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PubMed2004

The evaluation and treatment of female urinary incontinence--a comparison of clinical practice in the Republic of Ireland with the recommendations of the International Continence Society.

In 1998 the International Continence Society (ICS) developed a set of recommendations for the diagnostic evaluation and treatment of urinary incontinence. The aim of this study was to determine to what extent current clinical practice in the Republic of Ireland correlated with the ICS recommendations. We personally interviewed 100 gynaecologists at units around Ireland. Participants were presented with two clinical scenarios, one described a patient with predominantly genuine stress incontinence, the other described a patient with an overactive bladder. Ninety-five (95%) requested a midstream urine sample for culture and sensitivity, and 74 (74%) considered urodynamics an appropriate initial investigation for a woman with stress incontinence. Physiotherapy was recommended as a first line treatment for stress incontinence by 76 (76%). Burch colposuspension, chosen by 55 (55%), was the most common first line surgical procedure. Other first line surgical procedures were TVT [31(31%)] Marshall-Marchetti-Krants procedure [5(5%)], anterior colporrhaphy [4 (4%)] and a variety of other procedures [5 (5%)]. When considering the initial investigation for a woman with an overactive bladder, 95 (95%) asked for a midstream urine sample for culture and sensitivity and 85 (85%) requested urodynamic investigations. Initial management of this condition included anticholinergic therapy alone [57 (57%)], anticholinergic therapy combined with bladder retraining [36 (36%)], bladder retraining alone [5 (5%)], and cystoscopy and bladder distension 2 (2%). Seventy-six (76%) felt that cystoscopy was an appropriate investigation for a woman with symptoms of an overactive bladder who has failed to respond to initial therapy. The study reveals a significant degree of diversity in the evaluation and management of patients who present with symptoms of urinary incontinence. It also highlights a number of areas where current clinical practice deviates from the recommendations of the ICS. In particular, there is a high and inappropriate use of urodynamics in the initial management of these patients.

Adult↗
PubMedDate not supplied

[Three-dimentional echography in diagnosis and staging of urinary bladder cancer].

The role of USI and three-dimentional volumetric reconstruction was studied in diagnosis of urinary bladder cancer diagnosis. 69 UBC patients were examined. Examination included renal USI of the kidneys, urinary bladder, prostate, echoureterography, cystoscopy, CT, MRT. The number of the tumors, volume, area, invasion were studied in 3D mode. US angiography assessed resistance index and tumor vascularization by degrees 0-3. USI findings were compared with those of MRT, cystoscopy, histomorphology of the biopsies. 2D USI technique proved effective in detection of urinary bladder cancer at stage T1 in 66%, 3D in 100. At stage T2a-b informative value of both techniques reached 87%. Overall informative value of 2D in detection of urinary bladder cancer was 81%, three-dimentional echography--96%. USI proved effective in diagnosis and staging of urinary bladder cancer. Use of 3D ultrasonic angiography facilitates the choice of more effective surgical policy in the treatment of urinary bladder cancer patients.

Aged↗
PubMed2004

[Multiprobe FISH for enhanced prediction of recurrent bladder cancer].

The early detection of recurrent urothelial cancer is a great challenge for both urologists and pathologists. Cytology is a sensitive and highly specific tool for the diagnosis of high-grade bladder cancer and carcinoma in situ, but is not reliable in low-grade tumors. Therefore, cystoscopy has remained the gold standard for surveillance after resection of bladder cancer. Recent data suggest that multi-target fluorescence in situ hybridization (FISH) can markedly improve the sensitivity of urinary cytology. The goal of this study was to investigate the utility of the recently developed FISH assay Uro-Vysion for the prediction of recurrence during surveillance. 134 bladder washes obtained during a negative follow-up cystoscopy from 127 patients were analyzed. Positive cytology was strongly associated with subsequent recurrence, emphasizing the importance of conventional cytology for bladder cancer surveillance. A positive UroVysion FISH test significantly predicted recurrence when cases with rare tetraploic cells were considered as negative. Taken together, both cytology and FISH help to better determine the risk of bladder cancer recurrence in order to establish more individualized follow-up schemes.

Cystoscopy↗
PubMed2006

Bladder perforation of the tension-free vaginal tape detected with a flexible cystoscope.

A 67-year-old woman who presented with stress urinary incontinence underwent a tension-free vaginal tape (TVT) operation. Postoperatively, she complained of urgency, gross hematuria and dysuria, which persisted for one week. Cystoscopy with a flexible cytoscope revealed penetration of the bladder wall by the tape, which had been missed during the TVT procedure by rigid cystoscopy. After the penetrating portion of the tape was excised, her symptoms were resolved and continence was preserved. This case suggests that employment of a flexible cytoscope is useful to detect the placement of tape in the bladder wall, which may be missed with a rigid cytoscope.

Aged↗
PubMedDate not supplied

[Antibiotic prophylaxis with netilmicin in patients undergoing cystoscopic study].

Thirty adults of either sex, in several cases affected by severe urinary pathology, underwent check cystoscopy. An intramuscular injection of netilmicin 200 mg was administered one hour before the diagnostic procedure as antibiotic prophylaxis. Treated patients were controlled up to three months after cystoscopy, in order to verify the presence of urinary infections. Data obtained proved the efficacy of netilmicin in preventing postcystoscopy urinary infections in 87% of the cases. Safety was very good in all patients.

Adult↗
PubMed1987

Treatment of calculi in the upper ureter with extracorporeal shock wave lithotripsy.

Sixty-six symptomatic primary stones in the upper ureter were treated using extracorporeal shock wave lithotripsy (ESWL). All patients underwent preprocedural cystoscopy for stone manipulation and 27 of the patients had the stones dislodged proximally. The stone-free success rate for this group of dislodged stones was 93 per cent. Of 39 ureteral stones treated in situ (impacted), 33 patients were rendered stone-free at three months. Three stones in this group failed to disintegrate and required surgical treatment. Complications of ESWL were minimal. ESWL of upper ureteral stones is an effective noninvasive, noncontact method of treatment. Successful stone manipulation increased the stone-free rate, yet impacted stones disintegrated and passed in 85 per cent of treatments. Lithotripsy of small renal stones prior to migration and proximal ureteral stones early in the symptomatic course may significantly alter the incidence of distal ureteral calculi requiring hospitalization, cystoscopy or ureteroscopy.

Cystoscopy↗
PubMed1985

Intravesical ultrasonography as an aid to study the size of bladder cancers.

On clinical examination of 50 patients with bladder cancer the authors performed intravesical ultrasonography. By this method they never failed to detect the tumours. The stage of the pathological material obtained by operation or at autopsy was compared with that obtained by the intravesical ultrasonography. In 88% of the cases the two classifications gave identical results. By ultrasonography the pathologic stage was overestimated in 4, and underestimated in 2 cases. Intravesical ultrasonography can be combined with cystoscopy. It is a fast procedure and an ideal supplement to cystoscopy. The combination of the two methods permits the localization of intravesical tumours as well as the estimation of invasion and of the degree of infiltration.

Aged↗
PubMed1985

Infectious complications after instrumentation of urinary tract.

Urethral catheterization is the single most important predisposing factor in the development of nosocomial urinary tract infection. Infection rates, etiologies, and possible methods of prevention are reviewed. Cystoscopy may be followed by a transient bacteremia. It is recommended that patients with positive urine cultures who undergo diagnostic cystoscopy receive antibiotic prophylaxis, but this is not required in patients with sterile urine. The incidence of urinary tract infection following transurethral surgery in patients who have not been given prophylactic antibiotics ranges from 6 to 60 per cent. The value of antibacterial prophylaxis in TUR, is still somewhat controversial. The incidence of infection and the value of antibacterial prophylaxis in prostatic biopsy appear to be related to the technique (transperineal or transrectal) used for the biopsy. It is too early to assess the infection risks associated with relatively new urologic procedures, such as ureteroscopy and percutaneous nephrostomy. Nevertheless, any procedure that crushes or manipulates a potentially bacteria-harboring stone carries at least a theoretical risk of infection.

Bacterial Infections↗
PubMed1981

The effect of manipulation of the prostate gland on serum prostate-specific acid phosphatase measured by radioimmunoassay.

We investigated the effects of digital prostatic palpation, cystoscopy, and biopsy of the prostate on the concentrations of serum prostate-specific acid phosphatase (PAP) measured by radioimmunoassay. Serum concentrations of PAP in patients with normal or hyperplastic prostates did not exceed the upper limit of our reference range (4 microgram per liter) during the 48 hr after digital prostatic palpation. The serum concentrations of PAP did not significantly increase in patients with carcinomatous prostates after digital examination of the prostate. Serum PAP did increase in patients with benign prostatic hyperplasia soon after cystoscopy of biopsy of the prostate. No diurnal variation in the serum concentrations of PAP during the follow-up of 48 hr was detected in the patient groups with normal, benign hyperplastic, or carcinomatous prostates not subjected to rectal examination.

Acid Phosphatase↗
PubMed1982

Nosocomial Pseudomonas aeruginosa urinary tract infections.

Two separate outbreaks of Pseudomonas aeruginosa urinary tract infections (UTIs) were associated with cystoscopy or transurethral prostate resection. The first outbreak was identified after routine bacteremia surveillance demonstrated four cases of P aeruginosa septicemia in a three-month period. A six-month retrospective review of the microbiology records identified 14 cases of P aeruginosa UTI associated with urologic surgery instrumentation. The outbreak terminated after the implementation of two major control measures: (1) replacement of hexachlorophene solution with an iodophor solution for preparing patients and cleaning instruments before disinfection, and (2) weekly gas sterilization of cystoscopy instruments. The second outbreak, consisting of 11 cases of P aeruginosa UTI after transurethral resection of the prostate gland, occurred in a 187-bed community hospital. All available patient isolates were serotype 011, and culture of a rubber adaptor attached to the resectoscope also yielded growth of that serotype. The outbreak promptly terminated when the rubber adaptor was sterilized between cases.

Aged↗
PubMed1977

[Bladder carcinoma: therapeutic concept of the Urology Department of the University Hospital, Mainz].

A therapeutic concept based on tumor staging and grading is presented: T0N0M0 - urine cytology positive - cystoscopy every 3 months. Transitional cell carcinoma (90%): T(iS)N0M0 - carcinoma in situ - cystoscopic biopsy every 3 months. Cystectomy with commencing tumor infiltration. T1N0M0 (80% of all bladder tumors): T1N0M0G0 - TUR; cystoscopy every 3 months. T1N0M0G1-3 - TUR; control-TUR 6 weeks later with systematic biopsy. G3 with tumor recurrence - cystectomy. T2N0/N1M0; G1-2 - TUR; local chemotherapy (adriamycin). G3 - cystectomy; high voltage treatment in inoperable patients. T4NxMx - symptomatic-palliative therapy: TUR, urinary diversion. Squamous cell carcinoma (2-5%): as transitional cell carcinoma; with high voltage therapy adjuvant chemotherapy using bleomycine. Adenocarcinoma (2-3%): as transitional cell carcinoma; cystectomy including part of the anterior abdominal wall and umbilicus. Immunostaging (assessment of the immunocompetence) should be part of the diagnostic procedures and follow-up examination.

Adenocarcinoma↗
PubMed1981

[Contribution of intravenous urography to the etiological diagnosis of microscopic haematurias (author's transl)].

From a study of 216 patients with microscopic haematuria who were helped by technically complete intravenous urography (IU), the authors conclude that this investigations method is particularly valuable when haematuria is unaccompanied by proteinuria, pyuria or renal insufficiency. IU led to an etiological diagnosis in almost 50 p. cent of the patients revealing, among other causes, numerous calculi and a non-negligible number of tumours. Renal biopsy is very useful in cases with proteinuria but has few indications in isolated microscopic haematurias. The same applies to diagnostic angiography. Cystoscopy should be considered angiography. Cystoscopy should be considered when IU might be unable to detect small tumours of the bladder or, more generally, lesions of the vesical mucosa, particularly frequent in patients with pyuria.

Cystoscopy↗
PubMed1980

Routine investigations in the clinical staging of invasive carcinoma of the cervix. A critical evaluation.

From July 1976 to December 1978 invasive carcinoma of the cervix in 369 new patients at Tygerberg Hospital, Parowvallei, CP, was classified into stages according to the International Federation of Gynaecology and Obstetrics (FIGO) classification. Most of these patients underwent routine intravenous pyelography, cystoscopy, and skeletal and chest radiography, the results of which were analysed in relation to the stage of the disease to decide whether all these investigations are needed in every case. It is concluded that under certain circumstances cystoscopy and skeletal radiography may be omitted with safety in stage I and stage II disease.

Bone and Bones↗
PubMedDate not supplied

Preparing the male urethra for transurethral procedures.

The antiseptic and analgesic effectiveness of different preparations of lignocaine gel used prior to flexible cystoscopy were studied in patients recruited over a 12-month period. This random study involved 106 patients in four groups. There appeared to be no difference in bacterial colonisation of the urethra between the groups. Urethral analgesia was improved when higher volumes of gel were used. It was concluded that high-volume gel preparations (> 20 ml) with no antiseptic provided optimal conditions for flexible cystoscopy.

Analgesia↗
PubMed1993

Results of a prospective study with comparison of clinical, endosonographic, computed tomography, magnetic resonance imaging and pathologic staging of advanced gynecologic carcinoma and recurrence.

Between January 1988 and April 1991, 57 patients with advanced gynecologic carcinoma were preoperatively evaluated by gynecologic examination and endosonography (ESG) using general anesthesia. Abdominopelvic computed tomography (CT) was performed in 49 patients and magnetic resonance imaging (MRI) in 21 patients. There were 34 primary tumors and 23 instances of recurrence. Causes of gynecologic carcinoma were 38 carcinomas of the cervix uteri (26 primary and 12 recurrences), eight carcinomas of the ovary (four primary and four recurrences), three recurrences of carcinoma of the endometrium, five sarcomas of the uterus (one primary and four recurrences) and three primary carcinomas of the vagina. All of the patients were operated upon. This perspective study compares the data from clinical and imaging examinations to the data obtained from histologic examination of surgical sections. According to anterior or posterior tumor extension, the accuracy of clinical evaluation and preoperative imaging were studied for the posterior vesical wall and the vesicovaginal septum and the anterior rectal wall and the rectovaginal septum. Histologic examination revealed vesical involvement in 17 patients and of the involvement of vesicovaginal septum in 21 patients. The accuracy of the clinical examination, ESG, cystoscopy, CT and MRI was 83, 88, 87, 75 and 81 percent, respectively, for vesical extension. Cystoscopy was not taken into account for evaluation of extension to the vesicovaginal septum--accuracy was 80, 90, 67 and 86 percent for clinical examination, ESG, CT and MRI. Histologic examination showed involvement in the rectum in 14 patients and involvement in the rectovaginal septum in 19 patients. Rectoscopy was performed 13 times. The accuracy of clinical examination, ESG, CT and MRI was 91, 98, 89 and 71 percent, respectively, for extension to the anterior rectal wall. Rectoscopy was not taken into account for evaluation of extension to the rectovaginal septum--accuracy was 80, 96, 75 and 57 percent for clinical examination, ESG, CT and MRI. Endosonography would seem to be useful to complete examinations for regional extension of advanced gynecologic carcinomas. Its accuracy is superior to that of other examinations. Because it is performed using general anesthesia, there is no discomfort for the patient during this low cost procedure.

Cystoscopy↗
PubMed1993

Comparison of direct radionuclide cystography with micturating cystourethrography for the diagnosis of vesicoureteric reflux, and its correlation with cystoscopic appearances of the ureteric orifices.

Forty-eight patients with strong clinical suspicion of vesicoureteric reflux (VUR) as the cause for their renal disease; were subjected to direct radionuclide cystography and roentgenographic micturating cystourethrography for its detection. Forty-four of them underwent cystoscopy under local anaesthesia to document the position and appearance of the ureteric orifices. Of the 92 kidney-ureter 'units' available for study, 20 had reflux positive on micturating cystourethrography and 22 had direct radionuclide cystography positivity. Two of the three units picked up on direct radionuclide cystography but missed on micturating cystourethrography were severe refluxes up to the renal pelvis. On the other hand, one unit missed on direct radionuclide cystography but picked up on micturating cystourethrography was a lower ureteric reflux. The sensitivity and specificity of direct radionuclide cystography to detect VUR as compared to micturating cystourethrography is 95% and 95.8% respectively. The localization and appearance of ureteric orifices which were classified as per Lyon's classification greatly enhanced the predictive value of determining past or present VUR. Patients with golf-hole orifices placed laterally had 100% incidence of reflux. Thus, combining direct radionuclide cystography with cystoscopy may enhance the predictive value for diagnosis of VUR even higher than a micturating cystourethrography study.

Adolescent↗
PubMed1995

[Nephrogenic adenoma after kidney transplantation].

We report five cases of nephrogenic adenoma that arose several years after cadaver kidney transplantation. Cystoscopy was performed in all patients because of gross haematuria and revealed multifocal tumorous lesions in all parts of the bladder. On admission to of hospital graft function was satisfactory in all patients. There were three female and two male patients. In all patients the therapeutic procedure consisted of transurethral resection. Only very small lesions were fulgurated. Postoperatively an indwelling catheter was left in place for 2-4 days, and after a check on kidney parameters and immunosuppressive therapy all patients were discharged. Postoperative management consisted in cystoscopy every 3 months in the first year and then every 6 months. Though the etiology of nephrogenic adenoma remains unclear, mechanical traumatization and recurrent urinary tract infection seem to be the most important factors in its development.

Adenoma↗
PubMed1995

Transabdominal ultrasonography of the bladder as a staging examination for cervical carcinoma.

OBJECTIVE: To determine the potential of transabdominal ultrasonography to demonstrate the presence or absence of bladder infiltration in patients with cervical carcinoma. DESIGN: A descriptive study. SETTING: The oncology unit in a tertiary medical centre serving a black rural and urban population. STUDY POPULATION: 110 consecutive unstaged patients with histologically proven cervical carcinoma. MAIN OUTCOME MEASUREMENTS: The findings-designated normal, suspicious or infiltration-on ultrasonography and cystoscopy. RESULTS: Transabdominal bladder ultrasonography in this study had a sensitivity of 100%, a specificity of 76,5%, a positive predictive value of 60,4% and a negative predictive value of 100% compared with cystoscopy in the evaluation of the bladder for infiltration by cervical carcinoma. CONCLUSION: Although not accepted as a staging procedure by the International Federation of Gynecology and Obstetrics, transabdominal bladder ultrasonography can be used as a triage for bladder infiltration by cervical carcinoma in a cost-effective way, referring only those patients with abnormal cystoscopic and biopsy findings.

Cystoscopy↗