MULTIDETECTOR COMPUTED TOMOGRAPHY CYSTOGRAPHY AND VIRTUAL CYSTOSCOPY VERSUS CONVENTIAL CYSTOSCOPY IN EVALUATION OF URINARY BLADDER MASSES

Abstract

Background: Bladder carcinoma is the most common tumor among the low urinary tract, accounting for 90% of cancer cases. Conventional cystoscopy does not provide information about extravescical extensions of the tumor. Multi-detector computed tomography cystography (MDCTC), combined with virtual cystoscopy, is mandatory for tumor, lymph node and metastases staging, and also is useful when conventional cystoscopy is inconclusive or cannot be performed. Objective: Evaluation of the accuracy of 160-MDCT cystography and virtual cystography versus convention cystoscopy in diagnoses of urinary bladder masses Patients and methods: This study included seventy patients referred from the inpatient and outpatient clinic of Damietta and Al-Zahraa Urology Departments, Al-Azhar University Hospitals for 160-MDCT cystography and virtual cystoscopy examination, over a period from October 2014 to October 2016. Patients were fifty one males and nineteen females, their ages ranged from eighteen to eighty years, and the mean age was fifty eight years. Results: Convention cystoscopy detects eighty seven urinary bladder lesions while eighty three lesions identified in MSCT MPR & virtual cystoscopy when used together, while eight lesions detected with MSCT MPR and eighty two with virtual cystoscopy when used separable from each other. Their diameters ranged from 5-mm to 35-mm. Morphological classification were fifty two polypoid lesions and thirty five sessile. The histopathological examination of fifty eight malignant lesions in fifty one patients: Fifty lesions were transitional cell carcinoma, four lesions of squamous cell carcinoma, two lesions carcinoma in situ and two lesions of small cell carcinoma. In addition, twenty nine benign lesions were detected in nineteen patients: Eighteen lesions were polypoidal cystitis, eight were bilharzial, and three were papilloma. Conclusion: MDCT cystography and virtual cystoscopy were non-invasive technique for primary diagnosis of urinary bladder lesion and extravesical extension, but still convential cystoscopy was the method of choice for biopsy.