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A short series of intravesical prophylactic instillations of mitomycin C for relapsing or multiple superficial bladder tumors is reported. With a mean follow-up of 15 months, 6 out of 9 patients, had abnormal control cystoscopies at 12 months. However, only 2 of these 6 patients have presented with tumor recurrence.
To prevent urogenital infections occurring after urethrocystoscopy, we have studied the prevalence of these diseases without the use of antibiotic agents subsequent to urethrocystoscopy to determine the relative importance of aseptic procedures and whether administration of antibiotics is really required for this purpose. Patients enrolled in the present study included those undergoing urethrocystoscopy at four hospitals, totaling 146 patients (93 male and 53 female patients). All of these patients were apparently free of urogenital infections prior to urethrocystoscopy, with less than 5 leucocytes per field in urinary sediment, and a bacteria count of less than 10(4) cells/ml. Each patient was checked between 3 and 14 days after examination for 1) presence of clinical symptoms such as fever, bladder irritation symptoms and urethral secretion, 2) urinalysis and urinary culture, and 3) palpation of epididymis, testis and prostatic gland as required. The endoscope was sterilized for 20 to 30 minutes with 2% glutaraldehyde at 3 clinical institutions and with 0.5% chlorhexidine at the other, in a total of 116 and 30 patients, respectively. Sterilized distilled water was used as perfusate. The external urethral meatus of the subject was disinfected with 0.5% chlorhexidine, followed by local anesthesia with xylocaine jelly. Ten minutes after disinfecting the hands of the examiner, urethroscopy and cystoscopy were performed in this order. Urinary tract infection was detected in one male patient (1.1%) and 2 female patients (3.3%). In these cases, the endoscope was sterilized with glutaraldehyde in 2 cases and with chlorhexidine in the other. None of the subjects demonstrated fever or genital infections.(ABSTRACT TRUNCATED AT 250 WORDS)
Percutaneous anterior colpopexy, as described by Stamey, constitutes a simple, reliable method for treatment of orthostatic and stress incontinence of urine in women. As with all operations destined to correct this infirmity, its aim is to replace the bladder neck and initial part of urethra into spaces subject to pelvic pressure. The principle of the operation consists of solidly attaching the whole thickness of particularly the para-cervicourethral vagina fibrous layer to the anterior abdominal wall by means of two solid monofilament threads of caliber 2, scissoring on the threads being prevented by insertion of a 1 X 0.5 cm vascular prosthesis. The operation mainly involves a vaginal approach: the vaginal incision in T exposing the bladder neck. Two abdominal incisions 2 cm in length and avoiding the aponeurosis are made 1 cm above the pubis from one side of the median line to the other. These allow Stamey's needles to be passed behind the symphysis up to the vaginal incision under endoscopic control. Cystoscopy is an essential part of surgery since it allows verification of good positioning of thread exactly at the bladder neck level and of the quality of the hyperelevation of posterior lip of bladder neck obtained. As effective as other retropubic anterior colpopexies, this procedure under endoscopic control has the major advantage of avoiding opening of Retzius space, with its inevitable morbidity, and of being possible without difficulty in previously operated patients. It should undoubtedly be included in the therapeutic armament used for this frequent infirmity.
A 69-year-old male patient developed gross hematuria. Cystoscopy revealed a very small mass growing from the dome. The patient underwent transurethral resection of the mass under epidural anesthesia. Pathological examination of the resected specimen revealed submucosal leiomyoma of the bladder. The pathology, clinical manifestations, radiological and cystoscopic findings, treatment and prognosis of vesical leiomyoma are reviewed.
Lower urinary tract infections are not procedure-related conditions. Genitourinary tract abnormalities are uncommon, and there are few indications for an extensive workup of women with urinary tract infections. To avoid overtreating and yet remain confident of providing the best possible care, it is important to recognize that urinary tract infections are a spectrum of diseases with different etiologies and different diagnostic and therapeutic requirements. In the vast majority of cases, the urologist's responsibility is to avoid unnecessary treatment, to educate the patient on her condition, and to provide treatment with a first-line, established antimicrobial. The excretory urogram is indicated when the patient presents with symptoms of upper tract infection or asymptomatic hematuria. Urodynamic studies are useful for the patient with an abnormal voiding pattern or suspicion of neurogenic bladder. Cystoscopy has a place only when there is suspicion of bladder tumor. The voiding cystourethrogram is the most useful study for patients with urinary tract infection when there is suspicion of urethral diverticula. Studies are not recommended during a period of acute infection. Procedures that manipulate the urethra are contraindicated.
The level of day case surgery is much lower in Northern Ireland than in England. A questionnaire was sent to all 55 consultant general surgeons in Northern Ireland to assess attitudes to this form of care and 51 (93%) replied. They were asked about the suitability of five procedures for day surgery. The three minor procedures of vasectomy, cystoscopy and gastroscopy were regarded as suitable or very suitable by 50 (98% of those who replied), 48 (94%) and 48 (94%) respectively. For the two intermediate procedures, 25 (49%) regarded the repair of inguinal hernia as suitable for day case surgery and 22 (43%) ligation of varicose veins. When asked about eight factors limiting their use of day surgery for inguinal hernia repair, the two most frequently rated as important were 'home conditions' and 'level of provision of domiciliary care' (both by 44 (86%) of the surgeons). Of factors which might promote their use of day surgery for this operation the two most important were 'more efficient use of health service resources' (71%) and the 'ability to convalesce at home' (67%). The problem of under-reporting of day cases and the importance of accurate statistics are considered.
Many endourologic procedures can be performed routinely on an outpatient basis, including flexible cystoscopy, ureterorenoscopy, and percutaneous nephroscopy through a mature tract. Others, such as percutaneous nephrostomy, nephrostolithotomy, and antegrade ureteral stent placement, can sometimes be done on an outpatient basis. This article describes the indications, techniques, postoperative care, and results of these procedures.
A case of primary localized amyloidosis of the bladder during a twelve-year period is described. The initial symptom was miction pain when she was 43 years old. Cystoscopic examination revealed yellowish elevated lesion with hemorrhage at the right side of the bladder neck. Transurethral resection was performed, but two years later recurrence was found at the trigonum as well as the original site. The two lesions were apart. She remained asymptomatic for the following ten years until she returned to us with bladder symptoms. Cystoscopy showed the lesion was more diffuse and the posterior wall was involved in continuity with the trigonum. Complete transurethral resection was not possible because of generalized bladder involvement. Our case illustrates the clinically benign but slowly progressive nature of amyloidosis of the bladder. Multifocal recurrence is also to be noted. Our current treatment policy is conservative treatment with careful follow-up. She is asymptomatic three months postoperatively.
In summary, hematuria, either gross or microscopic and with or without any accompanying symptoms, should always alert the clinician to the possibility of serious urologic disease and should virtually always trigger a thorough urologic investigation. This can be done by immediate referral to the urologist, or it can be done by the primary care physician initiating the diagnostic work-up in children by obtaining studies for acute poststreptococcal glomerulonephritis and in adults by obtaining excretory urograms with physiologic voiding films and also by urine cytologic studies and urine cultures. Appropriate referral to a urologist can then be made for additional studies that might be indicated, such as cystoscopy and cystourethroscopy and for meticulous follow-up of any abnormal findings. The physician who delays or defers a careful investigation into the cause of a given patient's hematuria (gross or microscopic) does the patient a disservice at best and, at worst, may inadvertently permit a significant disease process to become more extensive.
An increasingly large volume of data is being accumulated regarding the effects of vesicoureteric reflux on the kidney, data that influence clinical management. Although concrete guidelines cannot be drawn that will apply to all patients, important considerations include the following: All children with documented urinary infections should have a voiding cystourethrogram. The voiding cystourethrogram may correlate with probability of spontaneous resolution of vesicoureteric reflux. Younger patients have a higher chance of spontaneous resolution of vesicoureteric reflux. There is a definite familial tendency to vesicoureteric reflux, and patients with significant vesicoureteric reflux and scarring are more likely to have affected siblings. DMSA renal scanning is highly sensitive in the detection of scarring. Cystoscopy may play a role in the evaluation of the refluxing ureterovesical junction, but does not have as much prognostic significance as the voiding cystourethrogram. Urodynamic investigation may be important in evaluating children with urinary infections, reflux, and symptoms of voiding dysfunction. High-grade vesicoureteric reflux is associated with an increased incidence of renal scarring, and the answer to optimal management is not yet available. Most scarring occurs in infancy or childhood. Nonoperative management, especially in moderate degrees of reflux, can achieve a high rate of success. Nonoperative management requires continuous antibiotic prophylaxis. Breakthrough infections or lack of compliance with nonsurgical management have a high complication rate and must be managed aggressively. Antireflux surgery can be performed with a minimal complication rate.(ABSTRACT TRUNCATED AT 250 WORDS)
Twenty patients involving three Cubans coming foreign countries with a diagnosis of urinary schistosomiasis are studied. The importance of laboratory diagnosis and radiographic study, mainly simple study and post-mictional cystography, is stressed. The lesions found during cystoscopies are described and it is attempted their classification. In all cases the diagnosis was corroborated from biopsy samples. The usefulness of the ambilhar therapy is pointed out.
The clinical course of sigmoidvesical fistula due to rupture of colonic diverticulitis is described. The patient, a 72-year-old-man, had chief complaints of cloudy urine, pneumaturia and fecaluria. The fistula was diagnosed by cystoscopy. In this case, primary resection of the sigmoid colon and wedge resection of the bladder including fistula were performed, and the sigmoidvesical fistula was completely cured. Statistical analysis was made on 43 cases of colovesical fistula due to diverticulitis in Japan including our own case.
Clinical observations were performed on 5 cases of eosinophilic cystitis that had been diagnosed by our criteria. In all 5 cases some kind of allergic diseases was found. General urinalysis did not show any definite tendency, but eosinophils in urine were found in 4 cases. Cystoscopy revealed only chronic inflammation and submucosal hemorrhage in 4 cases, and the other case showed ulcerative changes. A positive to immediate skin reaction was seen in 2 of the 4 cases. IgE RAST was positive for mite, house dust and mugwort in 1 of these 2 cases. In this case immediate allergic reaction was suspected as part of the cause of the cystitis.
A 44-year-old woman was admitted to our hospital, complaining of terminal hematuria. On cystoscopy four yellow and soft nodular masses were observed in the bladder, one of which had central ulceration. TUR was performed for these masses. Histological examination revealed that they were vesical malacoplakia. The masses consisted of aggregates of macrophages with abundant cytoplasma in which typical Michaelis-Gutmann bodies were demonstrated by light and electron microscopies.
The authors report eleven cases of interstitial cystitis, and discuss two different aspects of the disease: the classic form, with reduced bladder capacity and Hunner's ulcer, and the early form, which is diagnosed by cystoscopy under general anesthesia, and bladder biopsy. The hallmark of this early form is the discovery of multiple petichiae in the bladder mucosa during the second distension of the bladder.
A case of an infectious urachal cyst that presented as a lower abdominal mass in a 44-year-old man is reported. There was no urinary tract infection. Cystoscopy revealed the dome retracted. All other investigations were normal without microscopic hematuria. Laparotomy revealed the mass attached to the small intestine because of infection. The mass was excised after partial resection of small intestine and partial cystectomy.
Forty-seven patients undergoing cystoscopy received etomidate with either fentanyl or alfentanil to induce and maintain anaesthesia in a randomized, double-blind comparison. There were no significant differences in the composition of the groups, or in the clinical efficacy and side-effects of the anaesthetic combinations used. Early recovery of consciousness and orientation was similar in both groups, but late recovery, assessed by use of Maddox Wing and digit substitution tests, was faster in the patients who received alfentanil.
The different types of urinary incontinence in the female are defined and described. A meticulous differential diagnosis is a prerequisite for adequate treatment. The pre-treatment examination includes a detailed history, a residual urine, a gynaecological examination, a neurological examination, an intraveinous pyelogram, the incontinence test, the Bonney and the Bethoux tests, and a urethro-cystoscopy. In difficult cases urodynamic tests and X-rays of the bladder and the pelvic organs are added to the workup. Among 54 patients with urinary incontinence, 31 had stress incontinence and 23 had incontinence of another cause such as detrusor instability or a urethral syndrome.