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PubMed2006

A case of anaphylactic shock possibly caused by intravesical Hexvix.

BACKGROUND: We report a case of a 69-year-old Caucasian male who experienced a severe drop in blood pressure and a skin rash after fluorescence cystoscopy and transurethral resection of the prostate. The diagnostic agent used for fluorescence cystoscopy and suspected of causing the anaphylaxis was hexaminolevulinate hydrochloride (Hexvix). INCIDENT: A profound fall in blood pressure associated with atrial fibrillation, the appearance of a rash, vomiting and transient loss of consciousness occurred immediately after surgery. The hypotension persisted for several hours despite intensive treatment. The reaction commenced approximately 5 h after exposure to Hexvix. There was an increase in serum tryptase (almost nine-fold) and a positive skin prick test to undiluted Hexvix. CONCLUSION: The mechanism of the anaphylaxis is uncertain, but is considered likely to be a non-immunoglobulin E-mediated allergic reaction possibly caused by Hexvix. This is the first reported case of a severe allergic reaction after intravesical instillation of Hexvix.

Aged↗

PubMed2006

Clinical value of vesical leukoplakia and evaluation of the neoplastic risk by mutation analyses of the tumor suppressor gene TP53.

AIM: Leukoplakia has been found to be precancerous in organs covered with squamous epithelium. The present study was conducted to determine whether leukoplakia described in the female bladder is also a premalignant lesion. METHODS: Between 1973 and 1996, 77 female patients were diagnosed with vesical leukoplakia by cystoscopy and cytology and were followed-up until 2004 (mean follow-up time: 8.3 years). A survey was conducted to analyze exposure to cocarcinogens. Additionally, DNA was isolated from 36 urine sediments and analyzed for TP53 mutations. The results were compared to the mutation frequency of TP53 in urine sediments from patients diagnosed with transitional cell carcinoma (TCC) of the bladder and healthy controls. RESULTS: The whitish lesion was mostly located at the trigone and varied in size and location during the follow-up years. TP53 mutations were detected in 6 out of 36 urine samples in exons 5, 6 and 7 (mutation frequency: 16.7%). Among control patients with no leukoplakia or TCC of the bladder (n = 70), the spontaneous mutation frequency was similar (14.3%). In contrast, the mutation frequency in patients with TCC of the bladder (n = 148) revealed 39.9% in exons 5, 6, 7 and 8. The present study did not show any statistically significant correlations between chronic inflammations, TP53 mutations, exposure to carcinogens and vesical leukoplakia. CONCLUSIONS: Our data suggest that vesical leukoplakia does not necessarily hold neoplastic potential and needs to be clearly distinguished from leukoplakia in other localizations. Therefore, we suggest that a biopsy can be omitted, if follow-up controls by cystoscopy are performed regularly.

Adolescent↗

PubMed1978

Longitudinal study of bladder cancer with cytology and biopsy.

A study of urinary cytology and selected mucosal biopsies in conjunction with cystoscopy provided additional information of value in the management of 318 patients with bladder cancer. These procedures were especially helpful in patients with no visible lesions on follow-up cystoscopies in assessing the bladder epithelium, the behaviour of which may be unpredictable in that no further tumours may occur, or they may arise at irregular intervals.

Animals↗

PubMed1982

The clinical value and cost of a district hospital urodynamic unit.

A retrospective review has shown that urodynamic studies were useful in the diagnosis of 87% of our patients and were diagnostic in 43%. The cost per patient was 43 pounds, which compares favourably with urography (35 pounds) an in-patient cystoscopy (104 pounds). Provided that more than 200 patients a year are studied, the expense and effort of running the urodynamic unit are justified. We now perform urodynamic studies routinely in patients with complex lower urinary tract symptoms, prior to intravenous urography and cystoscopy.

Costs and Cost Analysis↗

PubMed1983

A controlled trial of otis urethrotomy.

Otis urethrotomy is an empirical procedure when used in the treatment of recurrent urinary tract infection and the urethral syndrome. Sixty-four female patients were randomised into two treatment groups. One group had cystoscopy alone and the other cystoscopy and Otis urethrotomy. The patients were assessed pre-operatively and at 6 weeks after surgery both symptomatically and by urodynamic testing. There was no significant difference in the results obtained in the two groups. We conclude that Otis urethrotomy has no advantage in the routine treatment of patients with lower urinary tract symptoms.

Clinical Trials as Topic↗

PubMed2002

Fistulas to the urinary system in Crohn's disease: clinical features and outcomes.

OBJECTIVES: Most reports of fistulas to the urinary system in Crohn's disease are relatively small. We sought to describe the clinical features and outcomes of these patients. METHODS: A centralized diagnostic index identified all Crohn's disease patients with urinary tract fistulas who were evaluated at our institution between 1976 and 2000. Medical records were abstracted for patient demographics, presenting symptoms, diagnostic tests, and all therapies. RESULTS: A total of 78 patients (56% men) were identified. Patients presented with pneumaturia (68%), dysuria (64%), recurrent urinary tract infections (32%), and fecaluria (28%). Cystoscopy and CT of the abdomen/pelvis had the highest diagnostic yield (74% and 52%, respectively). Fistulas originated from the ileum (64%), colon (21%), rectum (8%), and multiple sites (7%). Urinary tract sites included bladder (88%), urethra (6%), urachus (3%), ureter (1%), and other (1%). Median follow-up was 1.1 yr (0-22.3 yr). A total of 70 patients (90%) had surgery, with medical treatment first attempted in four patients with antibiotics and/or immunosuppressants. One patient had adequate symptom relief without surgery on antibiotic suppression alone. Six patients required a partial cystectomy, but no patient had a cystectomy or nephrectomy. Only three surgical patients had recurrent urinary system fistulas. CONCLUSIONS: Urinary tract fistulas in Crohn's disease occurred more often in men. Patients with these fistulas presented with pneumaturia, dysuria, recurrent infections, and fecaluria. The most helpful diagnostic tests were cystoscopy and CT of abdomen/pelvis. Surgery resulted in durable remission. Medical therapy for these fistulas deserves further study.

Adolescent↗

PubMed1994

Proposal for changes in cystoscopic follow up of patients with bladder cancer and adjuvant intravesical chemotherapy.

A famous surgeon observed that the most important instrument for the management of superficial bladder cancer was a typewriter because it facilitated the organisation of the regular follow up examinations that are so important in controlling this disease. Cystoscopic follow up must be lifelong, and the cost, in the broadest sense, to both patient and health service is considerable. A recent study has suggested that the conventional frequency of bladder examinations may not be necessary and that most patients could be spared many cystoscopies. Instillation of cytotoxic drugs in the bladder has been shown to reduce the recurrence of tumours destroyed endoscopically and the development of new tumours elsewhere in the bladder. Because intravesical instillations are inconvenient, expensive, and may be toxic they have been reserved for patients thought to be at greatest risk of recurrence. However, two clinical trials have shown that a single cytotoxic instillation may be beneficial for low risk patients. If this is verified in everyday practice, the routine use of intravesical chemotherapy for all patients at the time of initial treatment could reduce the need for cystoscopies even further. Such changes should improve the quality of life of the 7000 new patients with superficial bladder cancer each year in England and Wales and allow savings to be made in the NHS.

Administration, Intravesical↗

PubMed1974

The relationship between urinary infection, cystoscopic appearance, and pathology of the bladder in man.

Studies of bladder histology were made in patients with recurrent urinary infection or symptoms of cystitis, with a view to establishing its relationship to symptoms, cystoscopic appearance, and bacilluria. Bladder biopsies were taken from the patients and compared with control material obtained at necropsy. Acute inflammatory changes were inconstant and sometimes sparse. Chronic inflammatory changes were often marked, and were ranked by severity into four grades. There was a statistically significant correlation between the more severe grades and the finding of bacilluria, which was not dependent on sex or age. The grades in patients with recurrent non-bacterial dysuria (;urethritis') lay between those of the controls and the infected patients, and were statistically different from both. There was no correlation between these grades and either symptoms or the finding of trigonal hyperaemia during cystoscopy. However, heavy lymphocytic infiltration, and particularly germinal follicle formation, frequently resulted in macroscopic tubercle-like nodules which were visible on cystoscopy. Such germinal follicles may contribute to local antibacterial defences by their production of immunoglobulins, and may explain the high antibacterial antibody titres sometimes found in the sera of subjects with infection confined to the lower urinary tract.

Adult↗

PubMed1999

Small cell carcinoma of the urinary bladder treated with chemotherapy and radiotherapy: results in five cases.

Small cell carcinoma of the bladder is a rare and highly aggressive tumor. We report our experience with 5 consecutive patients treated with systemic chemotherapy and adjuvant radiotherapy. TNM stages were T2N0M0 (1 patient), T3aN0M0 (3 patients) and T3bN1M0 (1 patient). The chemotherapy protocol was the one used with small cell lung cancer patients at our hospital: six cycles of alternating PE/CAV (PE: cisplatin, etoposide; CAV: cyclophosphamide, doxorubicin, vincristine). Cystoscopy was performed after the third cycle. Four out of 5 patients were free of macroscopic disease. The fifth patient had persistent lesions and was treated by cystectomy. This patient developed a local-regional recurrence 4 months later and died shortly afterwards. Four patients completed the planned six cycles. Cystoscopy with bladder biopsy was then performed on each, and all had complete remission. They were treated with external radiotherapy (45 Gy pelvis, 60 Gy bladder). One patient had invasive bladder recurrence 12 months later and cystectomy was performed. At the last follow-up 42 months later, he was alive and well. The other 3 patients were alive and free of disease 60, 48 and 27 months after diagnosis, respectively. These results are clearly more favorable than previous reports. Cystectomy might, therefore, be unnecessary in some patients.

Aged↗

PubMed1999

Diagnostic value of voided urine and bladder barbotage cytology in detecting transitional cell carcinoma of the urinary tract.

In this article we report on our experience with the use of urine cytology for the screening and diagnosis of transitional cell carcinoma (TCC) of the bladder and upper urinary tracts at our institution between January 1987 and December 1995. A total of 76 patients were included in the study. All patients had voided urine cytology studies read as positive or highly suspicious for malignancy and no prior history of TCC of the urinary tract. All these patients subsequently underwent cystoscopy, bladder/ureteral barbotage cytology, random bladder biopsies, and radiographic studies of the upper tracts. Of the 76 patients with positive urine cytology, 53 also had barbotage urine cytologies which were positive. Six of these patients were found to have cystoscopically evident TCC of the bladder, and 1 patient had upper tract TCC. Three other patients subsequently went on to develop TCC of the bladder at 52, 89 and 111 months of follow-up. An additional patient was diagnosed with upper tract TCC at 12 months of follow-up. Among the 23 patients with negative bladder/ureteral barbotage cytology, 3 patients, 2 at the time of initial cystoscopy, and one 15 months later, showed evidence of TCC. Median patient follow-up was 97 (range 35-132) months. Thus of 76 patients with initial positive voided urine cytology studies, only 9 proved to have TCC at initial work-up, while 5 other patients were diagnosed with TCC during a median follow-up of 97 months. The statistical diagnostic values of the bladder/ureteral barbotage urine cytology studies at the time of cystoscopic work-up were: sensitivity 77%; specificity 31%; positive predictive value 13%, and negative predictive value 91%. Our data suggest that in patients without a previous history of TCC, the diagnostic value of bladder barbotage urine cytology is insignificant, and therefore not cost effective to be included as part of the routine work-up of TCC. Moreover, in patients with initially positive voided urine cytology and negative work-up, if the cytology subsequently becomes negative, the likelihood of the development of TCC is low. However, if the initially positive cytology continues to remain positive, there is a much higher probability of TCC being detected in this population.

Biopsy↗

PubMed2001

Eosinophilic cystitis presenting as urinary retention.

OBJECTIVE: To evaluate the incidence, etiology, diagnosis, therapy and results in patients with eosinophilic cystitis (EC), with special attention to patients with urinary retention as presenting symptom. PATIENTS AND METHODS: Between 1988 and 1999, 3 patients with EC were diagnosed. One patient presented with urinary retention, without other symptoms. All patients were evaluated for symptoms, urine culture, hematology including cell differentiation, blood chemistry, cystoscopy and intravenous urography. The international literature was reviewed for incidence, etiological factors, diagnostic procedures, therapies and outcome of EC presenting with urinary retention. RESULTS: Two male patients presented with pain, frequency of micturition and nocturia. One female patient presented with urinary retention. One patient had an urinary tract infection. One patient showed eosinophilia of the peripheral blood. Intravenous urography revealed hydroureteronephrosis in 2 patients (1 unilateral and 1 bilateral). Cystoscopy showed tumor-like lesions in 2 patients. Therapy consisted of oral or intravesical corticosteroids or transurethral resection of the lesions. All patients were cured. A review of the literature revealed that 14 patients with EC (10%) presented with urinary retention; the majority (79%) being children and women. All patients returned to normal miction following therapy. CONCLUSIONS: The clinical presentation of EC is varied. When the lesion is located at or near the bladder neck, it may present as urinary retention. In children and women with urinary retention, EC must be considered in the differential diagnosis. Corticosteroids are the mainstay of efficient therapy.

Adrenal Cortex Hormones↗

PubMed2003

Interferon-a2b reduces neo-microvascular density in the 'normal' urothelium adjacent to the tumor after transurethral resection of superficial bladder carcinoma.

BACKGROUND: As angiogenesis represents one of the hallmarks of cancer we investigated whether intravesically administered interferon-a (IFN-a2b) reduces neo-angiogenesis in the 'normal' urothelium adjacent to the tumor in patients with superficial bladder carcinoma after complete transurethral resection (TUR) of the tumor. PATIENTS AND METHODS: In the present study 47 patients after TUR of the tumor were examined. 10 patients (group A) received no further treatment (control group); 37 patients (group B) received intravesical treatment with IFN-a2b. The instillations started within 7 days after TUR, were performed weekly for 2 months, twice a month for the next 4 months, and thereafter monthly for 6 more months. Cold cup biopsies were taken before TUR of the transitional cell carcinoma (TCC): from the tumor (T), near tumor (NT) and from normal epithelium (N). Cold cup biopsies 'near tumor', were also taken during follow-up cystoscopy (C1, C2, and C3) 2, 6, and 12 months after TUR, respectively. Angiogenesis was estimated by counting the microvessels detected with CD31 immunostaining. RESULTS: Significant differences of microvascular density (MVD) between patients of group A and B appear after TUR (p < 0.005, Kruskal-Wallis and Wilcoxon test). The MVD difference was maximal 6 months after TUR (C2(A)-C2(B), second cystoscopy) and measured at 12.17 microvessels/ mm(2) (26.2%). CONCLUSION: Our results show that the intravesical administration of IFN-a2b after TUR significantly decreases the angiogenic potential of the 'healthy' urothelium adjacent to the tumor in patients with TCC. This observation could possibly explain, to a certain extent, the mechanism by which IFN-a2b reduces the recurrence rate of primary TCC.

Administration, Intravesical↗

PubMed2006

Incidental finding of a benign bladder tumor during the tension-free vaginal tape procedure.

As use of the tension-free vaginal tape (TVT) grows, more unexpected findings during this procedure are likely to be encountered. However, concomitant resection of a bladder tumor during the TVT procedure is rare. A TVT operation was carried out in a 56-year-old woman with urodynamic stress incontinence. A bladder tumor located in the trigone was found incidentally during cystoscopy. Concomitant resection of the bladder tumor was performed following the TVT procedure. The surgical result of our patient suggests that concomitant resection of a benign intravesical pathology with TVT procedure is safe and effective. Moreover, it does not compromise overall improvement of stress incontinence. The value of cystoscopy during the TVT procedure is emphasized.

Cystoscopy↗

PubMed1987

[Value of microhematuria, urine cytology, TPA and neopterin in the after care of patients with bladder tumors].

Tumor recurrences were observed 70 times in 715 cystoscopies performed in 253 patients. The sensitivity of microhematuria to detect a tumor recurrence was 61%, the specificity 84%. The sensitivity of microhematuria increased to 90% in Tis and T2 tumors. Urine cytology showed a specificity of 100% and a sensitivity of only 43%. The specificity and sensitivity of TPA was only 58% and 41%, respectively, the latter increased to 80% in Tis. 60 patients with proven tumor recurrence showed an increase of neopterin with higher tumor stage. In tumors of stage T2 and Tis serum neopterin was raised in 90% and urine neopterin in 75%. Based on these results cystoscopy, exfoliative urinary cytology and urine analysis are obligatory in the follow-up of patients with superficial bladder cancer. Because of the low specificity (29-41%) TPA and neopterin are not suitable for follow-up.

Biopterins↗

PubMed1985

Suprapubic ultrasonography in the follow-up of superficial bladder tumors.

40 patients with superficial (grade 1-3, stage 0) transitional cell carcinoma of the bladder were followed using urinary cytology, cystoscopy and suprapubic ultrasonography. Sonography detected tumors as small as 2.5 mm, but missed lesions that developed in the dome as well as flat anomalies associated with positive urinary cytology. Although, not a definitive alternative to cystoscopy, suprapubic ultrasonography of the bladder can, in selected cases, be used to widen the interval between endoscopic controls.

Carcinoma, Transitional Cell↗

PubMed1988

Intravesical chemoresection with 4'-epi-doxorubicin in patients with superficial bladder tumors.

The authors report the preliminary data concerning a multicentric study on ablative effects of 4'-epi-doxorubicin (EPR) on superficial bladder cancer. Forty-six patients affected by multiple transitional cell superficial bladder carcinoma were treated by transurethral resection of all but one tumor, left as a marker lesion. Subsequently, an intensive local treatment with EPR and 3-month control cystoscopies with biopsies were performed. In the 47% of cases the control cystoscopy and pathology assessed the complete disappearance of marker lesions without any new occurrence whereas it is interesting to observe that the breakdown of the complete remissions into primary (67%) versus recurrent (37%) and in intravesical unpretreated (55%) versus pretreated (31%) showed important differences. It may be concluded that EPR shows a real activity against transitional cell superficial bladder carcinoma.

Administration, Intravesical↗

PubMed1994

The treatment of superficial bladder tumours under local anaesthetic using suction diathermy electrodes.

Daycase cystoscopy under local anaesthetic is commonly used in screening patients with superficial transitional cell carcinoma of the bladder. Treatment of any lesions found, however, often requires a further cystoscopy under general or regional anaesthesia. Recent reports suggest that small lesions can be diathermied without anaesthesia with only mild patient discomfort. Suction diathermy electrodes, introduced for the treatment of small superficial bladder tumours, have significant advantages over conventional methods. Firstly, most of the superficial tumour fronds can be removed painlessly by suction alone. Diathermy, the uncomfortable component of treatment, is sparingly used to treat the tumour base. Larger tumours can therefore be treated by suction diathermy, with less patient discomfort, than by standard cystodiathermy methods. Secondly, by eliminating tumour debris within the bladder during treatment and reducing tissue damage due to diathermy, suction diathermy minimizes the risk of tumour recurrence due to implantation. In this preliminary report the ease and efficacy of using suction diathermy electrodes under local anaesthesia is assessed.

Aged↗

PubMed2005

The nurse cystoscopist. Extending the role.

Nurse-led cystoscopy has become an established service for bladder tumour surveillance patients. The role of the nurse cystoscopist has been developed to include diagnostic cystoscopy with telephone follow-up and counselling. Direct access to the service has reduced waiting times from presentation to diagnosis. The telephone follow-up has improved patients' experience of a diagnostic urology service.

Aftercare↗