Cystoscopic Technique Research Articles

Cystoscopy and Placement of Ureteral Stents: Preoperative for HIPEC Surgery

Cytoreductive debulking surgeries can be complicated by difficulty identifying the course of the ureters in the retroperitoneum due to exacerbation by any anatomical distortion from tumor burden or history of previous intra-abdominal operations. Inadvertent direct injury to or devascularization of the ureters or the rest of the lower urinary system during the course of these procedures is a serious concern and can result in increased morbidity for the patient. In order to reduce these risks, urologists often prophylactically place ureteral stents in patients preoperatively in order to aid surgical oncologists in readily identifying the course of the ureters during surgery. Here we present the prophylactic ureteral stenting of a patient undergoing cytoreduction and hyperthermic intraperitoneal chemotherapy for extensive appendiceal adenocarcinoma metastasis. We outline the proper cystoscopic technique, identification of the ureteral orifices, stent placement, bladder inspection, and how to secure the stents with the Foley catheter. The stents were placed without incident and without encountering any resistance, suggesting the ureters were not heavily involved with the tumor. Inspection of the bladder revealed no unusual indentation, extrinsic pressure, masses, or other pathology.

Transurethral Incision with Transverse Mucosal Realignment for the Management of Bladder Neck Contracture and Vesicourethral Anastomotic Stenosis

ObjectiveTo assess efficacy and safety of a novel cystoscopic technique for definitive repair of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS). MethodsA retrospective review of patients who underwent a transurethral incision with transverse mucosal realignment between July 2019 and December 2020 by a single surgeon was completed. This is novel procedure of incising a scar cystoscopically and using a laparoscopic suturing device transurethrally to bring healthy bladder mucosa across the defect, like a YV plasty. Patients were only included if they had ≥4 months follow-up. Surgical success was defined as ability to pass a 17 French flexible cystoscope through the previously stenotic segment at 4 month follow up. ResultsNineteen patients with a median follow-up of 6 months were included in this analysis. Etiology of posterior urethral stenosis was 53% from VUAS and 47% from BNC, with 32% of patients having prior pelvic radiation. Success was achieved in 89% of patients after 1 procedure and 100% of patients achieved success after a second procedure. There was no de novo incontinence or major complications. ConclusionTransurethral incision with transverse mucosal realignment for VUAS and BNC has a high success rate after only 1 procedure. This is the first reported series of an endoscopic Y-V plasty type repair for BNC and VUAS. Longer term follow up to ensure durability and reporting from other institutions will be needed to establish reproducibility.

Therapeutic Efficacy of onabotulinumtoxinA Delivered Using Various Approaches in Sensory Bladder Disorder

Cystoscopic onabotulinumtoxinA (onaBoNTA) intradetrusor injection is an efficient and durable modality for treating sensory bladder disorders. However, the inconvenience of using the cystoscopic technique and anesthesia, and the adverse effects of direct needle injection (e.g., haematuria, pain, and infections) have motivated researchers and clinicians to develop diverse injection-free procedures to improve accessibility and prevent adverse effects. However, determining suitable approaches to transfer onaBoNTA, a large molecular and hydrophilic protein, through the impermeable urothelium to reach therapeutic efficacy remains an unmet medical need. Researchers have provided potential solutions in three categories: To disrupt the barrier of the urothelium (e.g., protamine sulfate), to increase the permeability of the urothelium (e.g., electromotive drug delivery and low-energy shock wave), and to create a carrier for transportation (e.g., liposomes, thermosensitive hydrogel, and hyaluronan-phosphatidylethanolamine). Thus far, most of these novel administration techniques have not been well established in their long-term efficacy; therefore, additional clinical trials are warranted to validate the therapeutic efficacy and durability of these techniques. Finally, researchers may make progress with new combinations or biomaterials to change clinical practices in the future.

Noncystoscopic removal of retained ureteral stents in children: A retrospective study from a single-center.

Cystoscopic technique is the current common method of retrieving double J ureteral stent in most pediatric urological centers. In this study, we evaluated the feasibility and efficacy of a novel noncystoscopic method to remove retained ureteral stents in pediatric patients.We reviewed all medical records from a total of 102 patients who were treated in our hospital between January 2013 and December 2016 to remove the double J ureteral stent retained into the ureter. The pediatric patients were divided into 2 groups based on different surgical options: cystoscopic group and noncystoscopic group. The surgery time (including time for instrument preparation), operation time, expenses, postoperative urination discomfort, and hospitalization were compared between the 2 groups.The noncystoscopic group took significantly less time for surgery and operation than the cystoscopic group (surgery time:7.40 ± 3.75 vs 18.42 ± 2.77 min, P <.05; operation time: 3.54 ± 2.03 vs 4.48 ± 2.04 min, P <.05). The mean spending for patients in the noncystoscopic group were less than that in the cystoscopic group ($736.70 ± 105.96 vs $618.23 ± 110.31, P <.05). There were less children with postoperative urination discomforts in the noncystoscopic group than that in the cystoscopic group (8 vs 20 cases, χ2 = 4.241, P <.05). The mean hospitalization of the noncystoscopic group was shorter than that of the cystoscopic group (3.20 ± 1.25 vs 4.13 ± 1.63 d, P <.05). The differences in all comparison projects were significant.The noncystoscopic procedure is a safe and viable technique that may be used successfully in pediatric urology. This novel procedure which is much safer and more affordable provides an alternative solution to remove retained ureteral stents in child patients.

Repeated botulinum toxin type A (Dysport®) injections for women with intractable detrusor overactivity: a prospective outcome study

We present the cohort of 33 women who underwent botulinum toxin type A (BTX-A) injections examining the efficacy and safety of BTX-A in idiopathic detrusor overactivity (IDO). The aim of this report is to describe the outcomes of those who underwent repeated injections of BTX-A. All 33 women had 3 or more injections with an initial dose of 500 units of Dysport with subsequent injections between 500 and 750 U, administered by the classic trigone-sparing flexible/rigid cystoscopic technique. An informed consent was obtained in all cases. Efficacy was measured using voiding diaries and quality of life (QOL) assessed with the International Consultation on Incontinence Questionnaire-Short Form (ICIQ -SF). This project was approved by the Clinical Effectiveness Department and the Drugs and Therapeutics Committee (DTC). Therefore, ethical approval was not required. This study included 33 women who have been successfully treated with repeated intradetrusor injections of BTX-A (Dysport). Mean duration between the first and second injections was 15.2 ± 7.2 months, whereas between the second and third was 19.2 ± 10 months (P = 0.025). Two women developed urinary tract infection and required clean intermittent self-catheterization. Three women required dose escalation to 750 units. Longer duration of subjective QOL improvement was noted between the second and third botulinum toxin injections compared to duration between the first and second injections. BTX-A appears to be effective and safe after repeated administration in women with IDO. The duration of the injection tends to get prolonged after the second injection.

Transurethral neo-orifice (TUNO) a novel technique for management of upper pole obstruction in infancy

Ureteral duplication is the most common urologic abnormality. The upper pole ureter can sometimes be associated with a ureterocele. In rare cases the ureteral insertion is extravesical and can result in significant hydroureteronephrosis. Patients can present with urinary tract infection, abdominal mass or urinary obstruction. Traditional procedures include ureteral reimplantation, ureteroureterostomy or heminephroureterectomy. These reconstructive procedures are technically challenging in small infants, especially when the hydroureteronephrosis is severe. In some cases a distal cutaneous ureterostomy is performed for immediate drainage followed by definitive surgery when the child is older. We describe our initial experience with a novel cystoscopic technique which provides drainage of the upper pole ureter and avoids the need for an incision or stoma. A 3 month-old boy presented with urinary tract infections and failure to thrive. Ultrasound revealed severe upper pole hydroureteronephrosis. Voiding cystourethrography did not reveal vesicoureteral reflux or the presence of a ureterocele. The patient underwent cytoscopy. The ectopic ureteral orifice was not identified. A transurethral, transvesical needle puncture and confirmatory ureteropyelography was used to access the dilated upper pole ureter. Guidewire passage, followed catheter dilation then allowed creation of a new ureteral orifice using a holmium laser. The patient tolerated the procedure well. He was discharged after overnight observation. The hydronephrosis improved, urinary tract infections have not recurred and the patient rapidly improved feeding and weight gain. Trans-Urethral Neo-Orifice creation is a minimally invasive option for initial decompression for patients with obstructive ureteral ectopia.

Minimally painful retrieval of ureteral stents using by ureterescope

Aim: The standard method for retrieving the ureteral stents is the cystoscopic technique. We describe a minimally painful method for retrieving ureteral stents by using an ureteroscope. Methods: A total of 60 patients with ureteral stents were enrolled in this study. The patients were randomized into a cystoscopic (30 cases) and an ureteroscopic (30 cases) group. All stents were retrieved by a cystoscope in the first group and by an ureteroscope in the second group, under topical anesthesia. Patients in each group were assessed for stented time, stent side and reason of stent placement, operative time, peroperative pain, postoperative pain, irritative voiding symptoms and hematuria. Results: Stents were successfully retrieved in 60 patients. There were no statistical differences in the two groups regarding patient’s gender and age or stent side, operative time and stented time (p>0.05). Mean operative pain score was significantly higher in the cystoscopic group than in the ureteroscopic group (p<0.01). The irritative voiding symptom scores and hematuria were more prevalent in the first group than the second (p< 0.05). Conclusion: In present study ureteroscopic stent retrieval was found to be minimally a painful, safe and reliable method. The ureteroscopic retrieval procedure is highly tolerable by patients than the cystoscopic retrieval. We suggest that it may be the standard technique for stent retrieval.

Repeated Injections of Botulinum Toxin-A for Idiopathic Detrusor Overactivity

To report the efficacy and safety of repeated injections of botulinum toxin-A (BTX-A) in treating idiopathic detrusor overactivity refractory to anticholinergics. Furthermore, we describe whether dose alteration in patients with poor responses or voiding dysfunction after initial treatment can improve outcomes. A cohort of 34 patients who participated in a clinical trial was followed up and their progress reported. Twenty from this group had >1 BTX-A injection. Each patient received 200 U BTX-A initially, with subsequent injections between 100 and 300 U, administered by a trigone-sparing flexible cystoscopic technique. Efficacy was measured using voiding diaries and quality of life (QoL) assessed with Incontinence Impact Questionnaire-7 and Urogenital Distress Inventory-6 questionnaires. Urodynamic data were obtained for injections 1-3. All measurements were performed before and 3 months after injections. Twenty patients received a repeat injection and of these 9 subsequently received a third and fourth injection. Significant improvements in overactive bladder syndrome symptoms and QoL were observed after each injection as compared with baseline. Maximum cystometric capacity and bladder compliance increased with decrease in the maximum detrusor pressure during filling cystometry. When comparing overactive bladder symptoms, QoL, and urodynamic parameters 3 months after the first and last injections, no significant differences were found. Nine patients had their BTX-A dose altered, with better outcomes in 5. The commonest reported problems were difficulty in emptying the bladder and urinary tract infection. BTX-A appears to be effective and safe after repeated administration in patients with idiopathic detrusor overactivity. Certain patients will benefit from dose optimization to improve efficacy or prevent voiding dysfunction.

Improvement in quality of life after botulinum toxin‐A injections for idiopathic detrusor overactivity: results from a randomized double‐blind placebo‐controlled trial

OBJECTIVE To determine whether botulinum toxin-A (BTX-A) treatment has an effect on the quality of life (QoL) of patients with overactive bladder (OAB) refractory to anticholinergics. PATIENTS AND METHODS This was a single centre, randomized, double-blind, placebo-controlled trial. Participants were men and women with idiopathic detrusor overactivity (IDO). Participants were randomised to receive either 200 U of BTX-A (Botox(R), Allergan Inc., Irvine, CA, USA; n = 16) or placebo (n = 18) via a trigone-sparing flexible cystoscopic technique. QoL was assessed using the King's Health Questionnaire (KHQ) at baseline and at 4 and 12 weeks, after injection. At 12 weeks patients were 'unblinded' and a further open-label follow-up in the BTX-A group occurred at 24 weeks. The changes in the subdomains of the KHQ were assessed over the study period. RESULTS Overall QoL was significantly improved in the BTX-A treated patients compared with placebo in the blinded part of the study. When analysing the KHQ subdomains, 'Incontinence Impact', 'Emotions', 'Physical Limitations', 'Social Limitations' and 'Severity Measures' were significantly improved in those that received BTX-A compared with placebo. The 'Symptom Severity' domain was also significantly improved at 4 weeks but not at 12 weeks. At 12 weeks 'Role Limitations' also became statistically significant in favour of BTX-A. The open-label extension study suggested these benefits last for at least 24 weeks. CONCLUSIONS BTX-A bladder injections at 200 U appear to improve QoL in patients with OAB symptoms and IDO refractory to anticholinergics for at least 24 weeks. As well as the improvement seen in clinical parameters with this form of therapy, perhaps of more importance to the patient, is the improvement in QoL.

Resection of Inflammatory Polyps in Dogs Using Laparoscopic-Assisted Cystoscopy

Inflammatory polyps in the urinary bladder of two dogs were removed via laparoscopic-assisted cystoscopy. In addition, one dog had a calculus removed and liver biopsies taken using the same two trocar sites. The laparoscopic-assisted cystoscopic technique provided clear surgical margins and permitted a thorough examination of the inside of the bladder and urethra. The technique was minimally invasive, produced little abdominal injury, and limited urine contamination of the abdomen.

Treatment of detrusor sphincter dyssynergia by transperineal injection of botulinum toxin

Detrusor-sphincter dyssynergia is an involuntary contraction of the external urethral sphincter during the detrusor contraction. It causes voiding dysfunction and can lead to urologic complications such as hydroureteronephrosis and renal failure. Patients with spinal cord injuries are particularly vulnerable. Botulinum toxin has been used via cystoscopy to decrease the activity of the external urethral sphincter. This report describes the treatment of 5 tetraplegic patients by single transperineal injections of botulinum toxin for detrusor-sphincter dyssynergia, proved by a urodynamic study with electromyography. A total of 15 injections was given, resulting in improved bladder function in all patients. Urodynamic assessment after treatment showed an increase of the functional detrusor capacity and a decrease of the maximal detrusor pressure during voiding. These results confirm the consideration of botulinum toxin as a treatment for detrusor sphincter dyssynergia. A single transperineal injection is a valuable, less invasive treatment using a cystoscopic technique.

Transurethral Cystoscopic Balloon Dilatation of the Prostate

Balloon dilatation of the prostate for relief of symptoms secondary to benign prostatic hyperplasia is reported to be safe and effective. This study analyzes the First series of patients to be dilated by a method involving a direct-vision cystoscopic technique. Of the first 22 patients, 21 were available for follow-up: 17 (81%) were improved at the 1-month follow-up, and of those, 13 (76%) were still improved at 1 year. If patients with advanced obstruction, as documented by peak uroflow of no more than 5 ml/sec had been excluded, the early success rate would have been 87%. There were no recorded instances of retrograde ejaculation or incontinence. Of the patients, 77% were sent home on the day of the dilatation. Balloon dilatation of the prostate is less invasive and less costly than transurethral prostatectomy. It is effective in patients with mild degrees of obstruction, but patients with advanced obstruction or very large prostates continue to require prostatectomy.

Experiments with Induced Bacteriuria, Vesical Emptying and Bacterial Growth on the Mechanism of Bladder Defense to Infection

Experiments with Induced Bacteriuria, Vesical Emptying and Bacterial Growth on the Mechanism of Bladder Defense to Infection

Cystoscopic Technique and Instruments—General Considerations

Cystoscopic Technique and Instruments—General Considerations

Non-operative procedures in urology

T HE remarkabIe stride which has been made in the deveIopment of cystoscopic technique within the last two decades, the better understanding of underlying pathoIogy made possibIe by the introduction of urography, have tended to conservatism in the management of uroIogica1 conditions to a degree never known before. CauIk in his presidentia1 address before the American UroIogicaI Association Iaid emphasis on the fact that “in spite of surgica1 preparedness and surgica1 efficiency, the striking tendency of uroIogy today is conservatism. Science has reduced uroIogica1 surgery in the Iast quarter of a century to a striking degree in spite of the fact that it has given faciIities for its advancement . . . Many of the operations have been either restricted or erased from our surgica1 caIendar.” However true the above may be, a word of warning is in order against overinduIgence in conservative manipulations in various obstructed, infected or neopIastic Iesions of the urinary tract. A Iine must be drawn sharpIy between what constitutes an operative Iesion or a condition where cystoscopie measures have a reasonabIe chance to succeed. This entaiIs a carefu1 study of the case and a correct diagnosis. Too much temporizing with true surgica1 conditions is the one great danger so commonIy seen and which must be avoided. I shaI1 endeavor brieffy to enumerate the various conditions in the urinary tract which may be corrected by the empIoyment of minor surgica1 procedures in as much as they entail cystoscopic manipuIation, touching upon indications and, as much as the space wiI1 permit, on technique. I. Urethral stones frequentIy become Iodged either in the anterior or posterior YORK