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At least 163 records · Page 9Linked to original sources
PubMed2005

5-aminolaevulinic acid-induced fluorescence cystoscopy during transurethral resection reduces the risk of recurrence in stage Ta/T1 bladder cancer.

OBJECTIVE: To assess the influence of 5-aminolaevulinic acid-induced fluorescence cystoscopy (FC) during transurethral resection (TUR) on the recurrence rate and the length of tumour-free interval in stage Ta/T1 transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS: In all, 122 patients with primary or recurrent stage Ta/T1 bladder TCC treated with TUR were enrolled in a prospective randomized study. In group A the TUR was performed with standard white-light endoscopy, and in group B with FC. The patients were followed using standard cystoscopy and urinary cytology. The recurrence-free interval was evaluated in whole groups, for single and multiple, and for primary and recurrent tumours separately. RESULTS: At the time of the first cystoscopy (10-15 weeks after TUR) tumour recurrence was detected in 23 of 62 patients (37%) in group A, but only in five of 60 patients (8%) in group B. The recurrence-free survival rates in group A were 39% and 28% after 12 and 24 months, compared to 66% and 40% respectively in group B (P = 0.008, log-rank test). In separate analyses, the recurrence-free survival rates were significantly higher using FC in multiple (P = 0.001) and in recurrent (P = 0.02) tumours. In solitary and primary tumours the median time to recurrence was also longer in group B, but the difference was not statistically significant. CONCLUSION: 5-aminolaevulinic acid-induced FC during TUR reduces the recurrence rate in stage Ta/T1 bladder TCC. The most significant benefit is in patients with multiple and recurrent tumours.

Aged↗
PubMed2005

Is photodynamic diagnosis using hypericin better than white-light cystoscopy for detecting superficial bladder carcinoma?

OBJECTIVE: To review the initial clinical results of photodynamic diagnosis (PDD) using hypericin (a new photosensitizer for PDD that helps to label flat urothelial tumours to facilitate biopsy) for the early detection of superficial bladder carcinoma, as flat noninvasive tumours of the bladder may be missed during conventional white-light cystoscopy (WLC) if there is bladder overdistension or ongoing cystitis. PATIENT AND METHODS: Between 1 January 2001 and 30 October 2004, 41 consecutive patients (mean age 66.1 years, sd 9.1, range 46-81) had transurethral resection for bladder cancer. Hypericin was introduced intravesically for 2 h before cystoscopy. Immediately after WLC, fluorescence cystoscopy (FC) was used at the same location and the same bladder site inspected using violet light. FC findings, e.g. positive or negative red fluorescence, were documented for each specific bladder site examined, and the exact location sampled for biopsy. RESULTS: The mean (sd, range) bladder capacity of the patients was 431 (86, 300-650) mL. In all, 179 biopsies were taken from the 41 patients; urothelial cancers were found in 41% (74) and 80% (33) had macroscopically visible bladder tumours; 40% (71) of the biopsies were positive under FC and 86% (61) of the 71 FC-positive biopsies showed cancer on histology. Twenty-five biopsies (14%) were positive on FC but not WLC. PDD testing with hypericin had a sensitivity of 82% (61/74) and specificity of 91% (95/105), vs WLC, at 62% (46/74) and 98% (103/105), respectively. The PDD test had a positive predictive value of 86% (61/71) and a negative predictive value of 88% (95/108), vs 96% (46/48) and 79% (103/131), respectively for WLC. There were no reports of significant complications after the procedure. CONCLUSION: PDD using hypericin shows promise, as it has a higher sensitivity but equivalent specificity than WLC. It can be used to detect flat lesions not seen on WLC. PDD testing is also well tolerated with minimal side-effects.

Aged↗
PubMed1998

Effect of digital rectal examination and flexible cystoscopy on free and total prostate-specific antigen, and the percentage of free prostate-specific antigen. Differences between two PSA assays.

OBJECTIVE: To determine the effect of prostate manipulations on free PSA, total PSA and the percentage of free PSA using an equimolar and nonequimolar PSA assays. METHOD: A total of 67 men were studied. Blood samples were obtained before and 45-60 min after two different prostatic manipulations: DRE from 45 patients and flexible cystoscopy from 22 patients. Total PSA (t-PSA) was assayed with a non equimolar method using the Cobas Core PSA kit from Roche (Cobas Core-PSA) and an equimolar method using the Immulite 3rd-generation PSA kit from DPC (Immulite-PSA). Free PSA (f-PSA) was quantified with an Immulite free PSA kit. We obtained two f-PSA/t-PSA ratios dividing the f-PSA by both t-PSA (Cobas Core-PSA) and t-PSA (Immulite-PSA). RESULTS: The Cobas Core-PSA yielded higher values than Immulite-PSA and the baseline percentages of free PSA were different depending on the method used. Both t-PSA values were increased after DRE and flexible cystoscopy from the baseline although the increase of Cobas Core-PSA was much higher than Immulite-PSA. Also the f-PSA was increased after the two manipulations. The f-PSA/t-PSA ratio (Cobas Core-PSA) remains at the baseline whereas the f-PSA/t-PSA ratio (Immulite-PSA) had an important increase from the baseline. CONCLUSION: The effect of DRE and flexible cystoscopy is different depending on the PSA assay used. The data from studies which are carried out in relation with the molecular forms of the PSA are not interchangeable if they are performed with different PSA methods (equimolar and nonequimolar). The serum samples should precede any prostate manipulation in all investigations related to PSA molecular forms.

Aged↗
PubMed2001

Significance of fluorescence cystoscopy for diagnosis of superficial bladder cancer after intravesical instillation of delta aminolevulinic acid.

OBJECTIVES: Most lesions of superficial bladder cancer may be easily missed during conventional white light cystoscopy. The aim of this work was to evaluate the efficiency of endoscopic fluorescence diagnosis of superficial malignant bladder tumours following intravesical instillation of delta-aminoleviulenic acid. PATIENTS AND METHODS: 30 patients of suspected or previously diagnosed bladder cancer were subject of evaluation. All patients received 50 ml of a 3% delta-ALA solution intravesically, 2-3 h prior to diagnostic cystoscopy. Fluorescence excitation intraoperatively was achieved by a violet-blue light from a xenon light source. RESULTS: A clear strong red fluorescence colour was observed emitting from all malignant vesical lesions. A diagnostic sensitivity of 98% and specificity of 65% has been determined for this novel diagnostic modality. CONCLUSION: Fluorescence cystoscopy using delta-ALA is a reliable procedure that can be offered to all patients with suspected bladder cancer lesions.

Adenocarcinoma↗
PubMed2003

Is using lignocaine gel prior to flexible cystoscopy justified? A randomized prospective study.

OBJECTIVE: We evaluate the discomfort and efficacy of instilling 2% lignocaine gel (Instillagel) versus smearing water-soluble gel (Aquagel) around the flexible cystoscope and external urethral meatus in men undergoing flexible cystoscopy for the first time and the overall efficacy of lignocaine gel in completion of the procedure. MATERIALS AND METHODS: A total of 140 patients divided into two groups, were randomized for this study: group A (n = 70) received approximately 11 ml of 2% lignocaine gel (Instillagel) intraurethrally for approximately 15 min, while in group B (n = 70) approximately 10-15 ml of water-soluble gel (Aquagel) was smeared around the scope and external urethral meatus. Total completion time for each procedure was recorded. Primary outcomes were pain during instillation of lignocaine, during insertion of scope and cystoscopy. Pain was recorded by the patient using a 100-mm nongraphic rating visual analogue scale. Secondary outcome included procedure time and cost analysis. RESULTS: The majority of patients in both groups reported mild pain with VAS 3 or less throughout the whole procedure. No significant difference was noted in the two groups at any stage of the procedure. Use of lignocaine gel added approximately 10 min to the procedure time. CONCLUSIONS: In our study there was no significant difference in patient discomfort between instilling lignocaine gel and smearing of Aquagel in completion of flexible cystoscopy. However, application of lignocaine gel added extra time, effort and cost to the procedure.

Anesthetics, Local↗
PubMed2005

Fluorescence cystoscopy in the management of bladder cancer: a help for the urologist!

As a disease characterized by a nature polymorphic and fluctuant in its evolution, superficial transitional cell carcinoma of the bladder remains a perpetual therapeutic challenge, and raises a great interest in the development of new diagnostic and surveillance techniques. This paper reviews 10 years of experience of fluorescence cystoscopy, a simple technique perfectly adapted to the current endoscopic equipment. Its principle is to enhance the visual contrast between benign and malignant cells. Three photosensitizing agents are available, two prodrugs: delta-aminolevulinic acid or hexaminolevulinate, and a natural substance: hypericin. With a detection rate of over 90% for carcinoma in situ and a real potential for detecting small tumors overlooked by standard cystoscopy, fluorescence cystoscopy may be clearly recommended in clinical practice. This technique favors a standardization of superficial bladder cancer endoscopic management and is susceptible to have a real impact on the disease recurrence and progression rate.

Cystoscopy↗
PubMed1994

Influence of digital examination, cystoscopy, transrectal ultrasonography and needle biopsy on the concentration of prostate-specific antigen.

The influence of various prostatic manipulations, including digital rectal examination, cystoscopy, transrectal ultrasonography and transrectal needle biopsy, on the serum prostatic-specific antigen (PSA) levels in 170 men, were examined. We found that digital rectal examination, cystoscopy and transrectal ultrasonography had no significant effect on PSA levels, except for transrectal needle biopsy, which caused an immediate increase of serum PSA in 96.2% of the patients lasting more than 2 weeks in 42.3% of the cases. In conclusion, serum PSA determination after digital rectal examination, after cystoscopy and after transrectal ultrasonography is accurate and reliable. On the other hand, we must wait about 6 weeks after needle biopsy before measuring PSA in the serum of patients with prostatic diseases.

Biopsy, Needle↗
PubMed1990

Follow-up of superficial bladder cancer: how to spare cystoscopies?

To study the efficacy, specificity and sensitivity of ultrasonography, cytology and phospholipid/fatty acid quotient (PL/FA) in the detection of recurrences in patients with superficial bladder cancer we performed these three examinations simultaneously with cystoscopy. In over 405 cystoscopies, 348 were negative and 57 were positive for tumor. Sensitivity, the most important parameter, was 73% for the three examinations together. Each method separately had the following sensitivity: ultrasound 26%; cytology 14%, and PL/FA 47%. Considering that there were only 15 false-negatives, with this follow-up scheme we save the patient from a lot of cystoscopies, avoiding their inherent morbidity.

Biomarkers, Tumor↗
PubMed2004

Cystoscopy in cattle--a valuable additional tool for clinical examination.

Based on the findings of physical examination and on laboratory findings the urinary bladder of 23 cows was examined endoscopically in order to investigate the application of cystoscopy in cattle. The endoscopic findings of all examined cows were compared with the findings of physical examination and the results of macroscopic and microscopic urinalysis and the bacteriological culture of the urine. By physical examination only 3 cows were diagnosed to have urinary tract disease, whereas all other cows were suspected of having an urinary tract disease. Bacteriological culture of the urine revealed Corynebacterium renale and Escherichia coli infection in 18 cows, while the remaining 5 cows were negative. By cystoscopy catarrhal cystitis was diagnosed in 2 cases, haemorrhagic cystitis in 5 cases, and fibrinous-purulent and fibrinous-haemorrhagic cystitis in 13 cases. Three cows showed no pathological changes of the urinary bladder mucosa by endoscopic examination. Cystoscopy facilitates diagnosis through the direct visualisation of mucosal lesions and makes it possible to give a more accurate prognosis based upon the findings.

Animals↗
PubMed2006

Cystoscopy in the diagnosis and follow-up of urinary schistosomiasis in Brazilian soldiers returning from Mozambique, Africa.

The assessment of urinary schistosomiasis in individuals coming from endemic areas often requires diagnostic resources not used in areas of exposure in order to determine complications or to establish more precise criteria of cure. Cystoscopy and 24-hour urine examination were performed, after treatments with praziquantel 40 mg/kg body weight, single dose, on 25 Brazilian military men who were part of a United Nations peace mission to Mozambique in 1994. The median age of the individuals was 29 years and all presented a positive urine parasitological exam. The alterations detected by cystoscopy were hyperemia and granulomas in the vesical submucosa in 59.1% of the individuals and only granulomas in 40.9%. A vesical biopsy revealed granulomas in all patients and viable eggs in 77.3% even after a period during which the patients no longer excreted eggs in urine. Cystoscopy after treatment, followed by biopsy and histopathological evaluation, performed in areas where the evolution of the disease can be better monitored, was found to be a safe criterion of parasitological cure.

Adult↗
PubMed1987

The evaluation of gross hematuria in anticoagulated patients: efficacy of i.v. urography and cystoscopy.

To determine the efficacy of investigating gross hematuria in anticoagulated patients, records were reviewed of 24 patients who had gross hematuria while being treated with warfarin for various thromboembolic disorders. All had IV urography, and half had cystoscopy. Sources of bleeding were found in seven (29%) of 24 patients by IV urography and in five (42%) of 12 patients by cystoscopy. Abnormalities considered responsible for bleeding included renal stones (four), transitional cell carcinoma (one), calcified renal mass (one), lymphoma (one), bladder tumors (two), hemorrhagic cystitis (two), and a bleeding prostate tumor (one). Additionally, an enlarged prostate was the only abnormal finding in five patients. If an enlarged prostate is considered a source of bleeding, the workup that included both IV urography and cystoscopy identified a cause of bleeding in 17 (71%) of 24 patients. The results suggest that IV urography and cystography are warranted in patients who take anticoagulants and who have gross hematuria.

Adult↗
PubMed1991

[The evaluation of cystoscopy in the screening of asymptomatic microhematuria].

As a prospective study on asymptomatic microhematuria, complete urological examinations including cystoscopy, IVP, ultrasound and urinary cytology were performed on 422 patients over 40 years old between January 1987 and December 1988 (group A). The results of group A was compared with that of retrospective study on 266 patients, who had incomplete urological examination between January 1984 and December 1985 (group B). Cystoscopy was performed on 321 patients (87.2%) in group A and on 108 patients (40.6%) in group B. Bladder tumor was found in 10 cases (2.4%) in group A, including 7 cases of male patients (5.7%), but in only 1 case (0.4%) in group B. Since the negative rate of abnormal urinary cytology was 50% and that of abnormal IVP was 90% in 10 cases of bladder tumor in group A, cystoscopy was considered to be an essential examination for the screening of patients with asymptomatic microhematuria over 40 years old patients.

Adult↗
PubMed2000

Dynamic cystography can replace cystoscopy following prostate seed implantation.

PURPOSE: To determine if dynamic cystography can replace cystoscopy following prostate seed implantation. MATERIALS AND METHODS: Three hundred three consecutive patients underwent prostate seed implantation using the real-time method. Following implantation, 60 cc of contrast media was injected into the bladder using continuous fluoroscopy. If any seed motion was detected, cystoscopy was performed and any seeds encountered were removed. Patients were followed after discharge for any seeds passed in the urine. RESULTS: Of the 303 patients, 3 (1%) were found to have one or more seeds in the bladder. No patients passed seeds following discharge. There were no adverse events associated with the cystography. CONCLUSION: Dynamic cystography can replace cystoscopy as the postimplant study to evaluated misplaced intravesical or urethral seeds.

Brachytherapy↗
PubMed2001

[Role of antibiotic prophylaxis in ambulatory cystoscopy].

BACKGROUND: There has been a great deal of discussion regarding the necessity of antibiotic prophylaxis in transurethral cystoscopy. In order to clarify this complicated issue, a randomized prospective study was performed on 126 patients planned for cystoscopy. PATIENTS AND METHODS: 126 patients who underwent urethrocystoscopy and did not have pyuria and bacteriuria were included and divided randomly into 2 groups: group 1 received 400 mg of norfloxacine and group 2 nothing. Urinalysis were performed on all patients 3 days after the examination. Statistical analyses were performed using Chi 2 test and the level of significance was set at 5%. RESULTS: The global rate of infection was 5%. In the group 1 the incidence of infection was 3% (2/67) vs 5.1% (5/59) in group 2. There were no significant differences in the incidence in the background factor between the 2 groups of patients (p > 0.05). CONCLUSION: Prophylactic administration of antibiotic before cystoscopy does not decrease the incidence of urinary tract incidence and it is not necessarily in patients with sterile urine.

Adult↗
PubMed2003

[Fluorescence cystoscopy using 5-aminolevulinic acid].

BACKGROUND: Fluorescence diagnosis has an increasing importance in different medical fields. In the presented paper, comparison of cystoscopy in white light with fluorescence cystoscopy after intravesical administration of 1 g of 5-aminolevulinic acid is presented. METHODS AND RESULTS: From the group of 63 persons examined, no difference between findings in white and blue light was found in 39 cases. In 21 patients more pathological spots were found in blue light (10 cases) or, in agreement with histology, pathology was detected in the blue light only (11 cases). CONCLUSIONS: The intravesical administration of 5-aminolevulinic acid had no side effects. Our study has definitely proved the advantages of fluorescence cystoscopy.

Administration, Intravesical↗
PubMedDate not supplied

[Diagnosis and treatment of recurrent surface cancer of the urinary bladder (early repeated cystoscopy and biopsy)].

In spite of some achievements in the field of oncourology, the problem of diagnosis and treatment of surface cancer of the urinary bladder (SCUB) remains urgent because of early recurrence and progression after TUR (50 and 30%, respectively). Repeated cystoscopy and biopsy early after surgery enable the physician to establish a real stage of SCUB (invasion into the bladder wall--criterion T and cell differentiation--criterion G). Early accurate staging of the disease allows design further policy of treatment. Early repeated cystoscopy and biopsy detected recurrence of transient cell SCUB in 51 (24.75%) patients. In 20 (9.7%) patients recurrent tumor located at the site of the previous operation. In other places recurrences were detected in 31 (15.05%) patients. Recurrent tumor was found in 23 (11.16%) cases at stage Ta and 28 (13.6%) patients at stage T1; in 15, 30 and 6 patients with high, moderate and low malignancy grade (22.06, 24.79 and 35.29%, respectively). SCUB progression developed in a total of 15 (7.28%) patients: by T criterion (T1-T2a) in 9 (4.37%) patients and by criterion G (G2-G3) in 6 (2.91%) patients. Thus, early repeated cystoscopy and biopsy detect early residual and recurrent SCUB facilitating design of further treatment policy.

Adult↗
PubMed2004

Bladder tumors: dynamic contrast-enhanced axial imaging, multiplanar reformation, three-dimensional reconstruction and virtual cystoscopy using helical CT.

BACKGROUND: There have been few studies to evaluate the effects of helical CT on bladder tumor. This study was to evaluate the clinical applications of helical CT dynamic contrast-enhanced axial imaging, multiplanar reformation (MPR), three-dimensional (3D) reconstruction and virtual cystoscopy (CTVC) in bladder tumors. METHODS: The precontrast and four-phase postcontrast helical CT scans were performed in 42 patients with bladder tumors confirmed by conventional cystoscopy and pathology. MPR, 3D and CTVC images were generated from the volumetric data of the excretory phase. The results were then compared with the findings of conventional cystoscopy and surgery in a double-blinded mode. RESULTS: The sensitivity of the axial, 3D and CTVC images in detecting the bladder tumors were 90.8%, 76.9% and 95.4% respectively. The dynamic contrast-enhanced axial images could provide excellent intramural and extravesical information, and the accuracy in preoperative tumor staging was 87.7%. MPR could directly demonstrate the origin and extravesical invasions of the tumors and their relation to the ureter. 3D and CTVC images were useful for displaying the surface morphology of the tumor and the relationship between the tumor and the ureteric orifices, whereas CTVC could depict the tumors smaller than 5 mm that were not seen on the axial images. CONCLUSIONS: The combination of axial, MPR, 3D and CTVC images with helical CT can provide comprehensive information on bladder tumor.

Adult↗
PubMed2004

Practical cystoscopy: care of the instruments and preparation for a cystoscopic examination.

Periodically, a look at the past helps health care professionals see how much practice has changed as well as how some concepts and practices remain similar to the original rationales and techniques. Two chapters from a 1911 textbook on cystoscopy have been reprinted that describe catheter and instrument care and preprocedure requirements for cystoscopy performed in the hospital, office, or home. Sterilization methods and instruments for cystoscopy have improved in the century since this book was written but the rationale for the procedure and concepts guiding the instrumentation have some similarity with the practices performed nearly 100 years ago. Some comments also provide a bit of comic relief. One example, "this undoubtedly shortens the life of the catheter, but it lengthens the life of the patient" appears in the discussion about catheter cleaning after use in a pus case.

Cystoscopes↗