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PubMed2003

Experience with flexible video cystoscope equipped with built-in high-frequency cauterizing element for transurethral resection of the bladder.

We successfully treated three patients using the flexible video cystoscope (CYF-240A, Olympus, Japan) for superficial bladder cancer under local anesthesia and/or spinal anesthesia. The major advantage of this new technique is that surgeons can use digital pictures and high frequency cauterization. This new system provides good quality of life for bladder cancer patients experiencing frequent recurrences.

Aged↗
PubMed2001

Correlation of cystoscopic impression with histologic diagnosis of biopsy specimens of the bladder.

There is a paucity of information in the contemporary literature that would permit assessment of the urologist's ability to endoscopically discriminate between benign and malignant lesions of the bladder or to predict the grade and stage of papillary neoplasms. This prospective study evaluates the correlation between cystoscopic impression of urothelial lesions and final histologic diagnoses. Sixty-four patients with 68 urothelial abnormalities requiring formal biopsy or endoscopic resection were evaluated prospectively. At the time of endoscopy, treating urologists completed questionnaires documenting the surgeon's endoscopic impression of disease type and extent and performed standard biopsy or resection of all suspicious lesions. Specimens were submitted for routine histopathologic analysis, and the results were correlated with the questionnaire data. Endoscopic evaluation correctly discriminated between dysplastic/malignant and benign/reactive lesions in this study with a sensitivity of 100%, specificity of 100%, and positive and negative predictive values of 100%. Urologists could not readily distinguish between low- and high-grade papillary urothelial lesions and were frequently unable to determine if a tumor was invasive, particularly if the degree of invasion was microscopic. Endoscopic impression at the time of bladder biopsy or resection is accurate and discriminates between the presence and absence of cancer. Endoscopic impression alone is a relatively poor staging tool with respect to extent of invasive disease and must be coupled with careful histopathologic analysis of biopsy material, bimanual examination when appropriate, and axial imaging for complete assessment of a given tumor.

Biopsy↗
PubMed2006

Case report: Cystoscopic use of cyanoacrylate glue for bleeding during transurethral resection of bladder tumors.

An 81-year-old woman with a history of nephroureterectomy and bladder cuff excision for grade 3 stage pT3N0M0 transitional-cell neoplasia presented with three bladder neoplasms. She also had symptomatic varicose veins in the lower extremities and received low-molecular-weight heparin. During transurethral resection of the tumors, deep ablation of the base of one lesion resulted in significant arterial bleeding that could not be controlled with normal endoscopic techniques. On the basis of previous positive experience, we endoscopically injected 3 mL of cyanoacrylate glue (Glubran 2) deeply (5 mm) into the tissue surrounding the bleeding site, making four injections with a device used for collagen injections. The area was irrigated with mannitol and sorbitol, and within a few seconds, there was complete remission of bleeding. We waited a further 90 seconds with the bladder distended to allow the substance to lose its adhesive properties so as to avoid having the bladder walls stick together. The catheter was removed on the third day, with resumption of micturition and clear urine. This appears to be the first case of cystoscopic use of cyanoacrylate glue to control bleeding.

Adhesives↗
PubMed1995

Culture of bladder epithelium from cystoscopic biopsies of patients with interstitial cystitis.

Interstitial cystitis is a chronic disease of unknown etiology characterized by bladder pain and urinary frequency and urgency. The epithelium may be critical in its pathogenesis; the hallmarks of the disease are visible epithelial defects (Hunner's ulcers and epithelial ruptures). Areas denuded of epithelium are commonly seen, and defects in epithelial permeability are characteristic. We report here the culture and characterization of epithelial cells from cystoscopic bladder biopsies obtained from 7 female patients with interstitial cystitis. Within 4 to 14 days cellular outgrowths appeared from explants incubated in cell medium. Monolayers reached confluence after 6 weeks. Cells of the monolayer were cytokeratin-positive and smooth muscle actin-negative, confirming their epithelial origin. They exhibited epithelial cell ultrastructure including intermediate filaments and junctional complexes. Vesicles bounded by a trilaminar plasma membrane and lateral interdigitations were also present. This is the first report of the culture of bladder epithelium from interstitial cystitis patients. Epithelial cells may be targets for initiating agents and inflammatory effects of interstitial cystitis and should be useful for studies of the pathogenesis of this disease.

Adult↗
PubMed1990

Evidence that the soluble interleukin 2 receptor level may determine the optimal time for cystoscopically-directed biopsy in pancreaticoduodenal allograft recipients.

In 18 consecutive pancreaticoduodenal allograft recipients (15 combined kidney/pancreas and 3 pancreas only after a prior successful kidney transplantation) operated on between December 1987 and February 1989, we studied the soluble interleukin 2 receptor (SIL-2R) level over time. All pancreaticoduodenal allografts were transplanted with exocrine drainage via a duodenocystostomy that allowed for cystoscopically directed needle biopsies of the pancreas. Of these 18 recipients, at 6 weeks after transplantation, 6 had had no rejection episodes or cytomegalovirus disease (control group), an acute allograft rejection had developed in 7, CMV disease developed in 4, and both rejection and CMV disease developed in 1 by 12 days after transplantation. SIL-2R level increased in all patients during immunosuppressive induction therapy (preoperative mean +/- SE, 1637 +/- 284 U/mL; maximum, 4367 +/- 687 U/mL). After induction therapy, the mean was 2768 +/- 432 U/mL. In all 6 recipients in the control group, SIL-2R level continued to decrease. However, SIL-2R level was significantly higher compared with controls, in those who had CMV disease (levels were increased at a mean of 7 days before diagnosis of CMV disease) and in those who had acute rejection episodes (levels were increased a mean of 7 days before the clinical diagnosis of rejection). Factors that did not cause an increase in SIL-2R level included acute pancreatitis, wound infection, operative procedures, and CsA nephrotoxicity. SIL-2R level can be useful for monitoring pancreaticoduodenal allograft recipients. Increases predict impending rejection or CMV disease, prior to the onset of organ dysfunction. When SIL-2R level increases, we recommend cultures of blood and urine to exclude CMV and pancreaticoduodenal allograft biopsy to confirm early rejection prior to the initiation of potentially dangerous antirejection therapy.

Biopsy↗
PubMed1995

Cystoscopic biopsies in pancreaticoduodenal transplantation. Are duodenal biopsies indicative of pancreas dysfunction?

Tissue diagnosis of pancreas graft dysfunction is desirable. Bladder-drained pancreaticoduodenal transplants allow tissue diagnosis by cytoscopic biopsy procedures of the pancreas and duodenum. To assess the diagnostic utility of duodenal biopsies, we reviewed all cystoscopically obtained pancreas and duodenal biopsy tissues at our institution (July 1, 1989 through September 30, 1993). Adequate tissue for histologic examination was obtained from 75 biopsies in 58 recipients. Indications for cytoscopic biopsies were relative hypoamylasuria in 85%, hematuria in 6%, hyperamylasemia in 3%, and other causes in 6%. Duodenal specimens were available from 52 biopsies (25 with, and 27 without, concurrent pancreas biopsies). Of the 27 duodenal biopsies alone, 3 were diagnostic of rejection, 15 had features consistent with rejection, 6 were normal, 1 showed fibrosis, 1 showed necrosis, and 1 was ulcerated. Thus, two-thirds of the duodenal biopsies alone yielded clinically relevant information resulting in antirejection treatment. In 25 of the duodenal biopsies, pancreas tissue was also available (11 simultaneous pancreas-kidney, 9 pancreas transplant alone, and 5 pancreas after kidney recipients). Findings in both organs completely agreed in 9 (36%) of the biopsies. In 7 (28%), rejection was suggested or diagnosed in both organs, although the organs were discrepant with regard to the presence of vascular rejection (6 pancreas, 1 duodenum). In 2 (11%), minor nonrejection discrepant findings were present. Therefore, in 18 of 25 (72%) pancreas-duodenal biopsies, treatment would not have been different if only one graft had been biopsied. But in the other 7 (28%), treatment would have been different if only the organ with negative findings had been biopsied. In 6 cases (4 duodenal, 2 pancreas), rejection was seen in one organ but not the other. In 1 case, cytomegalovirus (CMV) inclusions were present in the duodenum, but the pancreas was normal. We conclude that (1) the duodenum and pancreas can reject independently of each other, and a negative biopsy does not preclude rejection of the other organ; (2) duodenal biopsies determined therapeutic decisions one-fifth of the time when both tissues were available for examination, and two-thirds of the time when only duodenal tissue was available; and (3) since cystoscopy allows easy access to the duodenum, both the pancreas and duodenum should be biopsied whenever possible; tissue samples of one organ alone are sufficient only with positive findings.

Adult↗
PubMed1998

Diagnosis of pancreas rejection: cystoscopic transduodenal versus percutaneous computed tomography scan-guided biopsy.

BACKGROUND: The most common cause of graft failure after technically successful pancreas transplants is rejection. Laboratory parameters for detecting pancreas graft rejection are not consistently reliable and can lead to unnecessary antirejection treatment. Histopathologic evaluation is the gold standard in the differential diagnosis of pancreas graft dysfunction. Four biopsy techniques have been described: cystoscopic transduodenal (CB), percutaneous computed tomography scan-guided (PB), open, and laparoscopic biopsy. METHODS: We studied the two most common techniques, CB and PB, in pancreas transplant recipients with presumed rejection. Group 1 comprised 103 attempts at CB in 82 recipients (53 men, 29 women) with bladder-drained (BD) pancreas transplants, at 1 to 80 (median, 14) months after transplant. Group 2 comprised 93 attempts at PB in 68 recipients (41 men, 27 women), at 0.5 to 64 (median, 14) months after transplant. RESULTS: In group 1, of 103 attempts at CB, adequate tissue was obtained in 90 (87%): pancreas alone in 23 (22%), pancreas + duodenum in 35 (34%), duodenum alone in 32 (31%). Of the 58 pancreas biopsies, 23 (40%) showed acute rejection. Of the 67 duodenal biopsies, 16 (24%) showed acute rejection. Complications of CB included macrohematuria in 4 recipients (4%) and microhematuria in 32 (31%). We noted no biopsy-related pancreatitis. The mean cost of CB was $2561+/-246. In group 2, of 93 attempts at PB, adequate tissue (all pancreas) was obtained in 67 (72%); of these, 29 (43%) showed acute rejection. Of 23 inaccessible pancreases, 9 (39%) underwent CB; pancreatic tissue was obtained in four (45%), and results were consistent with rejection in all four. Complications of PB included biopsy-related pancreatitis (serum amylase > or = 25%) in five (7%) recipients, macrohematuria in one (1%), and abdominal hemorrhage in two (3%). The mean cost of PB was $1038+/-78. (1) CB and PB prevented unnecessary antirejection treatment in 44% of our recipients with successful biopsies; (2) CB had a higher success rate for obtaining tissue (including duodenal specimens) and a lower rate of major complications; (3) PB was easier and cheaper, did not require general anesthesia, and was performed as an outpatient procedure. CONCLUSIONS: We conclude that PB should become the biopsy technique of choice in recipients with presumed pancreas graft rejection. If PB fails, recipients with bladder-drained pancreas transplants should undergo CB. If CB fails, or in recipients with enteric-drained or duct-injected pancreas transplants, a laparoscopic or open biopsy should be considered.

Adolescent↗
PubMed1984

Pre-cystoscopic diagnosis of bladder tumour by modified intravenous urography.

Intravenous urography is the primary radiographic procedure used to evaluate patients with haematuria. During the last 15 years a modification of intravenous urography, using delayed films of the bladder, has aided the correct pre-cystoscopic diagnosis of bladder tumor in 82 of the 95 patients seen with this condition at our medical centre. After injection of contrast medium, anteroposterior and oblique views of the abdomen are obtained up to 15 min. Our modification consists of taking delayed films of the full bladder 1/2 h and 1 h later, followed by a post-voiding film. A bladder tumour appears as a filling defect or space-occupying lesion and can be distinguished from other lesions. Such delayed films increase the yield in the radiographic diagnosis of bladder tumours.

Aged↗
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↗
PubMed1993

Retrograde catheterization of the ureter without cystoscopic assistance: preliminary experience.

Standard angiographic techniques were applied to fluoroscopically directed retrograde guide wire or catheter placement into the distal ureter without cystoscopic assistance. The procedure was successful in five of the seven initial attempts, with no complications. Retrograde pyelography and stent placement were accomplished for a benign posttraumatic ureteral stricture, a proximal ureteral calculus, and three malignant ureteral strictures. Percutaneous nephrostomy was obviated in all successful cases. Fluoroscopy time averaged less than 3 minutes. Mild intravenous sedation was used, and the procedure was well tolerated. This initial experience suggests that this method may be useful for a variety of endourologic procedures, as well as for routine retrograde pyelography.

Adult↗
PubMed1994

Pancreas transplants: efficacy of US-guided cystoscopic biopsy.

Between December 1991 and June 1993, the authors performed cystoscopic transduodenal biopsy of pancreas transplants in 35 consecutive patients (18 men and 17 women, aged 22-48 years [mean, 34 years]). The first 12 biopsies were performed under direct visualization and the last 23 were performed with ultrasonographic (US) guidance. Specimens were adequate for pathologic diagnosis in nine of 12 (75%) and in 22 of 23 (96%) biopsies, respectively. US-guided biopsy of pancreas transplants is safe and effective and gives increased diagnostic yield.

Adult↗
PubMed1978

Cystoscopic picture of Schistosoma haematobium in Egyptian children correlated to intensity of infection and morbidity.

Cystoscopy was done on 45 children, 5--12 yr old, infected with Schistosoma haematobium. On the basis of urinary egg output, the children were classifed as having mild, moderate, or heavy infection and the cystoscopic picture was correlated with their egg output and with their signs and symptoms. Lesions reported, in descending order of frequency, were: hyperemia, sandy patches, tubercles, ulcers, nodules, and polyps. Multiple schistosomal lesions were present in some patients and the frequency and severity of lesions correlated with the heaviness of infection. Individual variation in the severety of response to S. haematobium was observed.

Child↗
PubMed1993

[Use of Nd:YAG laser and flexible cystoscope in outpatient treatment of recurrent superficial bladder tumors].

Nd:YAG laser irradiation and flexible cystoscopy were used in the outpatient management of 16 cases (21 sessions) with superficial bladder tumors. Irradiation of tumors was accomplished in all cases except 3 in which the visual field was affected by bleeding after the cup biopsy of tumors. Tumors at the bladder neck were easily irradiated through the flexible cystoscope. No tumor recurred at or near the previously irradiated site. This method provided a safe and cost-effective means to treat superficial bladder tumors in selected cases.

Adult↗
PubMed2001

Chronic pelvic pain. Laparoscopic and cystoscopic findings.

OBJECTIVE: To study the laparoscopic and cystoscopic findings in women with chronic pelvic pain referred to the Gynecology Clinic at Sultan Qaboos University Hospital. METHODS: Women referred to Sultan Qaboos University Hospital, Sultanate of Oman from October 1998-September 2000 with pelvic pain of more than 6 months duration were clinically evaluated. Laparoscopic examination was always combined with cystoscopy. Bladder biopsy was performed only if there were doubts regarding the nature of pathology that was found. RESULTS: The mean age of the patients was 31 years and mean parity was 3.0. The minimum duration of symptoms was 6 months, but one 3rd of the patients had pain for more than 2 years. Bladder symptoms were present in 50% and bowel symptoms in 25% of patients. Laparoscopic examination revealed pathological findings in 80% of the cases. Adhesions of the omentum to the uterus or to the laparotomy or laparoscopy scar were the most common pathology (50%). Cystoscopy revealed one case of trigonitis and one case of cystitis. CONCLUSION: Pelvic adhesions were the most common cause of pelvic pain in our study group. Cystoscopy was normal in most of the patients.

Adult↗
PubMed2002

Accurate pathological staging of urothelial neoplasms requires better cystoscopic sampling.

PURPOSE: The frequency with which muscularis propria was sampled by urologists and the sources of interpretive discrepancies among pathologists were studied in a community practice setting. MATERIALS AND METHODS: A total of 217 consecutive cases of urothelial neoplasm were independently reviewed by 3 pathologists. The presence or absence of muscularis propria as well as interpretive discrepancies were recorded. RESULTS: Despite clinical emphasis on accurate pathological staging portions of muscularis propria were absent from samples of histologically documented urothelial neoplasms in up to 51% of cases. Failure to obtain muscularis propria varied widely among urologists but was most often associated with cases of low grade papillary neoplasms, in which invasion is less likely. Muscularis propria was usually present in cases of noninvasive carcinoma in situ but this may have represented inadvertent sampling of structures in close proximity. The incidence of interpretive discrepancies among pathologists who are required to assess the status of muscularis propria was significant (24%). Almost all problems were related to artifacts and most may have been avoided if careful attention had been given to specimen sampling and processing. CONCLUSIONS: The well documented tendency toward cystoscopic under staging has not necessarily resulted in a high incidence of muscularis propria in bladder cases of urothelial neoplasms. Even when muscle may have been sampled, artifacts that were often due to thermocoagulation hampered accurate pathological staging.

Artifacts↗
PubMed1990

Histologic diagnosis of rejection by using cystoscopically directed needle biopsy specimens from dysfunctional pancreatoduodenal allografts with exocrine drainage into the bladder.

To determine the histologic features of rejection and to identify nonrejection causes of human pancreatic allograft dysfunction, we analyzed 31 needle biopsy specimens (17 pancreatic, 14 duodenal) obtained under cystoscopic direction from 15 dysfunctional pancreatoduodenal allografts with exocrine drainage into the bladder. Eight allografts undergoing rejection showed the most common histologic features of rejection to be diffuse mixed inflammatory infiltrates of pancreatic acinar tissue and duodenum wall. Diffuse infiltration of pancreatic acinar tissue by neutrophils was the earliest histologic change in rejection. Seven dysfunctional allografts not undergoing rejection ("nonrejection") showed a normal pancreas or various changes including acinar dilation with inspissation of secretions, fibrosis, cytomegalovirus inclusions, and enzymatic necrosis. The histologic changes in the duodenum paralleled those in the pancreas in both rejection and nonrejection allografts. We conclude that the histologic features of rejection in pancreatoduodenal allografts are distinctive. The changes seen in biopsy specimens accurately reflect the state of the graft and can be used to diagnose rejection and to identify other causes of graft dysfunction. Biopsy samples from the duodenum as well as the pancreas are diagnostically useful. The biopsy findings can be used to guide the clinical management of rejection and in the development of other noninvasive tests for rejection.

Biopsy, Needle↗
PubMed1996

Deflation techniques for faulty Foley catheter balloons: presentation of a cystoscopic technique.

The Foley catheter is used for drainage of the urinary bladder in < or = 15% of hospitalized patients and is self-retained by an inflatable balloon mechanism. Faulty balloon deflation, which leads to a retained catheter, is a condition treated by the urologist. In this article we describe a cystoscopic approach to deflation, evaluation, and recovery of retained fragments; review the techniques for deflation; and provide an algorithm to approach the retained Foley catheter.

Algorithms↗