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PubMed1976

Anaesthesia for cystoscopy. A comparative study of 3 methods of intravenous anaesthesia: diazepam-fentanyl, thiomebumal and althesin.

Three different methods of anaesthesia for diagnostic cystoscopy are compared in randomly divided series of 100 males each. Group I received diazepam-fentanyl supplemented with Althesin in case of therapeutic transurethral procedures. Group II had thiomebumalnatrium-N2O-O2 and group III had althesin-N2O-O2. Group I had no premedication while the two others were premedicated with morphine-scopolamine mixture. The period during and after anaesthesia was observed independently by the urologist, the anaesthetist, the nurses on the ward and by interviewing the patient the day after the cystoscopy. The anaesthetist was the only one who knew the method to be used. Diazepam-fentanyl proved to give sufficient analgesia. This combination offered the shortest and most uncomplicated period of recovery. Five patients given diazepam-fentanyl remembered the cystoscopy as being painful. All these cases could be related to insufficient coordination of anaesthesia and cystoscopy, which seems to be of major importance for this method.

Aged↗
PubMed2002

[Value and significance of cystoscopy during laparoscopic hysterectomy].

The purpose of our study is to identify the ureteral and vesical lesions that may occur in the course of total laparoscopic hysterectomy using intraoperative cystoscopy. After the patient has been placed in dorsolithotomic position, we used a Hourcabie manipulator, a 10 mm umbilical trochar and two 5-mm suprapubics. Total hysterectomy is carried out and after closing the vagina 5 ml of stain in a physiological solution are injected into the vein to carry out cystoscopy. Analysis refers to the first 120 patients from 1998 to 1999 treated with laparoscopic hysterectomy. No material or vesical intraoperative lesions were found in any of the patients with the exception of a vesical lesion which was sutured during laparoscopy. Even with the cystoscopic finding normal, 2 fistulas were observed 20 and 25 days after the operation, so the negativity of the cystoscopy excludes certainly immediate complications but not late ones. Furthermore, not all surgeons carry out intraoperative cystoscopy, so the data available are scanty.

Cystoscopy↗
PubMed2005

Report of case: Partial ureteral obstruction masked by diuretics during intraoperative cystoscopy.

Injury to the lower urinary tract is a potential complication in all major vaginal and urogynecologic surgical procedures. Several authors have recommended the routine use of intraoperative cystoscopy during urogynecologic procedures. To evaluate possible injury to the lower urinary tract during intraoperative cystoscopy, the concomitant use of diuretics with indigo carmine dye has been advocated; efflux of dye is hypothesized to indicate functional patency of the urinary tract. This report describes a case in which a partial ureteral obstruction was present at the time of intraoperative cystoscopy--despite the observation of diuresis caused by furosemide. This case indicates that the efflux of indigo carmine-stained urine from both ureteral orifices is not conclusive evidence of the absence of ureteral insult during intraoperative cystoscopy.

Aged↗
PubMed1988

Flexible cystoscopy.

Flexible fiberoptic technology was first applied to cystoscopy in 1973, with greatly increased usage since 1982. Most procedures formerly performed with rigid cystoscopes can be done using flexible cystoscopes with minimal or no anesthesia. Patient positioning and precystocopy preparation and draping are simplified with the flexible fiberoptic instruments. Complete examination of the urethra and bladder can be performed with a single-lens system and with the patient in a variety of positions. Fiberoptic cystoscopy is limited in patients who are bleeding or have blood clots in their bladders. Withdrawal of irrigant or bladder drainage is cumbersome, and the fiberoptic image is currently not of the same caliber as that of the rigid-lens systems. Fiberoptic cystoscopy has become the procedure of choice for many urologists for ureteral stenting prior to extracorporeal shock-wave lithotripsy. With the advent of lithotripters that require no anesthesia, this application is likely to broaden. Future applications of flexible cystoscopy may include a flexible videocystoscope for use in diagnostic and therapeutic procedures.

Cystoscopes↗
PubMed1994

The value of cystoscopy in major vaginal surgery.

This article reviews the case histories of 236 patients who had cystoscopy as part of their major vaginal operations. Seven had cystoscopically detected potential lower urinary tract injuries. Five of these injuries were ureteral obstructions, one occurring after anterior repair, three associated with a McCall culdoplasty, and one associated with a modified Pereyra bladder neck suspension. Two injuries were subtle cystotomies. These compromises of the lower urinary tract were detected during the main operative procedure and immediately rectified. We propose that routine intraoperative cystoscopy associated with intravenous administration of indigo carmine is an excellent method for detecting actual and potential lower urinary tract surgical injury. Cystoscopy cannot distinguish which surgical distortion or injury will spontaneously resolve. The identification of non-blood-tinged urine from both ureteral orifices and the absence of bladder trauma should eliminate the possibility of lower urinary tract surgical injury, except for ischemic necrosis. Cystoscopy, like laparoscopy, is a procedure that should benefit our patients and should not isolate a specialty.

Cystoscopy↗
PubMed1997

Molecular staging of prostate cancer. III. Effects of cystoscopy and needle biopsy on the enhanced reverse transcriptase polymerase chain reaction assay.

PURPOSE: We examined the effects of prostatic manipulations, including flexible cystoscopy and transrectal needle biopsy, on the enhanced reverse transcriptase polymerase chain reaction assay in 57 men. MATERIALS AND METHODS: The reverse transcriptase polymerase chain reaction assay was performed on 25 patients with clinically localized stages T1 to T2cN0M0 prostate cancer before and 30 minutes after cystoscopy. In addition, blood specimens from 32 patients with elevated serum prostate specific antigen and/or abnormal digital rectal examinations were tested immediately before and at 30 minutes after transrectal ultrasound guided prostate needle biopsy. RESULTS: We detected no difference between polymerase chain reaction results obtained immediately before and 30 minutes after cystoscopy in 25 men. Transrectal needle biopsy had no effect on the polymerase chain reaction results in 30 of 32 men. However, 2 men had positive reactions on post-biopsy specimens only. Pathological results of the biopsy revealed benign prostatic hyperplasia and prostatic intraepithelial neoplasia, respectively, in these 2 men. CONCLUSIONS: We conclude that cystoscopy has no clinically significant effect on the reverse transcriptase polymerase chain reaction assay. However, prostatic needle biopsy may cause a positive polymerase chain reaction for PSA in the immediate post-biopsy period.

Biopsy, Needle↗
PubMed1997

[Can the combination of bladder ultrasonography and urinary cytodiagnosis replace cystoscopy in the diagnosis and follow-up of tumors of the bladder?].

OBJECTIVES: Cystoscopy is currently the reference examination for the diagnosis and surveillance of bladder tumours (BT). However, this examination remains unpleasant for the patient, despite the development of flexible cystoscopes. Among the many diagnostic methods performed in combination with cystoscopy, the authors decided to evaluate the performances of the combination of ultrasonography+urine cytology in the diagnosis and follow-up of bladder tumours. METHODS: This prospective study included 124 cases in the context of postoperative surveillance of BT (86) or aetiological assessment of haematuria (38). All patients were assessed by cystoscopy, suprapubic vesical ultrasonography, and urine cytology. RESULT: Cystoscopy revealed a bladder tumour in 30 patients. Urine cytology had a sensitivity of 53% and a negative predictive value (NPV) of 86%. Vesical ultrasonography had a sensitivity of 50% and an NPV of 85%. The false-positive and false-negative results of ultrasonography and urine cytology make these examinations unreliable when considered separately. The combination of ultrasonography and urine cytology had an overall sensitivity of 80% and an NPV of 93%. However, analysis of the group of patients undergoing postoperative surveillance for BT showed that although the combination of the two examinations had a diagnostic sensitivity of 100% in the case of high-grade tumour or CIS, this value was only 66% for low-grade tumours. The authors review other methods of bladder tumour diagnosis, but none of them appears to have demonstrated a sufficient reliability at the present time. CONCLUSION: The diagnostic sensitivity of the combination of ultrasonography and urine cytology, accurate but not recommended in high-risk patients with a high-grade BT, does not appear to be sufficient for systematic surveillance of patients with low-grade BT, despite the low risk of recurrence.

Adult↗
PubMed1998

[Usefulness of BTA Stat test (Bard) in the diagnosis of bladder cancer. Preliminary results and comparison with cytology and cystoscopy].

OBJECTIVE: The Bard BTA test is an immunochromatographic reaction to detect the bladder tumor antigen in patients with bladder cancer. The sensitivity, specificity and predictive values of this test are analyzed and compared with the standard methods of bladder cancer diagnosis (cystoscopy and cytology). METHODS: In 120 patients with symptoms suggestive of bladder cancer or who came for follow-up control evaluation for bladder cancer, we performed the BTA test and cytology in a voided urine sample prior to cystoscopy. TUR and randomized biopsies were performed in patients with a suspicion of bladder cancer. RESULTS: 76 patients had bladder cancer and 44 were free of cancer. The sensitivity was 76.36% for the BTA test, 61.84% for cytology and 98.5% for cystoscopy. The specificity was 77.7% for the BTA test, 86.36% for cytology and 86.36% for cystoscopy. The positive and negative predictive values were 85.29% and 65.38%, 88.68% and 56.72%, and 91.5% and 97.4%, respectively, for each of the foregoing tests. The sensitivity by grade was 43.75% for G1, 78.38% for G2, 95.65% for G3 for the BTA test; 18.75%, 59.46% and 95.65% for G1, G2 and G3, respectively, for cytology. The sensitivity by stage was 53.8% for Ta, 76% for T1, and 100% for T2-4 and Tis for the BTA test, whereas the sensitivity for cytology was 23.08%, 62% and 100%, respectively, for the foregoing tumor stages. CONCLUSIONS: The BTA test is simple, fast and useful in bladder cancer diagnosis. Our results show that the BTA test is superior to cytology.

Antigens, Neoplasm↗
PubMed1992

Transurethral ultrasonography, fiberoptic cystoscopy and bladder washout cytology in the evaluation of bladder tumours.

The impact of transurethral ultrasonography, fiberoptic cystoscopy and bladder washout cytology on assessment of bladder tumours was investigated in this study. Transurethral ultrasonography had an accuracy rate of 96.5% in diagnosing and staging bladder tumours. The accuracy rates of fiberoptic cystoscopy and washout cytology were 90.9% and 73.7%, respectively, in diagnosis. The efficacy of transurethral ultrasonography was found to be high enough for routine employment in the evaluation of the bladder tumours. Fiberoptic cystoscopy in conjunction with washout cytology as a combination relatively easy to perform can be used especially for follow-up purposes of the bladder tumours.

Carcinoma in Situ↗
PubMedDate not supplied

Virtual cystoscopy of the bladder based on CT and MRI data.

Carcinoma of the bladder can be a serious and complex condition that is not always easy to diagnose with radiologic methods. Numerous investigations are available to establish the diagnosis and demonstrate extravesical manifestations. This article updates the role of virtual cystoscopy based on computed tomographic (CT) data at different dose levels and magnetic resonance imaging (MRI) data in the diagnosis of the carcinoma of the bladder. The appearances of normal bladder and polypoid bladder carcinoma are shown. Factors for improvement of both virtual procedures are presented and pitfalls are discussed. New developments in CT, MRI, and postprocessing procedures are discussed. The value of virtual cystoscopy in sizing, localizing, and staging of bladder carcinoma is described and compared with cystoscopy, axial CT, and MRI.

Cystoscopy↗
PubMed2006

Microscopic hematuria as a predictive factor for detecting bladder cancer at cystoscopy in women with irritative voiding symptoms.

OBJECTIVE: The purpose of this study was to assess microscopic hematuria as a predictive factor for detecting bladder cancer at cystoscopy in women with irritative voiding symptoms. STUDY DESIGN: We conducted a retrospective cohort analysis of women with irritative voiding symptoms who presented for urodynamic testing and cystoscopy. Irritative voiding symptoms were defined as urgency, urge incontinence, frequency, dysuria, and/or nocturia. Patient demographics, risk factors for bladder cancer, presence of microscopic hematuria, urodynamic findings, and cystoscopy and biopsy results were recorded. RESULTS: Of 735 patients with irritative voiding symptoms, 264 (35.9%) had microscopic hematuria and 471 (64.1%) had no hematuria. Bladder cancer was detected in 3 women, for an overall detection rate of 0.4%. Microscopic hematuria, urgency, frequency, dysuria, nocturia, age, and tobacco use were not significantly associated with bladder cancer. CONCLUSION: In this cohort of women with irritative voiding symptoms, microscopic hematuria was not predictive for bladder cancer.

Aged↗
PubMed2004

Biopsy of the red patch at cystoscopy: is it worthwhile?

OBJECTIVE: At cystoscopy red patches of urothelium are commonly seen within the bladder and frequently biopsied in order to exclude carcinoma in situ (CIS), which classically presents as a red, velvety patch. This appearance however is not specific and it is possible that many lesions are biopsied without significant benefit to the patient. The objective of this study was to determine whether routine biopsy of red patches seen in the bladder at cystoscopy is warranted. PATIENTS AND METHODS: 193 biopsies were taken from red patches seen at flexible and rigid cystoscopy during a 4-year period from December 1997 to January 2002 and examined by histopathology. Patients included in the study were those on cystoscopic follow-up for transitional cell carcinoma (TCC) of the bladder and those undergoing investigation for haematuria or lower urinary tract symptoms. RESULTS: In 193 (17.7% of total biopsies) red patch biopsies, malignancy was found in 23 (11.9%) and 18 of 23 (78.3%) were CIS. No malignancies were detected in red patches from patients under the age of 60 years. CONCLUSION: Red patch biopsy yields a positive finding of malignancy in 12% and was concluded to be a valuable exercise, particularly in those over the age of 60 years and on follow-up for TCC.

Adult↗
PubMed1998

Can urine bound diagnostic tests replace cystoscopy in the management of bladder cancer?

PURPOSE: We compare the diagnostic value of NMP22 and BTA stat testing, and QUANTICYT computer assisted dual parameter image analysis to cytology and cystoscopy in patients who had symptoms suggestive of transitional cell cancer or were being followed after treatment for that disease. MATERIALS AND METHODS: We prospectively evaluated voided urine and/or barbotage specimens from 291 patients a mean of 65.2 years old. All voided urine samples were evaluated by quick staining and standard cytology, the BTA stat 1-step qualitative assay (which detects a bladder tumor associated antigen) and the NMP22 test (which detects a nuclear mitotic apparatus protein). In addition, barbotage specimens were evaluated by QUANTICYT computer assisted dual parameter image analysis. All patients underwent subsequent cystoscopy and biopsy evaluation of any suspicious lesion. Sensitivity, specificity, and the predictive value of positive and negative results were determined in correlation with endoscopic and histological findings. RESULTS: In 91 patients with histologically proved transitional cell carcinoma overall sensitivity was 48, 57, 58, 59 and 59% for the NMP22 test, the BTA stat test, rapid staining cytology of barbotage samples, rapid staining cytology of voided urine specimens and image analysis, respectively. For histological grades 1 to 3 underlying transitional cell carcinoma sensitivity was 17, 61 and 90% for urinary cytology, 48, 58 and 63% for the BTA stat test, and 52, 45 and 50% for the NMP22 test, respectively. Specificity was 100% for cytology, 93% for image analysis, 70% for the NMP22 test and 68% for the BTA stat test. CONCLUSIONS: Immunological markers are superior to cytological evaluation and image analysis for detecting low grade transitional cell carcinoma but they have low specificity and sensitivity in grade 3 transitional cell carcinoma. Urine bound diagnostic tools cannot replace cystoscopy.

Adolescent↗
PubMed2002

Tumor detection by virtual cystoscopy with color mapping of bladder wall thickness.

PURPOSE: We determine the value of color mapping of bladder wall thickness for detection of tumor as a component of virtual cystoscopy. MATERIALS AND METHODS: A total of 31 subjects with hematuria and/or a history of bladder tumor underwent helical computerized tomography of the pelvis after distention of the bladder with air. Three-dimensional (D) models were constructed, and thickness of the wall was color mapped according to a fixed and validated mm. scale. Axial source images and 3-D models were reviewed and graded for the presence of wall thickening. A comparison was made with findings on conventional cystoscopy in 31 patients and pathological specimen in 13. RESULTS: Compared with conventional cystoscopy, the analysis of axial image yielded a sensitivity of 0.80, specificity 0.90, positive predictive value 0.80 and negative predictive value 0.90 for the presence of tumor. Examination of color mapped 3-D renderings resulted in 0.83, 0.36, 0.42 and 0.71, respectively. CONCLUSIONS: Thin axial computerized tomography of the air distended bladder shows promise as a potential screening tool for bladder cancer. The low specificity of color mapped 3-D renderings makes the technique inappropriate for screening. It may valuable for guiding urologists to additional suspicious sites in a patient with a known tumor.

Aged↗
PubMed1993

Synchronous cystoscopy and cystometry in the management of neurogenic bladder dysfunction.

The physical difficulties associated with cystoscopy and cystometry in the spinal cord injury patient led to a clinical trial of synchronous cystoscopy and cystometry in these individuals. Following a disappointing experience with external transducer methodology, a recently available fiberoptic microtransducer system was used and an effective system was developed. A total of 20 individuals with spinal cord injury underwent a standard water cystometrogram on an examination table followed by synchronous flexible cystoscopy and cystometry using a 5F fiberoptic microtransducer while seated in a chair. The results showed both pressure tracings to be clinically identical. Uninhibited contraction spikes, compliance curves and leak point pressures were essentially the same by both methods and artifact was not a problem. Given the speed, ease and reproducibility of this method, the difficulties with patient transfer for these studies have been virtually eliminated. Two urethral instrumentations have been replaced by 1. Examination room time was decreased from 60 to approximately 10 to 15 minutes with half of the required personnel. Perhaps more importantly, these occasionally problematic individuals clearly prefer this streamlined approach and patient compliance with followup has improved.

Cystoscopes↗
PubMed1992

Balloon cystoscopy with neodymium:YAG laser.

We performed balloon cystoscopy for the diagnosis of gross hematuria as well as for the treatment of bladder tumor using the neodymium:YAG laser. Animal experiments were done to evaluate the efficacy of laser irradiation through the balloon, which proved to have the same effect as conventional laser irradiation. A total of 40 patients with bladder diseases was observed and treated by balloon cystoscopy, and the results were examined comparatively. Even with gross hematuria the structure of the mucosa and the tumor could be observed in detail without irrigating the inside of the bladder. Most bladder tumors were successfully treated with laser irradiation through the balloon through the optic lens system. Therefore, balloon cystoscopy appears to be a useful endoscopic modality in neodymium:YAG laser surgery for the treatment of bladder tumor.

Animals↗
PubMed1988

Is antibiotic administration indicated after outpatient cystoscopy.

The incidence of urinary tract infection was examined in 138 patients who underwent diagnostic cystoscopy in an outpatient clinical setting with preoperatively sterile urine. A prospective randomized trial was conducted to compare the incidence of infection in patients who received no antibiotic (controls, group 1) and those who received a postoperative course of oral antibiotics (group 2). The incidence of bacteriuria after cystoscopy was 2.8 per cent in group 1 (control) and 1.5 per cent in group 2, with an over-all incidence of 2.2 per cent. Only 1 patient presented with a symptomatic infection (0.7 per cent). This study has confirmed the safety of outpatient cystoscopy and has demonstrated that routine administration of postoperative antibiotics is not indicated.

Ambulatory Surgical Procedures↗
PubMed1987

The effect of nifedipine on cystoscopy-induced autonomic hyperreflexia in patients with high spinal cord injuries.

We evaluated the ability of the calcium channel blocker nifedipine to control autonomic hyperreflexia during cystoscopy in 7 patients with cervical spinal cord injuries. Nifedipine (10 mg.) alleviated autonomic hyperreflexia when given sublingually during cystoscopy and prevented autonomic hyperreflexia when given orally 30 minutes before cystoscopy. No adverse drug effects were observed.

Administration, Oral↗