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PubMed1996

The efficacy of urinary cytology in the detection of recurrent bladder tumours.

In a prospective study, 71 patients with superficial transitional cell carcinoma of the bladder were given topical immunotherapy with bacillus Calmette-Guerin after transurethral resection and the impact of cystoscopy and bladder wash-out cytology in assessment of recurrent tumours was investigated. Sixteen recurrences were noted histopathologically during the follow-up and 15 of them were also diagnosed properly by wash-out cytology (sensitivity 93.8%). During the follow-up, 10 patients had positive cytology results without evidence of recurrent tumour and 6 of them had recurred cystoscopically in 3 months' time. However, the remaining 4 patients were still tumour-free cystoscopically after a follow-up of 6 months (specificity 92.7%, positive predictive value 78.9%). Although, some false-positive results may be obtained by urine cytology after topical immunotherapy, urine cytology seems to be a reasonable alternative to more invasive and expensive methods during the follow-up of bladder tumours.

BCG Vaccine↗
PubMed1998

Experience with the Dornier lithotriptor MPL 9000-X for the treatment of vesical lithiasis.

Between February 1994 and March 1995, 52 patients (48 men and 4 women) with vesical lithiasis were treated by extracorporeal shock wave lithotripsy (ESWL), using the MPL 9000-X Dornier lithotriptor. Twenty-five patients showed bladder outlet obstruction. In 9 patients, there was evidence of associated bladder neuropathy. In 6 patients, calculi presented idiopathically in normal bladders. Two patients had silent migration of ureteral calculi and increase in bladder volume, 8 were high risk and 2 others refused other methods of up to date treatment. Vesical stone sizes ranged from 10 to 22 mm in greatest diameter (mean 15 mm). The treatments were performed without the use of anaesthesia and on an outpatient basis. Complete fragmentation was achieved after a single session in 46 patients and 3 required 2 sessions. Postoperative adjunctive endourological procedures included cystoscopy in 9 patients and urethroscopy in 1 patient for evacuation of stone fragments. The overall stone-free rate was 94.2% (49 out of 52 patients) with ESWL and adjunctive measures as needed. No major complications were noted. We find ESWL with the MPL 9000-X lithotriptor to be a simple, effective and safe modality for the treatment of most patients with vesical lithiasis, especially in high risk patients.

Adult↗
PubMed2003

[Non-invasive urine tests in diagnosis and as prognostic markers for urinary bladder carcinoma. Comparison of the BTAstat and NMP 22 tests with immunocytology using monoclonal antibodies against Lewis X and 486p3/12].

INTRODUCTION AND OBJECTIVES: The non-invasive detection of urothelial carcinoma remains challenging. The aim of this study was the prospective evaluation of urine markers for bladder carcinoma. We compared the NMP 22 and BTAstat tests with immunocytology (IC) using monoclonal antibodies against the Lewis X antigen and against 486p3/12. METHODS: NMP 22 and BTAstat were performed on urine samples, and IC with 486p3/12 and Lewis X staining was performed on urine samples as well as bladder wash specimens ( n=146) in patients ( n=115) undergoing transurethral resection on suspicion of bladder cancer (70 specimens) or follow up cystoscopy because of a history of bladder cancer (76 specimens). Bladder cancer was detected in 54 patients (pTa: n=25, pT1: n=20, pT2: n=8, CiS: n=1). Cut-off levels were 10 U/ml for the NMP 22, 30% positive cells for 486p3/12, and 5% positive cells for the Lewis X test. RESULTS: The BTAstat test was positive in 65 (44.5%) cases, the NMP 22 in 69 (47.3%) cases, IC with 486p3/12 and the Lewis X was positive in 52 (35.6%) and 109 (74.7%) cases, respectively. Sensitivity was 70.3% (BTAstat), 68.5% (NMP 22), 94.4% (Lewis X), and 68.5% (486p3/12), respectively. The specificity was 70.6% (BTAstat), 65.2% (NMP 22), 36.9% (Lewis X), and 83.6% (486p3/12), respectively. Among the patients with a false positive test 2/22 (9.0%) patients (BTAstat), 2/25 (8%) patients (NMP 22 test), 4/43 (9.3%) patients (Lewis X), and 3/11 (27%) patients (486p3/12), respectively, suffered from tumor recurrence. In contrast, among the patients with a correct negative test 2/39 (2.0%) (BTAstat), 2/36 (0.5%) (NMP 22), 0/18 (0%) (Lewis X), and 1/50 (2.0%) (486p3/12), respectively, suffered from tumor recurrence. CONCLUSIONS: IC with the Lewis X revealed a higher sensitivity than all of the tested, commercially available methods. Because of its high sensitivity and its high negative predictive value, the Lewis X test may be useful for screening a high-risk population. Patients with a false positive 486p3/12 test have an increased risk of tumor recurrence when compared with patients with a correct negative test.

Antibodies, Monoclonal↗
PubMed2003

[Urinary cytology in cases of bladder cancer: a critical evaluation].

Is urinary cytology still a useful method in cases of bladder cancer since additional methods (fluorescence image analysis, monoclonal antibody immunocytology, fibrin degradation products, nuclear matrix protein measurement and others) are under investigation? The literature has been reviewed and compared with classical and new cytology statistics: urinary cytology is less useful than cystoscopy and some of the urine bound tests for the diagnosis of low grade tumors. On the other hand, cytology is extremely valuable for the diagnosis of high grade transitional cell cancers (TCC) and especially carcinomas in situ. The presence of high-grade TCC in the cytology specimen from a patient with low grade papillary TCC suggests either an unrecognised carcinoma in situ or high grade disease in the upper urinary tract or urethra. Urinary cytology is still indispensable in the management of patients with transitional cancer.

Biomarkers, Tumor↗
PubMed2005

[A look inside the bladder--the human behind it].

To study the inside of humans is an old wish of mankind. Cystoscopy and its development are known to-initiates. In the following we do not stress this examination, but focus on those people behind it who shared in paving the way for improvement with their fantasy and energy without neglecting to report on the human and very human aspects.

Cystoscopes↗
PubMed2000

[Diagnosis of interstitial cystitis].

Interstitial cystitis (IC) represents a rare and complex inflammatory bladder condition in which diagnostics can be challenging. Strict NIH criteria for its diagnosis were designed for research purposes. Their routine application would miss large proportions of IC patients. When IC is suspected, history and physical exam are followed by an evaluation of long-term voiding diaries. Large voided volumes (functional capacity > 250 cc) or longer micturition intervals (> 2 h.), absence of nocturia or symptom-free periods reduce the likelihood of IC. Further exclusion diagnostics include urine tests (infection), cytology (in-situ carcinoma), ultrasound (calculi, bulks, anomalies) and urodynamics in selected cases. Bladder capacity measurements under sedoanalgesia are of limited value, since functional low-volume bladders can be mechanically extendable. Cystoscopy under general anesthesia represents the diagnostic standard procedure for IC during which 90% of IC-patients present with characteristic mucosal glomerulations after bladder distension. Biopsies are recommended for exclusion of malignancy. Potassium-leak testing plays no relevant role in routine diagnostics due to its poor sensitivity. Similarly, complex determinations of novel IC markers (histamine, tryptase, cytokines, growth factors, substance P, nitric oxide) are of no relevance in clinical settings and should be restricted to research projects.

Biopsy↗
PubMed2001

[After-care of bladder carcinoma].

The present article offers an introduction to the aftercare of patients with carcinoma of the urinary bladder. These recommendations are based on the guidelines of the German Association of Urology and the European Association of Urology. Aftercare always depends on the risk of recurrence and progression of the primary tumor and the extent of the therapy applied. Thus, after transurethral resection of a superficial carcinoma of the urinary bladder, aftercare focuses on follow-up cystoscopy. Radical cystectomy of the muscle-invading and locally advanced carcinoma should be followed by extensive examinations, including computed tomography of the pelvis and the abdomen. In addition, the various forms of urinary diversion after cystectomy with its specific late complications should be included in the aftercare. Moreover, the psychological significance of the follow-up examinations should not be neglected.

Aftercare↗
PubMed2006

Vesicouterine fistula: a review of eight cases.

Eight cases of vesicouterine fistula (VUF) (obstetrical etiology in six cases and inflammatory bowel disease in two) have been treated in the past 14 years. All six obstetrical cases were related to cesarean section. Both cases of colovesicouterine fistula presented acutely with watery vaginal discharge or fecaluria. Presenting complaints were vaginal urinary incontinence (five cases), hematuria (three), and vaginal discharge (two). Diagnosis was made with cystoscopy in seven cases and computed tomography in one. VUF usually was between posterior bladder and anterior uterine walls above the internal os. Of the initial treatments, six were surgical (three hysterectomies) with an abdominal (five) or transvaginal (one) approach. Mean follow up was 9 months (range, 2-24). Urinary incontinence resolved in all surgically treated patients. Two patients reporting cyclic hematuria were initially managed medically (medroxyprogesterone injections), with delayed surgical repair elsewhere. Surgical repair is the primary treatment for VUF. Successful pregnancy and cesarean delivery have been reported after VUF repair, without sequelae.

Adult↗
PubMed2005

Prospective, randomized, double-blind study of safety and tolerability of intravesical resiniferatoxin (RTX) in interstitial cystitis (IC).

OBJECTIVE: To determine the safety and tolerability of intravesical resiniferatoxin (RTX) in interstitial cystitis (IC) patients. MATERIALS AND METHODS: IC patients were instilled with 50 cc of test solution containing either placebo, 0.05 microM or 0.10 microM RTX in the bladder. Plasma concentration of RTX and its degradant resiniferonol 9-, 13-, 14-orthophenylacetate was measured. Immediate post-treatment blood sampling and cystoscopy were performed. Symptoms were evaluated before treatment, at 4- and at 12-week follow-ups, using VAS indicator for pain, voiding diary, and O'Leary's IC symptom/problem indices. RESULTS: Among 22 patients observed (ten in 0.10 microM RTX, eight in 0.05 microM RTX, and four in placebo groups), the most commonly reported adverse event was pain during instillation (80.0%, 87.5%, and 25.0%). No serious adverse events were reported. CONCLUSIONS: Use of intravesical RTX in IC patients is associated with important tolerability issues but safe at 0.10 microM and 0.05 microM.

Administration, Intravesical↗
PubMed2005

Life-threatening reaction to indigo carmine--a sulfa allergy?

Indigo carmine is commonly used during cystoscopy when evaluating for lower urinary tract safety after gynecologic surgery. We report a case of severe hypotension and bradycardia following intravenous indigo carmine injection in a patient with known sulfa allergy.

Aged↗
PubMed2006

Polypoid cystitis resulting from ovarian abscess.

We present the case of a 41-year-old woman who presented with gross hematuria, urinary urgency and frequency, and intermittent abdominal pain after vaginal hysterectomy 2 years prior. The presence of an adnexal mass was suspected by pelvic examination and confirmed by transvaginal pelvic ultrasonography. Cystoscopy with biopsy was consistent with an inflammatory bladder polyp, which was initially discovered by pelvic ultrasonography and noted to be contiguous with the adnexal mass. The patient underwent exploratory laparotomy, lysis of adhesions, left salpingoophorectomy, and transvesical resection of the bladder mass. Histology was consistent with ovarian abscess and chronic sinus tract formation that was contiguous with an inflammatory bladder polyp.

Abscess↗
PubMed2007

Adequacy of urine cytology specimens: an assessment of collection techniques.

The objective of this study was to determine whether the method of urine collection impacts the adequacy and cell counts of cytology specimens in a low-risk population. Voided, post-cystometrogram (CMG), and bladder irrigant specimens were collected and evaluated for cytologic adequacy and average cell count by a single cytopathologist masked to the source of each sample. Data were analyzed to detect differences in specimen adequacy and cell counts based on method of collection. Both the voided and post-CMG specimens (97.3%, 93.7% respectively) were significantly more likely to be adequate compared to the bladder irrigant specimen (11.7%, p < 0.0001). The spontaneously voided specimen (211.4 +/- 100.1) had significantly higher cell counts than both the post-CMG specimen (85.9 +/- 86.6) and the cystoscopy specimen (6.4 +/- 19.6, p < 0.0001). In a multivariate linear model, collection method and specimen adequacy were associated with increased cell count/hpf (p < 0.001), as was the presence of hematuria on urine dipstick (p = 0.03). No cytologic abnormalities were diagnosed. Whereas both spontaneously voided and post-CMG specimens were consistently adequate for interpretation, spontaneous voided specimens were optimal with regard to maximizing cell count/hpf.

Adult↗
PubMed1999

Asymptomatic microscopic hematuria in women: case series and brief review.

Recommendations for the work-up of asymptomatic microscopic hematuria (AMH) often derive from studies including both men and women. This study was undertaken to determine whether that work-up is appropriate for a female patient population. We studied 49 women referred to a urogynecologist for AMH. Patients underwent formal urinalysis, urine culture and cytology, cystoscopy, and either renal ultrasound or intravenous urography (IVU). Highly significant lesions diagnosed were one renal cell carcinoma and one acute tubular necrosis (ATN). Moderately significant lesions included one candidal urinary tract infection. Insignificant lesions included bladder inflammation in 46 patients and renal cysts in 5. Our findings confirm the importance of the work-up of AMH in women. Ultrasound was effective in diagnosing upper tract lesions, with less cost and morbidity than IVU. Larger studies are needed to determine who should be screened, whether the work-up should differ for younger women, possible treatments for benign findings, and appropriate follow-up.

Adult↗
PubMed1999

Bladder cancer in women.

In women bladder cancer usually occurs above the age of 60 and comprises 3% of all female cancers. The hallmark of presentation is hematuria, which must be investigated by radiological imaging and cystoscopy. The best prognostic indicators are grade and stage. Stage divides the disease into two separate entities, superficial and invasive disease. Approximately 70%-80% of patients will present with superficial disease, 10% will fail treatment or progress to invasive disease, and 20% present with invasive disease. Superficial disease is managed by transurethral resection and additional intravesical therapy when high-risk parameters for recurrence or progression exist. Overall survival is good and the morbidity acceptable. Invasive bladder cancer carries a worse prognosis, with an average of 50% 5-year survival. Management of invasive disease warrants extensive surgery, which is the best single treatment modality. Chemotherapy and radiotherapy are implemented in the management of progression or metastasis.

Antineoplastic Agents↗
PubMed2002

Cystoscopic confirmation of inadvertent ureteral catheterization during cystometry.

A patient in whom the right ureter was inadvertently catheterized at the time of cystometry is described. Upon filling, the patient immediately developed severe colicky right flank pain and the vesical pressure of 150 cmH(2)O triggered the pump's automatic shut-off mechanism. Cystoscopy was performed and confirmed the inadvertent placement of the microtip catheter in the right ureteral orifice. After the catheter was repositioned, symptoms resolved and the remainder of the examination was performed routinely, with normal vesical and urethral pressures.

Aged↗
PubMed2003

Detection of bladder hemangioma in a child by blood-pool scintigraphy.

Bladder hemangioma is a rare cause of gross hematuria. A 5-year-old boy was investigated for recurrent episodes of asymptomatic gross hematuria, but no abnormalities were found. Blood-pool scintigraphy using (99m)technetium-human serum albumin combined with diethylene triamine penta-acetic acid (DTPA) revealed an area of increased activity in the right side of the bladder, which was confirmed by cystoscopy as a bladder hemangioma. Endoscopic laser therapy was used to remove two lesions successfully that were diagnosed histologically as cavernous hemangioma. The patient had no further episodes of hematuria in the 2-year period after this treatment. This case study indicates blood-pool scintigraphy may be a useful technique for detecting bladder hemangiomas.

Child, Preschool↗
PubMed1999

Complete duplication of bladder and urethra in the coronal plane in a girl: case report and review of the literature.

An unusual case of complete duplication of the bladder and urethra in the coronal plane associated with left ectopic kidney, duplication of the clitoris and a chondrolipomatous malformation in the pelvic region in a girl is reported. The accessory bladder was located posterolateral to the normal bladder and a ureteric opening into the accessory bladder was found. The malformation was initially identified by US and cystography and confirmed by cystoscopy.

Abnormalities, Multiple↗
PubMed2006

Histological changes in bladders of patients submitted to ifosfamide chemotherapy even with mesna prophylaxis.

PURPOSE: Hemorrhagic cystitis (HC) is a limiting side effect of chemotherapy with ifosfamide (IFS). Mesna is the drug of choice for prevention of HC. In this study, we analyzed cystoscopic and histological changes present in bladders of patients using IFS with mesna prophylaxis. METHODS: Thirty-three patients selected for IFS plus three doses of mesna chemotherapy regime were assigned at random to two groups: Group I or reference group consisted of 18 patients yet untreated. Group II consisted of 15 patients in whom urinalysis and cystoscopy plus vesical biopsy were performed only 24 h after receiving the last dose of IFS. The cystoscopic and histological findings were used as parameters for evaluating the results. For the former the criterion adopted was macroscopic vesical changes in accordance with Gray's criteria. Histological analyses were performed by evaluation method especially adapted to this study. RESULTS: Even under treatment with three doses of mesna, 66.7% of patients presented cystoscopic alterations and 100% showed bladder mucosa microscopic alterations such as edema, exocytosis, and hemorrhage. CONCLUSIONS: The standard protocol used for prevention of IFS-induced HC with three doses of mesna does not completely prevent bladder damage. The histopathological criteria used in this study for observation of inflammatory events allowed staging the intensity of IFS-induced urothelial and mucosal injury.

Adolescent↗