed on previously frozen urine samples. Eighty-one patients had symptoms suggestive of bladder cancer and 159 patients were being followed up after complete TUR of UCC. Voided urine was evaluated by the NMP22 test and the monoclonal UBC-ELISA test, which traces cytokeratins 8 and 18. All patients underwent subsequent cystoscopy and biopsy evaluation of any suspicious lesion. The cutoff levels for bladder cancer positivity were 10 U/mL for the NMP22 test and 12 microg/L for the UBC test. RESULTS: In the 54 patients with histologically proved UCC, the NMP22 test had a sensitivity of 55.5% and the UBC test a sensitivity of 64.8%. According to the histologic stages, the sensitivity of NMP22 was 51.7% in pTa tumors, 46.1% in pT1, and 70% in pT2 or higher tumors; the sensitivity of UBC was 62.1% in pTa, 53.8% in pT1, and 80% in pT2 or higher tumors. For histologic grades 1 to 3, the sensitivity was 50%, 50%, and 68.7% for NMP22 and 66.6%, 60%, and 68.7% for UBC, respectively. The specificity was 79% and 92% for NMP22 and UBC, respectively. CONCLUSIONS: The monoclonal UBC-ELISA test is superior to the NMP22 test in both sensitivity and specificity. Nevertheless, neither test can replace cystoscopy.

Adult↗
PubMed1996

Split course radical radiotherapy for bladder cancer in the elderly: nonsense or commonsense? A report of 76 patients.

The role of split course radical radiotherapy in bladder cancer is controversial. We have pursued such a policy in elderly patients in view of the unpredictable toxicity of radical radiotherapy in this group. Between 1987 and 1992, 76 patients were treated in this way, with 2 weeks' treatment followed by a 3-week gap. Patients were then reassessed and, if considered fit enough, a further 2 weeks of treatment was given. Fifty-three patients (mean age 78.4 years) completed treatment and 23 (mean age 78 years) received phase 1 alone. Thirty-seven of 53 patients completing treatment has a follow-up cystoscopy at 6 months. Twenty-five percent of all patients, 36% of those completing treatment, and 51% of those undergoing cystoscopy, achieved a complete response. The reasons for not completing treatment and not being followed up cystoscopically are examined. We feel that this policy has a role in selected patients whose fitness to tolerate a conventional radical course of radiotherapy is in doubt.

Aged↗
PubMed1998

Teloscopy after bladder neck suspension.

Teloscopy, a method of suprapubic cystoscopy, involves placing a telescope into the dome of a full bladder to examine the bladder interior. A 5-mm Dexide cannula was pierced through the dome of the bladder and a telescope was inserted through it. This specialized cannula sleeve maintained bladder distention and allowed an excellent wide-angle view of the interior of the bladder and ureteral orifices. In a retrospective analysis, 103 consecutive women with stress urinary incontinence who underwent retropubic urethropexy were placed into one of three categories: Burch laparotomy (13), Burch laparoscopy (44), or laparoscopy with mesh and staples (46). Teloscopy was performed and indigo carmine was given intravenously at the end of the procedure in 90 patients. Of these, seven (8%) were positive. In all seven a suture was seen through the bladder mucosa, and in five an additional obstructed ureter was observed. In all seven women the suture was removed and replaced, and all obstructed ureters were patent before the end of the procedure. Average time required was 4 minutes. No complications, short- or long-term, occurred in the 90 women. Our results support the view that cystoscopy should be performed at the end of bladder neck suspension.

Cystoscopy↗
PubMedDate not supplied

DD23 Biomarker: a prospective clinical assessment in routine urinary cytology specimens from patients being monitored for TCC.

BACKGROUND: A prospective clinical study was conducted to assess the ability of the DD23 murine monoclonal antibody to enhance detection of bladder cancer in routine alcohol fixed urine cytology samples. METHODS: Prospectively, 308 bladder cytology specimens were obtained from patients with a history of bladder cancer with a mean age of 71.4+/-11.9 (27% female, 73% male). Data included 121 biopsy-confirmed results and 187 cystoscopy results to assess presence or absence of cancer. Thirty-five normal cytology specimens were obtained from asymptomatic men and women between 55-85 years of age. Separate slides from the alcohol fixed cytology specimens were stained using the Papanicolaou (Pap) and Feulgen staining procedures. The DD23 assay was performed using an avidin-biotin alkaline phosphatase immunocytochemical procedure, with a single urothelial cell exhibiting intense immunostaining sufficient to make a positive call. RESULTS: Pap-Feulgen cytopathology for the 308 cases yielded an overall sensitivity of 65.5% and a specificity of 85.1%, and the DD23 biomarker alone yielded a sensitivity of 80.5% and a specificity of 59.7%. Analysis of the voided urines only (n=164) yielded sensitivities of 61.0% and 73.2% and specificities of 86.2% and 67.5% for cytopathology and DD23 alone, respectively. Results in 49 bladder wash urine cytology cases produced a sensitivity of 70.2% and 100% and specificities of 92.3% and 61.5% for cytopathology and DD23 alone, respectively. In 133 patients that underwent biopsy or had positive cystoscopy results, cytopathology yielded a sensitivity of 65.5% and a specificity of 69.6% while DD23 yielded a sensitivity of 80.5% and a specificity of 58.7%. In 25 biopsy-confirmed low-grade cancers, DD23 improved cancer detection from 32% to 72% when compared to cytopathology. The DD23 biomarker had a specificity of 85.7% in 35 age-matched normal asymptomatic control specimens. CONCLUSIONS: The DD23 biomarker is an adjuvant test that provides improved detection of bladder cancer in cytology specimens and enhances the sensitivity of the cytopathology diagnosis, especially in low-grade cancers.

Adolescent↗
PubMed2003

Non-invasive methods of bladder cancer detection.

At present, the gold standard for the detection of bladder carcinoma is cystoscopy, often as part of the investigation of haematuria. There has been substantial research into the development of a non-invasive test for voided urine that would obviate the requirement for flexible cystoscopy. If such a test was 100% sensitive and 100% specific, and was cost-effective, it could represent a way of separating patients who required tumour resection from those with no bladder carcinoma development. This article reviews the development of non-invasive tests for the detection of bladder carcinoma, with emphasis on the most recent developments in fields such as microsatellite analysis, telomerase, and matrix metalloproteinase detection, in addition to the more widely researched tests such as NMP22 and BTA.

Biomarkers, Tumor↗
PubMed2000

Prostatic manipulation has a minimal effect on complexed prostate-specific antigen levels.

OBJECTIVE: To assess the effect of prostatic manipulation on complexed prostate-specific antigen (cPSA), as various forms of prostatic manipulation are known to increase the serum free and total PSA level. PATIENTS AND METHODS: A series of 92 men (58 after prostatic biopsy, 16 after digital rectal examination and 18 after flexible cystoscopy) were assessed. Blood samples were taken from each patient before and 30 min after manipulation. Total and cPSA levels were measured using appropriate assays, respectively. RESULTS: There was no significant increase in cPSA levels after flexible cystoscopy and digital rectal examination, but prostate biopsy caused a statistically significant although minimal rise in cPSA level. There was no statistically significant increase in cPSA level after prostate biopsy in patients with prostate cancer (P = 0. 35) although there was a statistically significant but minimal rise in cPSA level in patients with benign histology (P < 0.01, mean increase 2.13 ng/mL) compared with that of total PSA, which increased markedly (P < 0.01, mean increase 19.79 ng/mL). CONCLUSION: Prostatic manipulation has minimal effects on cPSA levels.

Aged↗
PubMed2001

The clinical and radiological findings in boys with endoscopically severe congenital posterior urethral obstruction.

OBJECTIVE: To assess the clinical and radiological spectrum in boys with endoscopically severe posterior urethral obstruction, as there is a broad clinical spectrum which does not always correlate with the cystoscopic findings. PATIENTS AND METHODS: Between December 1990 and July 2000, 39 boys (newborn to 12 years old) underwent cystoscopy to investigate a urethral anomaly and were found to have a severe obstructing posterior urethral membrane. Their voiding cystograms, video-recorded cystoscopy and presenting signs were reviewed. RESULTS: Of the 39 boys assessed, a voiding cystogram and presenting signs were available in 36. Of these 36 boys, three cystograms were initially reported as normal, eight showed posterior urethral dilatation as the only feature, and the remainder had more severe bladder and upper tract changes. Fourteen were diagnosed after identifying antenatal hydronephrosis, four presented with voiding dysfunction, one with haematuria and 17 were found after investigation of a urinary tract infection. CONCLUSIONS: This study shows that a congenital posterior urethral membrane that has only a small posterior defect endoscopically can have a wide clinical and radiological spectrum. The difference in outcome may be caused by variations in the response of the bladder to the obstruction, resulting in a different effect on the upper tracts.

Child↗
PubMed2002

Comparison of the bladder tumour antigen test with photodynamic diagnosis in patients with pathologically confirmed recurrent superficial urinary bladder tumours.

OBJECTIVE: To verify the sensitivity of the bladder tumour antigen (BTAstat, Bard Urological, Covington, GA) test against the sensitive procedure of photodynamic diagnosis (PDD), in which 5-aminolaevulinic acid (5-ALA, a precursor of fluorescent porphyrins) is absorbed by the tumour and detected by ultraviolet cystoscopy, in the early diagnosis of urinary bladder tumours. PATIENTS AND METHODS: Forty-three patients (31 men and 12 women, age range 21-87 years) were assessed after transurethral resection of their bladder tumour using the BTAstat test and PDD. Sixty-nine biopsies from suspect areas of bladder mucosa were taken during cystoscopy under ultraviolet light and all suspect lesions electrocoagulated. RESULTS: Thirty-five patients (81%) had a positive BTAstat test; in these patients PDD detected malignant lesions (17 Ta1G1-2, two T1G2, two T1G3 and 14 Tis). In eight patients (19%) the BTAstat was negative but PDD detected three malignant lesions (two Tis and one TaG1). CONCLUSIONS: PDD is valuable for detecting bladder malignancy and can identify small lesions not detected by the BTAstat test.

Adult↗