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At least 1,171 records · Page 65Linked to original sources
PubMed2002

Clinical evaluation of a multi-target fluorescent in situ hybridization assay for detection of bladder cancer.

PURPOSE: The UroVysion fluorescence in situ hybridization assay (UroVysion Bladder Cancer Recurrence Kit, Vysis, Inc., Downers Grove, Illinois) is a multi-target assay that detects aneuploidy of chromosomes 3, 7 and 17, and loss of the 9p21 band in exfoliated cells in urine from patients with transitional cell carcinoma. We performed 2 multicenter trials. In 1 trial we compared the sensitivity of the FISH assay to the BTA Stat test (Bion Scientific, Redmond, Washington) and voided cytology in the detection of transitional cell carcinoma. In a separate study of healthy volunteers and patients with other (nontransitional cell carcinoma) conditions we determined the specificity of the FISH assay. MATERIALS AND METHODS: A total of 176 patients with transitional cell carcinoma in the previous 9 months provided voided urine before cystoscopy. Each specimen was split, preserved and shipped to a central laboratory where all 3 tests were performed. All sites were blinded to results. Sensitivity calculations were based on central pathology review of resected tissue. Specificity was determined by testing 275 volunteers who were healthy and with nontransitional cell carcinoma conditions. RESULTS: The 21 sites enrolled 176 patients with a history of transitional cell carcinoma, with 62 recurrences while undergoing surveillance. Overall sensitivities (with 95% CI) were FISH 71% (95% CI 58 to 82), BTA Stat test 50% (37 to 63) and cytology 26% (16 to 39). FISH was negative in 260 of the 275 healthy volunteers or patients with no history of transitional cell carcinoma (specificity 94.5%). CONCLUSIONS: Sensitivity of the FISH assay is superior to that of cytology and at least equivalent to the BTA Stat test in detecting recurrent transitional cell carcinoma. Its specificity approaches that of cytology. Further testing of its clinical use is warranted.

Adult↗
PubMed2002

Newly diagnosed bladder cancer: the relationship of initial symptoms, degree of microhematuria and tumor marker status.

PURPOSE: We recorded initial symptoms and evaluated the frequency and intensity of hematuria in patients with newly diagnosed bladder cancer. We also evaluated and compared the sensitivity of bladder wash cytology, NMP22 (Matritech, Newton, Massachusetts), BTA Stat (Bion Diagnostic Sciences, Redmond, Washington) and UBC antigen (IDL Biotech, Sollentona, Sweden) with hematuria dipsticks and flow cytometry for determining the size of erythrocytes in urine. MATERIALS AND METHODS: Urine samples were collected from 92 patients with newly diagnosed bladder cancer, 64 with idiopathic microhematuria and 42 with nephritis. Urine was analyzed for NMP22, BTA Stat, UBC and erythrocytes size using flow cytometry. Bladder wash cytology was done at cystoscopy. Urine was analyzed for microhematuria with hematuria dipsticks at home for 7 consecutive days immediately before the operation and in the hospital on the day of surgery. RESULTS: Sensitivity was 75% for NMP22, 78% for BTA Stat, 64% for UBC and 61% for flow cytometry at 73% specificity. Cytology had 42% sensitivity at 97% specificity. Tumor size, grade and stage had a statistically significant influence on NMP22, BTA Stat, UBC and cytology. Of the patients 75% had microhematuria on the day of the operation and 75% had hematuria at least 1 of 7 days when tested at home the last week before transurethral bladder resection. The 70% of all patients with macroscopic hematuria as the initial symptom did not seem to differ from those without the condition in tumor size, grade, stage or tumor marker levels. CONCLUSIONS: Flow cytometry was not well enough able to distinguish patients with bladder cancer from controls. The sensitivity of all tested markers, including hematuria dipsticks, was high for large and high grade, high stage tumors. Further studies are needed to evaluate whether a marker could be used to determine priority among patients referred due to microhematuria.

Aged↗
PubMed1993

Endopyelotomy in the elderly.

Elderly patients with ureteropelvic junction obstruction present higher risks for operative repair than younger patients and may benefit from a less invasive approach. We review 18 patients older than 65 years who underwent endopyelotomy for a primary (8) or secondary (10) ureteropelvic junction obstruction. Average followup was 32 months (range 3 to 80). Average operating time, including cystoscopy and patient positioning, was 85 minutes. Average hospital stay was 6.3 days. No intraoperative complications were encountered. One failure occurred immediately postoperatively and the patient underwent corrective pyeloplasty. One patient has had intermittent pain but a negative Whitaker test with no evidence of obstruction. The success rate is 88%. Endopyelotomy can be considered a safe and satisfactory procedure for initial treatment of significant ureteropelvic junction obstruction in the elderly.

Aged↗
PubMed1993

Impaired bladder perfusion in interstitial cystitis: a study of blood supply using laser Doppler flowmetry.

Laser doppler flowmetry was used to study bladder blood flow in 16 patients with interstitial cystitis and in 18 control subjects. All studies were performed at cystoscopy under general anesthesia. Interstitial cystitis patients conformed to the diagnostic criteria of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Blood flow measurements were made at four specific sites in the bladder at a capacity of 100 ml. and at full capacity. The mean maximum capacity under anesthesia was 828 cc for the control group and 562 cc for the IC group. Blood flow at low capacity was similar in the two groups. When the bladder was filled to capacity, blood flow increased by a mean of 9.05 LDF units in the control group but only by 0.06 LDF units in the IC group (p = 0.007). Vault perfusion increased considerably more in the control group compared to the IC group (p = 0.002). The mean ratio of vault to trigonal perfusion was similar in both groups and was not affected by the overall blood flow changes which accompanied distension. Although the mean bladder capacity under anesthesia was greater in the control group, covariant analysis showed that the significant differences in perfusion between the two groups occurred independently of changes in capacity. It is concluded that bladder perfusion at capacity is significantly impaired in interstitial cystitis.

Cystitis↗
PubMed1992

A new technique for bladder washing.

We describe a simple adaptation of the Water Pik (Teledyne Water Pik, Fort Collins, Colorado) irrigating device which allows vigorous, direct-vision agitation of the bladder wall. Three groups of mongrel dogs were subjected to cystoscopy and either syringe barbotage, half-speed Water Pik irrigation, or full-speed Water Pik irrigation of the bladder wall. Transitional cell counts were then done on centrifuged aliquots of each bladder wash specimen. The average number of transitional cells per high-power field were similar between the control group and the syringe barbotage group (2.5 and 1.5 respectively). However, both the half-speed and the full-speed Water Pik groups demonstrated statistically higher cell counts (5.7 and 13.7) when compared to both the controls and syringe barbotage groups. We conclude that Water Pik irrigation is an effective method to increase cell yield in bladder wash specimens.

Animals↗
PubMed1992

The impact of iatrogenic urothelial trauma on urinary levels of transforming growth factor-alpha.

Growth factors are important regulators of epithelial cell biology. We postulated that iatrogenic bladder manipulations may alter urinary growth factor levels and thereby influence both normal and neoplastic urothelium. Using a rat model we studied the effects of various types of urothelial injury, corresponding to bladder catheterization, cystoscopy, fulguration, and chronic indwelling catheterization (Groups B, C, D, and E respectively) on levels of urinary transforming growth factor-alpha (uTGFa). Urine samples collected circa the time of transurethral bladder manipulation were analyzed for protein, creatinine (Cr), and TGFa. Results in experimental groups were compared to control values (group A). Peak concentrations of uTGFa uniformly occurred on the day of surgery and represented 176%, 196%, 726%, 461% and 916% increases relative to pre-operative values in groups A, B, C, D and E respectively. Total uTGFa (nM/mg. Cr) was maximal on experimental day 0 in groups A, B, C, D and day 2 in group E (102%, 114%, 227%, 290% and 976% change from baseline respectively). Compared to control, levels of uTFGFa were significantly elevated on day 0 in the fulguration group, and day 0 and 2 in the chronic catheterization animals (p less than .05). Nonsignificant elevations of uTGFa relative to control were based in all groups through day 7. The chronic catheterization levels remained significantly elevated, compared to control, over the duration of the study (ANOVA, p less than .05). Urinary protein levels correlated with the severity of the injury and showed a strong positive correlation with uTGFa (p = .0001). This study demonstrated a clear impact of iatrogenic urothelial trauma on urinary levels of TGFa.

Animals↗
PubMed1991

Extracorporeal shock wave lithotripsy in combination with transurethral surgery for management of large bladder calculi and moderate outlet obstruction.

In 5 men evaluated for symptoms of obstructive voiding flexible cystoscopy revealed large or multiple bladder calculi along with small to moderate prostatic enlargement. All patients had successful localization and fragmentation of calculi with the Dornier HM3 lithotriptor. Of these patients 4 underwent transurethral resection or incision of the prostate under the same epidural anesthesia for moderate prostatic obstruction without complication and 1 subsequently required suprapubic prostatectomy of a gland with a large middle lobe that made a transurethral operation difficult. Extracorporeal shock wave lithotripsy should be considered for the primary management of large or hard bladder calculi and it is of particular value in combination with a transurethral operation for patients with small to moderate prostatic obstruction.

Combined Modality Therapy↗
PubMed1991

Tamm-Horsfall autoantibodies in interstitial cystitis.

Interstitial cystitis presents a diagnostic and therapeutic challenge. Although many etiologies, including autoimmunity, have been proposed its pathogenesis remains obscure. Tamm-Horsfall protein has been identified in the superficial urothelium of patients with interstitial cystitis demonstrating abnormal urothelial permeability. Eight patients with a clinical diagnosis of interstitial cystitis underwent cystoscopy and bladder biopsy. Characteristic cystoscopic findings were present, and each patient had chronic inflammation and mast cells by histopathological analysis. Preoperative anti-Tamm-Horsfall protein serum antibody (IgG) titers were determined by enzyme-linked immunosorbent assay (range 500 to 8,000, mean 2,750). A control group of 8 patients with a negative urological history also had titers of 0 to 500 (p = 0.02). The humoral response to Tamm-Horsfall protein in these patients suggests a role for Tamm-Horsfall protein in interstitial cystitis. Measurement of serum Tamm-Horsfall protein antibody may prove to be useful as a noninvasive diagnostic test in patients with this disease.

Adult↗
PubMed1991

Long-term followup of asymptomatic microhematuria.

We present a 10 to 20-year followup assessment of 191 patients with unexplained microhematuria (including persons with insignificant lesions). Genitourinary malignancies did not develop in any of the patients (128 alive and 27 dead) evaluated after the first diagnostic investigation. Patient and physician compliance with followup protocols was poor. We currently recommend renal ultrasound and cystoscopy for the first diagnostic survey, have abandoned routine periodic studies and advise diagnostic studies only for patients in whom symptoms develop.

Aged↗
PubMed1989

Prognostic factors for recurrence and followup policies in the treatment of superficial bladder cancer: report from the British Medical Research Council Subgroup on Superficial Bladder Cancer (Urological Cancer Working Party).

With data from 2 large randomized British Medical Research Council studies we identified several factors influencing the recurrence of newly diagnosed superficial bladder cancer. Using multivariate methods to assess the relative importance of these factors we found the most important to be the result of cystoscopy performed 3 months after initial transurethral resection and the number of tumors (single or multiple) at presentation. With these 2 factors we divided the patient population into 3 groups with varying degrees of prognosis. Different followup procedures are proposed for each of these 3 groups.

Administration, Intravesical↗
PubMed1990

Strategies for asymptomatic microscopic hematuria: a prospective study of 1,034 patients.

To establish strategies for treatment of asymptomatic microscopic hematuria we conducted a prospective study of 1,034 patients with this disease. The patients were examined by cystoscopy, urine cytology, abdominal ultrasound and excretory urography. On initial examination 30 highly significant lesions, including 24 cases of urological malignancies, 195 moderately significant lesions and 246 insignificant lesions were detected. In the remaining 563 patients no underlying lesion could be found. Of the 246 patients with insignificant lesions and 563 with unexplained asymptomatic microscopic hematuria followup was done in 421 at 6-month intervals for more than 1 year. A diagnosis became clear within 3 years in 22 patients, including 3 cases of bladder carcinoma and 1 of prostatic carcinoma.

Aged↗
PubMed1990

Follicular cystitis in girls with untreated asymptomatic or covert bacteriuria.

Nodular changes of the bladder mucosa, that is cystitis follicularis or cystitis cystica, are found in 2 to 9% of all children with urinary tract infections. The nodules are composed of lymphoid aggregates, resembling Peyer's patches in the intestine. Children with this finding are considered to have a poor short-term prognosis with a marked tendency for recurrent infections. Screening programs for bacteriuria have revealed that a few per cent of the female population are bacteriuric without symptoms of overt disease. Of 59 girls followed with untreated asymptomatic bacteriuria 52 had nodular changes of the bladder mucosa at cystoscopy. Biopsy was performed in 22 girls, and revealed lymphocytic infiltration in 19 and follicular formation in 11. The nodular changes persisted when bacteriuria continued but disappeared in patients who became abacteriuric. This finding demonstrates the reversibility of the changes, and supports the assumption that they are secondary to the presence of bacteria and not a primary lesion.

Bacteriuria↗
PubMed1989

Primary bladder carcinoma presenting during pregnancy in 3 cases.

We report 3 cases of primary transitional cell carcinoma of the bladder presenting during pregnancy. Only 10 such cases have been reported in the literature. Patient age ranged from 23 to 24 years at 15 to 24 weeks of gestation. Only 1 of the 3 patients presented with gross hematuria and this was initially mistaken as vaginal bleeding. Initial diagnosis in all cases was made with sonography. Diagnosis then was easily confirmed by cystoscopy and treatment was uneventful. Transurethral resection did not present a problem. All patients had single papillary superficial tumors (stage Ta, grades 1 and 2). Pregnancy was not affected in any case. Diagnosis and prompt treatment are emphasized.

Adult↗
PubMed1984

Surveillance of stage O, grade I bladder cancer by cytology alone--is it acceptable?

Although the high incidence of subsequent tumors is well established there is accumulating evidence that few cases of low grade, low stage transitional cell carcinomas will progress in stage. Since the purpose of intensive endoscopic monitoring following initial tumor resection is to detect potentially lethal new tumors as soon as possible, we reviewed retrospectively the course of 36 patients with an initial grade I, stage O (Ta) transitional cell carcinoma to determine whether cytology was capable of achieving this goal. Of these patients 10 (28 per cent) had a subsequent tumor of a higher grade or stage. Cytology performed at or before recurrence was positive in 8 patients (80 per cent) and 2 (20 per cent) had grade II, noninvasive transitional cell carcinoma with negative cytology. Subsequent tumors in these 2 patients have been grade I. All 36 patients are alive. Given the patient inconvenience, expense and risk of infection of cystoscopy compared to cytology, this retrospective review suggests that when an experienced cytopathologist is available patients with grade I, noninvasive transitional cell carcinoma may be monitored primarily by urinary cytology with less frequent endoscopy. A prospective study must be performed to confirm this approach.

Aged↗
PubMed1984

Detection of enteric-urinary fistulas with a noninvasive quantitative method.

The 51chromium test is an inexpensive, noninvasive test to evaluate patients for enteric-urinary fistulas. Of 11 patients studied the 51chromium test demonstrated correctly a fistula in 5 of 6 patients with fistulas and showed no lesion in all 5 without fistulas. Excretory urography, barium enemas, visible contrast medium, cystograms and upper gastrointestinal series failed to demonstrate the fistulas with similar accuracy. Cystoscopy suggested a possible lesion in 4 patients but was definite for a fistula in only 2 of those patients.

Adult↗
PubMed1983

In vivo urothelial surface histology by microscopic chromocystoscopy.

Microscopic chromocystoscopy is a new in vivo procedure that we have developed to aid in the detection and treatment of bladder tumors. Intravesical ionic dye chromocystoscopy was introduced by our group to permit cystoscopic viewing with ordinary light of selectively stained malignant urothelial surfaces by the cationic dye, methylene blue. With the recent availability of the Hamou hysteroscope, a microscopic endoscope, we have combined intravesical ionic dye chromocystoscopy with microscopic cystoscopy to give in vivo urothelial surface histology, with resolution of cytological detail. We herein describe our new method and preliminary results with this procedure, which we have designated in vivo urothelial surface histology by microscopic chromocystoscopy.

Cystitis↗
PubMed1983

Chronic lower quadrant abdominal pain due to vesicoureteral reflux.

Chronic lower abdominal pain or flank pain in adults may be associated with vesicoureteral reflux. Although it is well known that renal scarring may occur in adults with vesicoureteral reflux associated with urinary tract infection, renal function may vary significantly when these patients are found to have sterile vesicoureteral reflux. We report 2 cases of lifelong intermittent lower abdominal pain associated with vesicoureteral reflux without damage to the upper urinary tracts. A voiding cystourethrogram should be included in the evaluation of adults with chronic lower quadrant pain or flank pain even if excretory urography and cystoscopy are normal and the urine is sterile.

Abdomen↗
PubMed1981

Ultrasonographic assessment of bladder tumors. I. Tumor detection.

A total of 37 patients with 71 bladder tumors underwent ultrasonographic examination in an attempt to evaluate its accuracy in detection of bladder tumors. Accurate detection depended on the size and location of the neoplasm. Bladder tumors less than 0.5 cm. in diameter, regardless of location, as well as those of any size located in the bladder neck or dome areas were difficult to detect. On the other hand, diagnostic accuracy was 95 per cent for tumors more than 0.5 cm. in size and situated on the posterior or lateral walls of the bladder. Thus, ultrasound is an additional diagnostic tool for detection of bladder tumors and is indicated in those cases in which cystoscopy could not be done or was not conclusive.

Cystoscopy↗