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At least 883 records · Page 49Linked to original sources
PubMed2005

Is retrograde stenting more reliable than antegrade stenting for pyeloplasty in infants and children?

OBJECTIVES: To compare antegrade and retrograde internal double-J stenting for pyeloplasty drainage in children. The success of placing the stent in position and the complications were compared in both groups. METHODS: Between October 2001 and December 2004, 42 children with unilateral pelviureteral junction obstruction underwent pyeloplasty by a single surgeon. Antegrade and retrograde double-J stenting was attempted in 17 children (mean age 1.3 years) and 25 children (mean age 1.5 years), respectively. Antegrade stenting was attempted during the pelviureteral anastomosis, and the retrograde stent was placed just before the operation by cystoscopy. Fluoroscopy was not routinely used to confirm stent placement in either group. The stents were removed 4 weeks later at cystoscopy. RESULTS: Successful stent placement without malpositioning was achieved in 14 (82%) of 17 and 24 (96%) of 25 children, respectively, in the antegrade and retrograde groups. The cause of unsuccessful stenting in both groups was the inability to cross the ureterovesical junction. The mean time taken for retrograde stenting was 9 minutes (range 6 to 15). All children with successful stent placement by either technique were discharged within 72 hours after the operation. The hospital stay for children with unsuccessful double-J stent placement varied from 7 to 10 days. No stent malpositioning occurred with retrograde stenting; 1 child in the antegrade stent group had a malpositioned stent in the distal ureter, which was retrieved at ureteroscopy. CONCLUSIONS: In our experience, retrograde double-J stenting seems more reliable than antegrade stenting for pediatric pyeloplasty, with greater success and lower complication rates.

Child↗
PubMed2006

Prevalence of benign microscopic hematuria among women with interstitial cystitis: implications for evaluation of genitourinary malignancy.

OBJECTIVES: To assess the prevalence of benign microscopic hematuria among a cohort of women with clinical interstitial cystitis (IC). METHODS: A total of 100 women were prospectively assessed for microscopic hematuria with postvoid sterile catheterization. The evaluation for all patients included urine culture, potassium sensitivity test (PST), cystoscopy with hydrodistension under general anesthesia, and symptom assessment with the Pelvic Pain and Urgency/Frequency (PUF) questionnaire. RESULTS: The mean age +/- SD was 37 +/- 15 years, with no difference noted in those with or without microscopic hematuria (P = 0.71). Microscopic hematuria was present in 24 (24%) of the 100 women. No patient had gross hematuria, positive urine culture, or cystoscopic findings suspicious for malignancy. The mean PUF score was 17 +/- 6. The PST was positive in 92 (92%) of 100 women, and 8 patients had only cystoscopic findings diagnostic of IC. The likelihood of a positive PST or positive cystoscopic findings among patients with microscopic hematuria was similar to that of patients without microscopic hematuria. The PST results correlated with the cystoscopic findings (P < 0.001). Of 36 patients with positive cystoscopic findings, 28 (78%) had a positive PST, and 28 (30%) of 92 with a positive PST had positive cystoscopy findings. CONCLUSIONS: In this cohort of women with IC, the prevalence of benign microscopic hematuria was 24%. These data suggest that in women at low risk of genitourinary malignancy who have clinical IC, microscopic hematuria may be an incidental finding.

Adult↗
PubMed2006

Robotic repair of vesicovaginal fistula: case series of five patients.

OBJECTIVES: To describe a technique of robotic repair of vesicovaginal fistula (VVF) and present our experience with 5 such patients. METHODS: A total of 5 patients were diagnosed with posthysterectomy (n = 4) or postmyomectomy (n = 1) VVF. All patients were first treated conservatively with continuous drainage using a Foley catheter without any success. After 12 weeks, these patients underwent robotic repair of the VVF. The steps of the technique of robotic repair are (a) vaginoscopy, (b) cystoscopy, (c) bilateral ureteral catheterization, (d) placement of ports for robotic repair, (e) peritoneoscopy, (f) lysis of adhesions, (g) incision of the bladder and cystotomy in reverse tennis racquet fashion encircling the fistula, (h) excision and freshening of the fistulous margins after complete separation of the bladder from the vagina, (i) closure of the vaginal opening horizontally and bladder opening vertically with interrupted Vicryl sutures, and, finally, (j) interposition of the omentum between these suture lines. RESULTS: Fistula repair was successful in all cases, with a mean operative time (from cystoscopy to the end of the procedure) of 233 minutes (range 150 to 330) and estimated blood loss of less than 70 mL. The length of hospital stay was a mean of 5 days (range 4 to 7). The Foley catheter was removed on the 10th postoperative day after voiding cystourethrography. At 6 months of follow-up, these patients continued to void normally without any recurrence of VVF. CONCLUSIONS: These data suggest that robot-assisted VVF repair is feasible and results in lower morbidity, a shorter hospital stay, and a quicker recovery. The minimally invasive approach of robot-assisted VVF repair may be a more attractive option for patients with VVF.

Adult↗
PubMed2006

Combined buccal mucosa graft and genital skin flap for reconstruction of extensive anterior urethral strictures.

OBJECTIVES: Buccal mucosa has become the graft material of choice for substitution urethroplasty, but the tissue may be insufficient to completely reconstruct an extensive or panurethral stricture. We reviewed our experience with the combination of buccal mucosa and a genital skin flap to assess the efficacy of this approach in this setting. METHODS: Eighteen patients underwent single-stage urethral reconstruction at our institution from November 1997 to May 2003 using a buccal mucosa onlay graft and a penile and/or scrotal island flap. After surgery, patients were evaluated with voiding urethrography at 3 weeks, followed by flexible cystoscopy at 6 and 12 months and as needed thereafter. RESULTS: The mean stricture length was 15.1 cm (range 9.5 to 22), with an average graft length of 6.3 cm and flap of 8.5 cm. The stricture etiology included multiple hypospadias repair failures in 4 (22.2%), prior instrumentation in 4 (22.2%), pelvic trauma in 3 (16.7%), balanitis xerotica obliterans in 3 (16.7%), and unknown in 4 (22.2%) of the 18 patients. At the last follow-up visit, 3 patients (16.7%) had had recurrent stricture noted on follow-up cystoscopy. CONCLUSIONS: In this series, the combination of buccal mucosa and a genital skin flap proved to be a reliable and durable method of single-stage repair for extensive and panurethral stricture disease. The use of longitudinal island flaps and patient repositioning during surgery seemed to contribute to a decreased incidence of local and systemic morbidity.

Adult↗
PubMed2006

Significance of fibrosis around and/or at external urinary sphincter on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence.

OBJECTIVES: To determine the clinical importance of fibrosis on pelvic magnetic resonance imaging in patients with postprostatectomy incontinence (PPI) due to sphincteric incompetence. METHODS: Urethral and periurethral fibrosis was determined by pelvic magnetic resonance imaging in patients who did (n = 22) or did not (n = 14) have urinary incontinence after transurethral resection, transvesical prostatectomy, or radical retropubic prostatectomy. The relation between fibrosis and the duration of incontinence, pad weight, symptom score, cystoscopy findings, and urodynamic findings was examined. RESULTS: Fibrosis was seen in all patients (22 of 22) in the study group and in 4 of 14 patients in the control group (P <0.001). All the patients with severe fibrosis had undergone radical retropubic prostatectomy (P <0.001). Similar to the etiology for incontinence, no relation was found between the severity of fibrosis and the duration of incontinence, pad weight, symptom score, cystoscopy findings, or urodynamic findings. However, the duration of incontinence was shorter in patients with mild fibrosis, clinically. CONCLUSIONS: The results of our study have shown that the incidence of fibrosis is much greater in patients with PPI than in patients without PPI. Consequently, we believe that fibrosis plays an important role in the development of PPI because it may have a negative effect on external urethral sphincter function.

Aged↗
PubMedDate not supplied

Use of polymerase chain reaction analysis of urinary DNA to detect bladder carcinoma.

A cohort of 113 patients underwent prospective evaluation with a panel of seven microsatellites, on chromosomes 9, 13 and 17. Thirty-seven patients had histologically confirmed bladder tumors, 53 patients had a history of previous transitional cell carcinoma of the bladder (TCC) but normal cystoscopies (control Group 1), and 23 patients had no previous history of TCC and normal cystoscopies (control Group 2). Urinary DNA was considered to show a deletion if an allele was reduced by more than 50%, and this was considered diagnostic of bladder carcinoma. The sensitivity of the method was 50%, positive predictive value was 80%, and specificity was 93%. Reducing the threshold for defining allelic loss increases sensitivity, but reduces specificity. The concentration of urinary DNA in the sample did not influence detection rate. The grade and stage of the bladder tumor did not influence the likelihood of detection. This method detects bladder carcinoma with high specificity, and increasing the number of microsatellites used should increase sensitivity.

Carcinoma, Transitional Cell↗
PubMed2001

Bladder tumor antigen assay as compared to voided urine cytology in the diagnosis of bladder cancer.

BACKGROUND: The study was aimed at comparing the diagnostic accuracy of the quantitative bladder tumor antigen (BTA) TRAK immunoassay with exfoliative urine cytology in the detection of primary and recurrent bladder cancer. METHODS: The analysis was carried out on 194 high risk patients undergoing a diagnostic cystoscopy, 279 patients with previous history of transitional cell carcinoma awaiting a follow-up cystoscopy, and 45 healthy controls. Urine cytology was performed by a skilled cytopathologist on three consecutive samples. RESULTS: BTA TRAK values resulted significantly higher in tumor positive cases than in absence of bladder tumor for both groups of patients. Non neoplastic urothelial diseases as well as the absence of mucosal abnormalities were associated with a marked increase in BTA TRAK levels with respect to the control group. Overall sensitivity and specificity was 63 and 63% for BTA TRAK (cut-off 34 U/ml), and 68.3 and 73.4% for urine cytology, respectively. The diagnostic advantage of urine cytology was maintained when patients were stratified by tumor grade. CONCLUSIONS: The clinical performance of the BTA TRAK in the detection of primary or recurrent bladder cancer is acceptable and reproducible as shown by similar results with previous reports, although urine cytology performed on three samples showed the highest sensitivity and specificity.

Aged↗
PubMed1990

Accuracy in staging carcinoma of the bladder by magnetic resonance imaging.

Thirty-four patients with a presumptive diagnosis of carcinoma of the bladder diagnosed at EUA and cystoscopy have been staged by MRI and the findings correlated with pathology in 15 patients and clinical follow-up, including repeat cystoscopy, in the remainder. MRI is accurate in identifying tumours confined to the bladder wall or extending beyond the wall to involve perivesical fat or adjacent organs. Whilst it is not possible to distinguish between T1, T2 or early T3a tumours they can be distinguished from advanced T3a lesions and this may affect management. MRI is superior to clinical staging, particularly in detecting lymphadenopathy and provides information for optimal radiotherapy planning. The problem of distinguishing between the effects of radiotherapy and suspected recurrent tumour is discussed.

Aged↗
PubMed1987

The operative management of posterior urethral valves.

The surgical management of posterior urethral valves remains controversial. To examine the effects and results of operative treatment in boys with proven posterior urethral valves, a retrospective study was undertaken. The case records of 33 male children who presented with posterior urethral valves over a 10-year period were reviewed. Two patients died prior to definitive treatment and one died postoperatively. Following resuscitation and diagnostic procedures, the remaining patients had eradication of the posterior urethral valves by electrothermic fulguration. In 14 patients this was performed using the Innes-Williams diathermy hook under control of contrast enhanced radiography. In 16 patients the valves were fulgurated under direct cystoscopic visualization. All surviving patients had an uneventful postoperative recovery. However, of those undergoing cystoscopic fulguration, four developed symptomatic urethral strictures necessitating repeat cystoscopy and urethral dilatation. No cases developed strictures following the use of the diathermy hook. One patient from each treatment group developed dribbling. The Innes-Williams diathermy hook has been proven to be a safe, simple, and inexpensive technique. This has specific application in the neonate and small infant where cystoscopy poses technical problems because of anatomic size and where potentially traumatic urethral instrumentation should be avoided.

Child↗
PubMed2001

Bladder exstrophy associated with complete urethral duplication: a rare malformation with excellent prognosis.

PURPOSE: We report the association of complete urethral duplication and bladder exstrophy in 5 males, and describe the main characteristics to achieve diagnosis. MATERIALS AND METHODS: From 1983 to 2000, 5 males with single bladder exstrophy and complete urethral duplication were seen at 3 institutions. Although bladder exstrophy was obvious at birth, only 1 patient had the preoperative diagnosis of associated urethral duplication. All patients were evaluated with abdominal ultrasound, voiding cystourethrogram after bladder closure and cystoscopy. RESULTS: All patients were totally incontinent, including 4 after primary bladder exstrophy closure. Although it was initially unnoticed by the urologist, most patients had leakage from the tip of the penis during the Valsalva maneuver. In all cases bladder exstrophy was single and deeply situated in the pelvis with excellent elasticity. All patients had a normal sized penis with less severe dorsal chordee and conical shaped glans. The duplicate epispadiac urethra did not have a verumontanum. Only 1 of the 5 patients had the correct diagnosis made before primary closure of bladder exstrophy, while in the other 4 diagnosis of a duplicate ventral urethra was made at the time of epispadias or fistula repair. There were no other associated malformations. In all cases the dorsal epispadiac urethral plate was excised and bladder emptying occurred through the ventral urethra, which at cystoscopy had a normal verumontanum. Postoperatively, all patients became continent and voided with good flow through the ventral urethra and, as opposed to many cases of exstrophy and epispadias, had normal size and excellent cosmesis of the penis. CONCLUSIONS: Complete urethral duplication is a rare variant of the exstrophy-epispadias complex. Patients with this anomaly present with a larger and more deeply situated bladder plate than classical exstrophy and a larger penis. A high index of suspicion is necessary to make a preoperative diagnosis. Excision of the dorsal urethral plate and maintenance of the ventral urethra are the treatment of choice, resulting in a continence and normal voiding.

Adult↗
PubMed1994

Pancreas transplantation and dysuria.

Bladder drainage of the pancreatic graft remains the most common technique in pancreatic transplantation. Graft and patient survival is superior to duct injection and bowel drainage techniques. However, several urological complications develop as a result of bladder drainage. We report 6 cases of the dysuria syndrome after combined kidney/pancreas transplantation. Retrograde urethrography or cystoscopy showed extravasation from the bulbous urethra in all cases, which was most likely caused by activated proteolytic exocrine enzymes from the transplanted pancreas. Minor urethral trauma due to Foley catheterization or cystoscopy may predispose patients to this syndrome. Short-term urethral catheterization or suprapubic catheter drainage led to resolution in all cases. A high index of suspicion coupled with early intervention is recommended for patients with the dysuria syndrome.

Adult↗
PubMed1992

The predictive value of flow cytometry and urinary cytology in the followup of patients with transitional cell carcinoma of the bladder.

To determine the predictive value of flow cytometric deoxyribonucleic acid (DNA) ploidy and urine cytology in patients with superficial transitional cell carcinoma of the bladder, a retrospective analysis was performed on 181 patients who presented for evaluation of presumed superficial transitional cell carcinoma of the bladder. Of the patients 91 were confirmed to have superficial transitional cell carcinoma and were systematically followed with cystoscopy, flow cytometry and urine cytology from 1984 until 1989. They underwent 637 evaluations (mean 7 evaluations per patient). At initial evaluation, flow cytometry had 81% sensitivity and 57% specificity, while urine cytology was 75% sensitive and 94% specific. During the followup flow cytometry was 76% sensitive and 36% specific. Urine cytology was less sensitive (40%) but more specific (81%) than flow cytometry in followup evaluation. These results were similar whether intravesical chemotherapy or bacillus Calmette-Guerin was administered. To ascertain whether false positive flow cytometry represented early detection of recurrent transitional cell carcinoma not apparent at cystoscopy, patients with positive flow cytometry and urine cytology were followed longitudinally. False positive flow cytometry and urine cytology were equally predictive of recurrent transitional cell carcinoma progressively with time. However, for any given examination flow cytometry was more likely to detect and predict recurrent transitional cell carcinoma. At 4 years the bladder transitional cell carcinoma incidence for false positive flow cytometry and urine cytology was 87% and 84%, respectively.

Adult↗
PubMed1987

Painful bladder disease: clinical and pathoanatomical differences in 115 patients.

The diagnostic criteria for interstitial cystitis considered as a subgroup of painful bladder disease (that is sensory bladder disease and chronic abacterial cystitis) are not well established. Some urologists rely on symptoms, while others rely on cystoscopic appearance or pathological findings. Among 115 patients with painful bladder disease we compared symptoms, and cystoscopic and urodynamic findings in those with and without detrusor mastocytosis (28 or more mast cells per mm.2) and attempted to elucidate possible differences between the groups. We chose the pathological anatomical criterion of detrusor mastocytosis to be diagnostic for interstitial cystitis. A total of 43 patients had detrusor mastocytosis and other pathological anatomical signs of interstitial cystitis, and 72 had no mastocytosis but the pathological diagnoses of chronic unspecific cystitis, fibrosis of the bladder, detrusor myopathy, intestinal metaplasia and normal findings. When the 2 groups of patients were compared we found no differences in regard to symptoms (pain, dysuria, frequency, nocturia and urgency), frequency of allergy and hysterectomy, duration of symptoms, petechial bleeding during cystoscopy with bladder distension and cystometric findings. The patients with mastocytosis differed from those without mastocytosis in that they were older, and had a higher frequency of hematuria, a higher frequency of a red, scarred and richly vascularized bladder at cystoscopy before distension, and a smaller cystoscopic bladder capacity. We conclude that by dividing patients with painful bladder into 2 groups according to the mast cell counts in the detrusor, certain differences in the clinical findings in the groups can be ruled out. However, in individual patients one cannot note with certainty to which pathological anatomical group the patient belongs, since great overlapping between the groups exists. Whether only patients with detrusor mastocytosis have interstitial cystitis depends on definitions and still remains an open question.

Adult↗
PubMed1984

Evaluation of bladder washings and urine cytology in the diagnosis of bladder cancer and its correlation with selected biopsies of the bladder mucosa.

We report a prospective study of 136 patients with biopsy proved bladder tumor who underwent 311 evaluations with cystoscopy, urinary cytology, bladder washing and, when indicated, bladder biopsies. Cytology results from bladder washings were superior to routine urinary cytology studies in detecting abnormal cells. Also, there was a significant increase in the number of positive cytology studies in bladder washings from patients with no evidence of tumor by cystoscopy but who had biopsy proved dysplasia. Multiple selective bladder biopsies showed a higher incidence of mucosal abnormalities if the primary tumor was of a higher grade.

Biopsy↗
PubMed1984

Intravesical doxorubicin for prophylaxis in the management of recurrent superficial bladder carcinoma.

Intermittent intravesical doxorubicin chemotherapy was given to 27 patients with multiple recurrent superficial transitional cell carcinoma of the bladder, including 12 who had become refractory to intravesical thiotepa. The starting dose was 60 mg. doxorubicin diluted in 40 to 50 ml. normal saline solution and doses were increased to 90 mg. The duration of instillation was 60 minutes. Treatments were administered every 3 weeks for a total of 8 doses, then every 6 weeks for 2 doses and then every 12 weeks for 2 doses. Therapy then ended for patients who were rendered free of disease. Cystoscopy and urinary cytology studies were performed every 3 months throughout the study. Of the patients 30 per cent had intermittent episodes of dysuria, 26 per cent had urinary frequency, 41 per cent had hematuria and 15 per cent had bladder spasms. None of these toxicities required discontinuation of the drug. Analysis of plasma samples for doxorubicin and metabolites revealed no systemic absorption and there was no myelosuppression. Of the 27 patients 15 (56 per cent) have maintained complete eradication of bladder cancer without any evidence of residual carcinoma detected endoscopically or with urinary cytology. Recurrent disease developed in 9 patients (33 per cent) while on therapy, including 3 with muscle invasion. Cystoscopy has remained grossly negative in 3 patients who have had positive class 5 cytology studies. The median duration of followup in all patients has been 12 months, with a range of 6 to 24 months. We conclude that intravesical doxorubicin is tolerated well and is effective in the management of multiple recurrent superficial transitional cell carcinoma of the bladder.

Administration, Topical↗
PubMed1988

Neoadjuvant chemotherapy for locally advanced transitional cell carcinoma of the bladder: do local findings suggest a potential for salvage of the bladder?

Sixteen patients with locally advanced transitional cell carcinoma of the bladder were given two to four cycles of combination chemotherapy with methotrexate, vinblastine, doxorubicin hydrochloride (Adriamycin), and cisplatin (M-VAC) in an effort to reduce tumor size and enhance the potential for surgical resection. All patients had initial clinical staging (based on cystoscopy and cystoscopic biopsy, urine cytology, computed tomographic scanning, and excretory urography). Before each cycle, all patients had repeat clinical staging tests. Ten patients underwent postchemotherapy bilateral pelvic lymphadenectomy and radical cystoprostatectomy, and their bladders were examined histopathologically by step-sectioning techniques. One patient underwent abdominal exploration, bilateral pelvic lymphadenectomy, and ipsilateral partial cystectomy. Five patients had repeat clinical staging only without removal of their bladders. Of the 16 patients, 5 (31%) had residual invasive tumor and no tumor response. Three patients (19%) had a partial response, two of whom had only carcinoma in situ (one with prostatic duct involvement) and one of whom had stage pT1, NO, MO disease. Five patients (31%) had normal findings on computed tomographic scans, cystoscopy, biopsy, and urine cytology and thus had complete responses. In addition, 3 of 11 patients who underwent pathologic staging had no residual tumor on clinical and surgical staging and were complete responders. The overall (partial + complete) response rate was 69%, and the overall complete remission rate (pathologic + clinical staging) was 50%. These results suggest that the concept of possible salvage of the bladder with the current treatment program might be premature and must be applied selectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2002

Recognition of occult bladder injury during the tension-free vaginal tape procedure.

OBJECTIVE: To identify signs and the etiology of occult bladder injury during the tension-free vaginal tape sling procedure. METHOD: The charts of 140 women who underwent a tension-free vaginal tape procedure were reviewed, and complications were tabulated and analyzed. The tension-free vaginal tape procedure was performed in six fresh-frozen pelves to demonstrate the mechanism of the occult bladder injury. RESULTS: Occult bladder injury was suspected when cystoscopy instillation fluid flowed from the plastic sheath that covers the prolene tape after the extraction of the tension-free vaginal tape trocar. Three of six cases of intraoperative bladder injury had occult bladder injury identified on repeat cystoscopic inspection. The bladder injury caused by the rough edge at the point of attachment of the tension-free vaginal tape to the trocar was reproducible in three of 12 tension-free vaginal tape applications in fresh-frozen pelves. Traction on the tension-free vaginal tape reapproximates the injured bladder edges and potentially promotes spontaneous healing. CONCLUSION: Bladder injuries may go unrecognized during a tension-free vaginal tape procedure. Continuous seepage of water through the prolene plastic sleeve is suggestive of occult bladder injury and requires repeat cystoscopy to identify the potential site of injury.

Female↗
PubMed2002

Treatment of a complete lower urinary tract obstruction secondary to an expandable foam sealant.

We present a unique case of an iatrogenic complete lower urinary tract obstruction with an expandable foam sealant. A 41-year-old man presented in urinary retention 36 hours after self-injecting his urethra with the foam sealant, which could be palpated throughout his entire urethra. The sealant was removed from the distal urethra in numerous fragments with a hemostat and cystoscopically. A perfect mold of the bladder and prostatic urethra were removed by suprapubic cystotomy. Cystoscopy 2 months later demonstrated a mild bulbar urethral stricture, but normal bladder mucosa. The cystoscopy at 6 months was normal.

Adult↗