Cystoscopy Group Research Articles

Delayed Cystoscopic Follow-up of Non-muscle Invasive Bladder Cancer during the COVID-19 Pandemic may Increase Recurrence Rates but not Progression Rates

Background: This study aimed to investigate whether there is a difference in recurrence and progression rate before and after the pandemic in patients who applied for bladder cancer and/or were followed-up-treatment-operated in the urology clinic during the pandemic.
 Material and Methods: A total of 116 non-muscle invasive bladder cancer (NMIBC) patients with delayed cystoscopy and 90 control patients with timely cystoscopy were included in the study between June and July 2020. Demographic data of the patients were recorded. Recurrences and progression scores were calculated and grouped according to these scores. The cystoscopy delay time was calculated from the planned cystoscopy time to the performed cystoscopy time. The recurrence and progression status of the patients were recorded, and a comparison was made between the two groups.
 Results: The median age was 63.6 years (interquartile range [IQR] 35–85) in the delayed cystoscopy group and 67.3 (25-87) in the control group. In the delayed cystoscopy group, 29 (25%) patients had tumour recurrence on follow-up cystoscopy, and 3 (10.34%) patients had tumour progression on subsequent TUR-BT. The mean cystoscopy delay time is 89.27±27.35 days. As a result of the chi-square analysis performed on the group with 10-17 recurrence points found a statistically significant relationship between the experimental and control groups (χ2=5.792; p=.016; p0.05).
 Conclusions: In this study, we reported that superficial bladder cancers with low recurrence scores could wait 3-6 months, but delaying 3-6 months in cases with a recurrence score of 10 or more increases the recurrence rate.

Comparison of hexaminolevulinate (HAL) -guided versus white light transurethral resection for NMIBC: A systematic review and meta-analysis of randomized controlled trials.

We systematically reviewed the effectiveness of hexaminolevulinic acid (HAL) after traditional light cystoscopy vs. only white light cystoscopy (WLC) on nonmuscle-invasive bladder cancer (NMIBC) clinical outcomes. Systematic literature searches of PubMed, Embase, Web of Science, and the Cochrane database and reference lists were performed. A total of 12 randomized controlled trials (RCTs) of HAL fluorescent cystoscopy (FC) and WLC vs. white light cystoscopy alone for the diagnosis of initial or recurrent bladder cancer that reported bladder cancer recurrence, progression, recurrence-free survival (RFS), and other effects were selected for review. Our results included 2,775 patients identified for analysis and showed that the HAL group had a lower recurrence rate than the white light cystoscopy group with a statistically significant difference (RR=0.77, 95% CI 0.69-0.85. P<0.05), and this advantage still existed for patients receiving intravesical chemotherapy. There was also a statistically significant difference in favour of fluorescent cystoscopy in recurrence-free survival and progression rate (HR=0.79, 95% CI 0.67-0.92. P<0.05, RR=0.63, 95% CI 0.43-0.94. P<0.05, respectively). The time to first recurrence was not significantly different from that in the WLC group (SMD=0.73, 95% CI, -0.39-1.85. P=0.2). And the HAL group did not have a significantly reduced residual tumor rate (RR=0.59, 95% CI 0.23-1.51. P=0.27). Fluorescent cystoscopy was associated with a reduced risk of bladder cancer recurrence and reduced progression rate; it also has advantages for RFS. However, there was no significant difference in the rate of residual tumor and the time of first recurrence. More studies are needed to better understand the effects of the photosensitizer used on NMIBC patients.

English

BACKGROUND Cystoscopy is a commonly performed routine outpatient procedure and an essential diagnostic tool in urology. It may be performed using either rigid or flexible cystoscopes. From the clinical perspective, it might appear that flexible cystoscopy causes less discomfort than rigid cystoscopy, but remarkably head-to- head comparisons of these two devices are sparse. We wanted to compare rigid cystoscopy with flexible cystoscopy in men with lower urinary tract symptoms (LUTS), in terms of the post-procedure outcomes defined as discomfort / pain experienced by the patient using the visual analogue score (VAS) scoring and duration of the procedure. METHODS A total of 60 male patients with LUTS were randomised to flexible and rigid cystoscopy groups (N = 30 each group). Cystoscopy was done using appropriate rigid and flexible cystoscope. Post procedure, patient was assessed with VAS scaling for pain. The duration of the procedure and any post-procedure discomfort and complication were also noted. RESULTS The mean age of patients of flexible cystoscopy group was comparable to that of a rigid cystoscopy group (39.43 ± 11.45 vs. 41.7 ± 10.8, P = 0.433). The mean duration (minutes) for flexible cystoscopy was significantly less than that of rigid cystoscopy (8.53 ± 1.81 vs. 9.77 ± 2.14, P = 0.019). The mean VAS score for flexible cystoscopy was significantly less than that of rigid cystoscopy (2.57 ± 0.97 vs. 3.97 ± 1.1, P &lt; 0.0001). There was no significant difference between groups in terms of diagnosis (P = 0.796). Post-procedure complications were also comparable between the two groups. CONCLUSIONS Flexible cystoscopy caused less pain and discomfort as compared to rigid cystoscopy. Duration of procedure was also less for the flexible cystoscope. KEY WORDS Cystoscopy, Flexible Cystoscopy, Lower Urinary Tract Symptoms, Pain, Rigid Cystoscopy

Efficacy of the direct grasping technique using pean forceps under fluoroscopy to replace ureteral stents in women.

Purpose : To evaluate the efficacy of the direct grasping technique using pean forceps under fluoroscopic guidance for ureteral stent replacement in women. Methods : Between April 2018 and September 2020, 28 female patients underwent ureteral stent replacements at our facility, and 184 stent replacement procedures were performed. A total of 127 stents were replaced using pean forceps under fluoroscopic guidance (pean forceps group), and 57 stents were replaced using the cystoscope (cystoscopy group). Clinical characteristics and surgical outcomes were compared between the groups. Results : All stents were successfully replaced. There was a statistically significant difference in the procedure time between the two groups (median [interquartile range], pean forceps group : 10.8 [8.2-13.9] minutes vs. cystoscopy group : 15.8 [11.1-20.9] minutes, P < 0.001). There were no intraoperative complications in either group and no difference in the incidence of postoperative complications (pean forceps group : 1.6% vs. cystoscopy group : 1.8%, P = 1.000). Fluoroscopy time was longer in the pean forceps group, although this difference was not statistically significant (pean forceps group : 38.9 [22.6-60.1] seconds vs. cystoscopy group : 33.0 [20.0-48.9] seconds, P = 0.0558). Conclusion : The direct grasping technique using pean forceps under fluoroscopy may be a beneficial alternative to cystoscopy for ureteral stent replacement in women. J. Med. Invest. 68 : 326-329, August, 2021.

The impact of frequent cystoscopy on surgical care and cancer outcomes among patients with low-risk, non-muscle-invasive bladder cancer.

Surveillance recommendations for patients with low-risk, non-muscle-invasive bladder cancer (NMIBC) are based on limited evidence. The objective of this study was to add to the evidence by assessing outcomes after frequent versus recommended cystoscopic surveillance. This was a retrospective cohort study of patients diagnosed with low-risk (low-grade Ta (AJCC)) NMIBC from 2005 to 2011 with follow-up through 2014 from the Department of Veterans Affairs. Patients were classified as having undergone frequent versus recommended cystoscopic surveillance (>3 vs 1-3 cystoscopies in the first 2years after diagnosis). By using propensity score-adjusted models, the authors estimated the impact of frequent cystoscopy on the number of transurethral resections, the number of resections without cancer in the specimen, and the risk of progression to muscle-invasive cancer or bladder cancer death. Among 1042 patients, 798 (77%) had more frequent cystoscopy than recommended. In adjusted analyses, the frequent cystoscopy group had twice as many transurethral resections (55 vs 26 per 100 person-years; P<.001) and more than 3 times as many resections without cancer in the specimen (5.7 vs 1.6 per 100 person-years; P<.001). Frequent cystoscopy was not associated with time to progression or bladder cancer death (3% at 5years in both groups; P=.990). Frequent cystoscopy among patients with low-risk NMIBC was associated with twice as many transurethral resections and did not decrease the risk for bladder cancer progression or death, supporting current guidelines.

PD25-10 COMPARISON OF CYSTOSCOPIC VERSUS MAGNETIC RETRIEVAL DEVICE FOR REMOVAL OF URETERAL STENTS IN RENAL TRANSPLANT PATIENTS: A RANDOMIZED PILOT STUDY.

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2018PD25-10 COMPARISON OF CYSTOSCOPIC VERSUS MAGNETIC RETRIEVAL DEVICE FOR REMOVAL OF URETERAL STENTS IN RENAL TRANSPLANT PATIENTS: A RANDOMIZED PILOT STUDY. Jason Akerman, Gaurav Vasisth, Camilla Tajzler, Fadil Hassan, Simreet Hansra, Shahid Lambe, Kevin Piercey, and Anil Kapoor Jason AkermanJason Akerman More articles by this author , Gaurav VasisthGaurav Vasisth More articles by this author , Camilla TajzlerCamilla Tajzler More articles by this author , Fadil HassanFadil Hassan More articles by this author , Simreet HansraSimreet Hansra More articles by this author , Shahid LambeShahid Lambe More articles by this author , Kevin PierceyKevin Piercey More articles by this author , and Anil KapoorAnil Kapoor More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1337AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intra-operative placement of a ureteral stent during renal transplant has been shown to reduce urologic complications when compared to non-stented anastomoses. Stents are then removed 3-6 weeks post-operatively under direct vision by flexible cystoscopy. Cystoscopy itself is associated with patient bother and even pain. Newly-developed magnetic stents offer a means of bypassing flexible cystoscopy with a small retrieval device. In this single-centre, prospective, randomized feasibility study, we assess the potential use of the Black-Star® stent and magnetic retrieval device for post-operative stent removal in renal transplant patients. METHODS Patients undergoing deceased-donor renal transplantation at a single Canadian centre were computer-randomized to receive either a traditional double-J ureteral stent or the Black-Star® magnetic stent. A baseline survey assessment was completed at the time of randomization followed a post-operative symptom questionnaire (Ureteral Stent Symptom Questionnaire, USSQ) before and after stent removal. Patient satisfaction, time required for stent removal, urinary tract infection rates, and procedure costs were all recorded. RESULTS 28 patients were randomized to traditional ureteral stent or Black-Star® magnetic stent. The total time required for stent removal under flexible cystoscopy was significantly longer (496 seconds, sd 202.4) compared to magnetic stent removal (269 seconds, sd 138.7, p 0.022). No significant difference was seen in all USSQ domains between groups pre and post stent removal. No difference was observed in the rate of urinary tract infections or surgical complications. Stent removal was well tolerated in both groups with 2 patients in the Black-Star® group and a single patient in the flexible cystoscopy group reporting discomfort with the procedure. CONCLUSIONS USSQ scores suggest that the Black-Star® magnetic stent is equally well tolerated by patients when compared to traditional ureteral stents. Removal of the Black-Star® magnetic stent required less time with no greater discomfort or complication rate compared to traditional stent removal under cystoscopy. A cost-savings analysis is currently underway and will be included. The Black-Star® magnetic stent may offer a well-tolerated and convenient alternative to traditional ureteral stent removal by flexible cystoscopy in renal transplant patients. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e550 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jason Akerman More articles by this author Gaurav Vasisth More articles by this author Camilla Tajzler More articles by this author Fadil Hassan More articles by this author Simreet Hansra More articles by this author Shahid Lambe More articles by this author Kevin Piercey More articles by this author Anil Kapoor More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Novel Retrieval Technique for Ureteral Stents Under Ultrasound Guidance in Male Patients

To simply retrieve double-J stents in male patients under ultrasound guidance, a novel technique is developed and evaluated for efficiency, safety, and tolerability. Fifty-six male patients, ranging in age from 23 to 65 years old, were recruited from March to December 2015. Thirty patients (32 stents) underwent double-J stent retrieval by ultrasound guidance and 26 patients (28 stents) underwent cystoscopy retrieval separately. Clinical outcomes were compared between groups. Hematuria and leukocytosis were assessed every day postoperatively. A visual analog pain scale on a scale of 0-10 was used to assess procedure-related pain. In the experimental group, 87.5% of ureteral stents were successfully removed. Using our novel technique without any local anesthesia, male patients experienced less pain compared with the cystoscopy group significantly (P < .001). The majority of complications were microscopic hematuria (39.28%), less than that in the cystoscopy group (69.23%, P = .027). Meanwhile, only few patients have leukocytosis in both groups (14.3% vs 11.5%, P > .05). Average procedure time was 7.35 ± 2.59 minutes longer than that of the standard group (5.13 ± 1.29 minutes; P < .001). However, it had been improved with increasing experience (r = 0.618, P < .001). In addition, this novel technique is cost-effective for clinical practice. This is the first study to assess the possibility of ultrasound-guided retrieval technique in male patients. The safety and success rate of this new technique is similar to that of a conventional procedure. Whereas it is tolerable and cost effective for male and disabled patient bear with lithotomy position.

Report on The Society for Fetal Urology panel discussion on the selection criteria and intervention for fetal bladder outlet obstruction

The Society for Fetal Urology panel section at the 2016 Fall Congress featured a multidisciplinary discussion on appropriate patient selection, the conservative versus surgical management, and postnatal renal outcome of fetuses with lower urinary tract obstruction (LUTO). Rodrigo Ruano shared his experience of prenatal intervention, presenting the outcome of 111 fetuses with severe LUTO treated with vesicoamniotic shunting (VAS) (n=16), cystoscopy (n=34) or no intervention (n=61) in a non-randomized series. Multivariate analysis at the 6-month follow-up suggested a significantly higher probability of survival with fetal intervention versus no intervention. A clear trend for normal renal function was present in the fetal cystoscopy group, but not in the VAS group. In cases in which there was a postnatal diagnosis of posterior urethral valves (n=57), fetal cystoscopy was effective in improving both the 6-month survival rate and renal function, while VAS was associated with an improvement in the 6-month survival rate. In an attempt to better define which fetuses would benefit from intervention, Michael Braun explained the proposed LUTO classification system that incorporates: (1) fetal urinary biomarkers of renal injury; (2) amniotic fluid levels as a surrogate for the severity of obstruction; and (3) imaging studies to identify signs of renal dysplastic or cystic changes. Intervention was not recommended in patients at low risk of either renal disease or pulmonary hypoplasia (Stage 1). Vesicoamniotic shunting was performed in patients at high risk of either progressive renal injury or pulmonary hypoplasia without evidence of severe pre-existing renal damage (Stage 2). For those patients, who at the time of evaluation had evidence of severe renal disease (Stage 3), fetal intervention was individualized and often based on bladder capacity and bladder refilling after vesicocentesis. He went on to present the nephrologic outcome of fetuses managed over the last 3 years utilizing the selection criteria. Craig Peters supported the concept of selective criteria and discussed the cautious viewpoint, namely: (1) the procedure may be unnecessary, as it is possible for patients to do well, in spite of severe prenatal obstruction; and (2) the risk of giving partial treatment by allowing the baby to survive to delivery with the daunting postnatal journey of renal and pulmonary insufficiency. Standardized patient selection utilizing a staging system is undoubtedly the way forward and will enable comparable long-term renal and bladder functional outcome studies.

AMBULANT FLEXIBLE CYSTOSCOPY FOR FOLLOW-UP OF Ta-TI UROTHELIAL CARCINOMA OF THE URINARY BLADDER: PAIN PERCEPTION AND COST EFFECTIVE.

Ambulant flexible cystoscopy is the standard procedure in the urological practice for follow-up of Ta-T1 urothelial carcinoma (UC) due to its ability to survey the bladder for a variety of indications. It is the principal means of diagnosis and surveillance of bladder tumors. The follow-up of patients treated for Ta-T1 UC is of great importance because of the high incidence of recurrence and progression of the disease, whereby patients with Ta-T1 UC undergo cystoscopy every three months. The aim of this study to evaluate the procedure of ambulant flexible cystoscopy in proper diagnostic follow-up of Ta-T1 UC, patient's acceptance in regard to pain tolerance, non-hospital stay and expenses. Twenty one patients (18 male and 3 female) were diagnosed before as Ta-T1 UC by rigid cystoscopy and transuretheral resection of bladder (TURB) lesion scheduled for follow up by flexible cystoscopy under local anesthesia using 20 ml 2% lidocain gel on an ambulatory bases. Comparison was done using a cohort of 32 patients who underwent the procedure of follow-up of Ta-T1 cystoscopy and TURB using rigid cystoscopy and resectoscope. Seventeen patients 80.9% (16 male and 2 female) proved to be bladder free from recurrent lesion, 4 patients {19.1 %} (3 males and one female) which revealed recurrent lesions in spite of that the urinary bladder was free in pelvic ultrasonography. Cold cup biopsy from the lesions sent for histopathological examination which revealed recurrence of the tumor in 3 patients (two patients with Ta and one patient T1. TURB was done to have complete resection in 4 patients, the histopathological examination revealed ulcerating mucosa and free lamina propria in 3 specimens, and T2 in the fourth specimen. Comparison between the 2 groups revealed more patient's acceptance for the flexible cystoscopy group as regard pain tolerance, non-hospital stay and expenses. Ambulatory flexible cystoscopy with 20 ml of 2% lidocaine gel anesthesia is tolerated well by patients, with advantage of no hospital stay in the regular follow up of Ta-T1 tumors, pain perception was accepted by all patient provided delayed cystoscopy after lidocaine-gel instillation.

Utility of Intraoperative Cystoscopy in Detecting Ureteral Injury During Vaginal Hysterectomy

Ureteral injury is a serious complication of vaginal hysterectomy and other gynecologic surgery. Its incidence during vaginal surgery is estimated to be 0.9% to 1.7%. Although intraoperative cystoscopy can provide a timely diagnosis and expedite management, it is not routinely performed. Barriers to routine use include cost and training. As an alternative to cystoscopy, ureteral injury may be detected by symptoms, an increase in perioperative serum creatinine level, or both. The primary aim of this study was to determine the rate of ureteral injury and associated costs in patients undergoing selective cystoscopy during vaginal hysterectomy. Another aim was to determine whether changes in perioperative creatinine level could be used to reliably diagnose ureteral injury in the absence of intraoperative cystoscopy. A secondary analysis of a retrospective cohort study was performed. A total of 593 patients underwent vaginal hysterectomy for benign indications, with or without additional pelvic floor repairs, from January 2, 2004, through December 30, 2005, at Mayo Clinic (Rochester, Minn). A logistic regression model was constructed to determine the propensity for a surgeon to perform intraoperative cystoscopy, in order to allow adjustment for the likelihood of detecting ureteral injury in a given surgical case. The rate of ureteral injury and associated cost was determined in patients undergoing surgery both with and without cystoscopy. In cases in which cystoscopy was not performed, standard practice of postoperative creatinine level determination allowed the authors to investigate the feasibility of using perioperative change in creatinine level to detect ureteral injury. Of the 593 eligible patients included in the analysis, 230 (38.8%) underwent cystoscopy during the hysterectomy. Ureteral injuries occurred in 6 patients (2.6%) in the cystoscopy group and 5 (1.4%) in the no-cystoscopy group; the odds ratio was 1.92, with a 95% confidence interval (CI) of 0.58 to 6.36, P = 0.35. After adjusting for the propensity to perform cystoscopy, the association was further attenuated (odds ratio, 1.31; 95% CI, 0.19–9.09). Five of the 6 were detected intraoperatively; of those, 4 were successfully managed intraoperatively. Adjusted mean-predicted costs for patients undergoing and not undergoing cystoscopy were $10,686 (95% CI, $7500–$13,872) and $10,217 (95% CI, $6894–$13,540), respectively; P = 0.28. The 5 patients with ureteral injury in the no-cystoscopy group had a median increase in perioperative creatinine level of 0.2 mg/dL, whereas patients without injury had a median decrease in creatinine level of 0.1 mg/dL (P < 0.001). Overall, the likelihood of ureteral injury with and without cystoscopy is similar, and predictive costs do not significantly differ. The use of postoperative creatinine level to detect ureteral injury is highly sensitive, but limited by a low positive predictive value and variable range. Based on these data, the authors recommend routine universal screening cystoscopy for patients undergoing vaginal hysterectomy.

Comparison of outcomes between ultrasonography and cystoscopy in the surveillance of patients with initially diagnosed TaG1-2 bladder cancers: A matched-pair analysis

PurposeTo examine the clinical outcomes of regular use of ultrasonography when compared with those of cystoscopy in the follow-up of patients with TaG1-2 bladder tumors. Patients and methodsBetween 1990 and 2012, 197 patients with TaG1-2 bladder tumors from a retrospective 2-institution cohort were included. We assessed clinical outcomes in 83 patients followed up by ultrasonography, matched for propensity score calculated from clinicopathological variables including age, gender, tumor multiplicity, size, grade, postoperative immediate chemoinstillation, and adjuvant intravesical treatment. ResultsAmong the 166 patients identified using the one-to-one propensity score analysis, the 5- and 10-year recurrence-free survival rates were both 63.3% in the cystoscopy group and 69.1% and 58.4%, respectively, in the ultrasonography group (P = 0.762). A total of 54 patients experienced disease recurrence, and 18 patients acquired progressive disease such as tumor grade 3, pT1 tumors, and the appearance of concurrent carcinoma in situ. There were no significant differences in the characteristics of recurrent tumors between both the groups, whereas time to first recurrence in the cystoscopy group was significantly shorter than that in the ultrasonography group (P = 0.021). In a subgroup analysis using 111 patients without adjuvant intravesical treatments, the 5- and 10-year recurrence-free survival rates were both 56.9% in the cystoscopy group and 71.9% and 60.3%, respectively, in the ultrasonography group (P = 0.282). ConclusionsThis retrospective study suggests that ultrasonography may be one of the follow-up substitutes when considering the management of low-risk bladder tumors such as TaG1-2 bladder tumors.

Fetal intervention for severe lower urinary tract obstruction: a multicenter case-control study comparing fetal cystoscopy with vesicoamniotic shunting.

To evaluate the efficacy of fetal intervention using fetal cystoscopy or vesicoamniotic shunting in the treatment of severe lower urinary obstruction (LUTO). A cohort of 111 fetuses with severe LUTO attending two centers between January 1990 and August 2013 were included retrospectively. Fetuses were categorized into three groups based on the method of intervention: (1) fetal cystoscopy, (2) vesicoamniotic shunting or (3) no intervention. Multivariate analyses were performed to determine the probability of survival and normal renal function until 6 months of age by comparing fetal cystoscopy and vesicoamniotic shunting to no fetal intervention. Of the 111 fetuses with severe LUTO that were included in the analysis, fetal cystoscopy was performed in 34, vesicoamniotic shunting was performed in 16 and there was no fetal intervention in 61. Gestational age at diagnosis, method of fetal intervention and cause of bladder obstruction were associated with prognosis. In multivariate analysis and after adjustment for potential confounders (considering all causes of LUTO) the overall probability of survival was significantly higher with fetal cystoscopy and vesicoamniotic shunting when compared to no intervention (adjusted relative risk (ARR), 1.86 (95% CI, 1.01-3.42; P = 0.048) and ARR, 1.73 (95% CI, 1.01-3.08; P = 0.04) respectively). A clear trend for normal renal function was present in the fetal cystoscopy group (ARR, 1.73 (95% CI, 0.97-3.08; P = 0.06)) but was not observed in the vesicoamniotic shunt group (ARR, 1.16 (95% CI, 0.86-1.55; P = 0.33)). In cases in which there was a postnatal diagnosis of posterior urethral valves, fetal cystoscopy was effective in improving both the 6-month survival rate and renal function (ARR, 4.10 (95% CI, 1.75-9.62; P < 0.01) and 2.66 (95% CI, 1.25-5.70; P = 0.01) respectively) while vesicoamniotic shunting was associated only with an improvement in the 6-month survival rate (ARR, 3.76 (95% CI, 1.42-9.97; P < 0.01)) with no effect on renal function (ARR, 1.03 (95% CI, 0.49-2.17, P = 0.93)). Fetal cystoscopy and vesicoamniotic shunting improve the 6-month survival rate in cases of severe LUTO. However, only fetal cystoscopy may prevent impairment of renal function in fetuses with posterior urethral valves. Our data support the idea of performing a subsequent randomized controlled trial to compare the effectiveness of fetal cystoscopy vs vesicoamniotic shunting for severe fetal LUTO.

Utility of intraoperative cystoscopy in detecting ureteral injury during vaginal hysterectomy.

The aim of this study was to determine the utility of intraoperative cystoscopy in detecting and managing ureteral injury among women undergoing vaginal hysterectomy. We performed a secondary analysis of a retrospective cohort study of 593 patients who underwent vaginal hysterectomy for benign indications, with or without additional pelvic floor reconstructive surgery, from January 2, 2004, through December 30, 2005. A logistic regression model determining the propensity to undergo intraoperative cystoscopy was constructed. Comparisons of ureteral injury and cost between patients with and without cystoscopy were adjusted for the cystoscopy propensity score. We further explored the feasibility of using perioperative change in creatinine level to detect ureteral injury. In total, 230 (38.8%) of 593 patients underwent cystoscopy. Six patients (2.6%) in the cystoscopy group and 5 (1.4%) in the no-cystoscopy group had ureteral injuries (odds ratio, 1.92; 95% confidence interval [CI], 0.58-6.36). This association was further attenuated after adjusting for the propensity to undergo cystoscopy (odds ratio, 1.31; 95% CI, 0.19-9.09). Four injuries detected cystoscopically were managed intraoperatively. Adjusted mean-predicted costs for patients undergoing cystoscopy were $10,686 (95% CI, $7500-$13,872) versus $10,217 (95% CI, $6894-$13,540). In the no-cystoscopy group, patients with ureteral injury had a median increase in creatinine level of 0.2 mg/dL, whereas patients without injury had a median decrease of 0.1 mg/dL (P < 0.001). The level of selection for cystoscopy did not significantly increase the mean predicted costs for patients. Reliance on postoperative creatinine level to detect ureteral injury, while highly sensitive, is limited by a low positive predictive value and variable range.

Routine cystoscopy after robotic gynecologic oncology surgery.

Background and Objectives:Our aim was to determine whether the use of routine cystoscopy increases lower urinary tract injury detection (bladder and/or ureter) after robotic surgery performed by gynecologic oncologists.Methods:A retrospective chart review of patients who presented for robotic hysterectomy from 2009–2012 was performed at 2 separate academic medical centers, one that performed routine cystoscopy and one that did not. Statistical analysis was performed with t tests and χ2 tests.Results:We identified 140 cases without cystoscopy and 109 cases with routine cystoscopy. There were no intraoperative or postoperative urinary injuries detected in either group. There were no significant differences in age and body mass index. In the non-cystoscopy group, a larger specimen size (P < .001), less blood loss (P = .013), and a longer mean operative time were observed (P < .0001). In the routine cystoscopy group, more lymphadenectomies were performed with hysterectomy (P = .007) and more patients underwent hysterectomy for ovarian cancer (P = .0192). There were no differences in surgical indications or secondary procedures including bilateral salpingo-oophorectomy, radical hysterectomy, ureterolysis, and pelvic organ prolapse–related procedures. The minimum follow-up period was 30 days in both groups.Conclusion:Routine use of cystoscopy did not appear to affect the detection rate of intraoperative lower urinary tract injury during robotic gynecologic surgery because this rate was zero in both groups. However, cystoscopy is relatively simple to perform and can be efficiently incorporated into robotic surgery to avoid the severe morbidity and possible litigation surrounding a urinary tract injury.

Therapeutic Outcome of Fluorescence Cystoscopy Guided Transurethral Resection in Patients with Non-Muscle Invasive Bladder Cancer: A Meta-Analysis of Randomized Controlled Trials

ObjectivesTo conduct a meta-analysis of randomized controlled trials (RCTs) to assess the therapeutic outcome of fluorescence cystoscopy (FC) guided transurethral resection (TUR) in non-muscle invasive bladder cancer (NMIBC).Materials and MethodsRelevant RCTs were identified from electronic database (MEDLINE, Embase and the Cochrane Library). The proceedings of relevant congress were also searched. The primary parameters were recurrence rate, the time to fist recurrence, recurrence free survival rate (RFS) and progression rate.Results12 RCTs including 2258 patients, which were identified for analysis in our study. Our study showed that the FC group have lower recurrence rate than the white light cystoscopy (WLC) group with statistically significant difference (OR: 0.5; p<0.00001). The time of the FC group first recurrence delayed significantly 7.39 weeks than WLC group (MD: 7.39 weeks; p<0.0001). There was a statistically significant difference in favor of FC in RFS at 1 yr (HR: 0.69; p<0.00001) and 2 yrs (HR: 0.65; p=0.0004). However, the FC group cannot significantly reduce the rate of progression into muscle invasive bladder cancer compared with the WLC group (OR: 0.85; p=0.39).ConclusionsFC guided TUR was demonstrated to be an effective procedure for delaying recurrence of NMIBC. Unfortunately, FC guided TUR could not significantly decrease the rate of progression into muscle invasive bladder cancer.

Comparison of Flexible and Rigid Cystoscopy-Assisted Ureteral Catheter Insertion Before Percutaneous Nephrolithotomy: A Prospective Randomized Trial

To compare the advantages of flexible and rigid cystoscopy-assisted ureteral catheter placement before prone percutaneous nephrolithotomy (PCNL). From March to September 2012, a total of 80 patients with kidney stones underwent PCNL by the same surgical team. The patients were randomly assigned into one of the groups according to the technique used for ureteral catheter insertion: Flexible cystoscopy (group 1, n=40) or rigid cystoscopy (group 2, n=40). Patient demographics and operation-related factors were compared. The preparation period included positioning, cystoscopy-assisted stent insertion, and patient repositioning for PCNL. In addition, discomfort scores of the operating room (OR) staff were measured. The demographic values of the groups in terms of patient sex, age, body mass index, and stone size were comparable. While the mean preparation period was calculated as 9.9±2.3 minutes in the flexible cystoscopy group, it was significantly longer (19.7±2.9 minutes) in the rigid cystoscopy group (P<0.0001). In addition, the discomfort score of the OR staff was found to be significantly higher in the rigid cystoscopy group (1.1±0.9 vs 2.05±0.68, P<0.0001). The rest of the operative and postoperative parameters were similar. The insertion of a ureteral catheter with a flexible cystoscope before prone PCNL shortens the preparation period and minimizes the discomfort of OR staff related to patient positioning and transfer.

Assessing treatment response after induction Bacillus Calmette-Guerin for carcinomain situof the urinary bladder: can post-induction random bladder biopsies be avoided?

Patients diagnosed with bladder carcinoma in situ (CIS) and treated with intravesical Bacillus Calmette-Guerin (BCG) often undergo post-induction random bladder biopsies to assess treatment response. We sought to determine the correlation between post-induction urinary cytology/cystoscopy and histopathological findings obtained by random bladder biopsies. Patients who were treated with BCG between 2006 and 2010 for CIS, had surveillance cystoscopy and cytology, and subsequently underwent random bladder biopsies were selected for analysis. Patients with a history of or concomitant urothelial cell carcinoma (UCC) stage T1 or higher were excluded. Cystoscopic finings were characterized as follows: negative - no mucosal erythema, raised lesions or papillary tumours; suspicious - mucosal erythema, but no raised lesions or papillary tumours; and positive - sessile or papillary tumours. The accuracy of cytology in predicting the results of subsequent random bladder biopsies was analysed. Of 21 patients included, surveillance cystoscopy findings were characterized as negative in nine, suspicious in seven and positive in five. Of 16 patients with negative/suspicious cystoscopy, 13 had agreement between cytology and biopsy, nine of whom were negative and four positive. Three of 16 patients had positive cytology, but negative biopsies; on further investigation of these three, one had CIS and two subsequent UCC. In the positive cystoscopy group, four of five patients had agreement between cytology and biopsy, two of whom were negative and two positive. One of the five patients had negative cytology, but a positive biopsy. Our data suggest foregoing random bladder biopsies in patients with negative urine cytology and no evidence of intravesical recurrence on cystoscopy following an induction course of BCG for CIS of the urinary bladder.

Cystoscope flexible à gaine stérile à usage unique : impact organisationnel et économique et sécurité bactériologique

To assess both economical and organizational impact as well as bacteriologic safety of a flexible cystoscope with sterile disposable sheath (FCSDS) compared to standard flexible cystoscopy (SFC) in two French urologic academic units. Two-center prospective study, comparing the use of the FCSDS to the SFC on two consecutive periods of time. Two hundred and five patients were included and divided into each group. Duration procedures and costs were analysed in the two techniques. The urinary tract infection rate was also described. A dedicated sheaths leaks test after use was performed systematically. The preparation time of the fibroscope was longer for the sheathed cystoscopy group: 16.2 minutes versus 10.9 minutes for the standard group. The mean duration of disinfection was significantly shorter for the sheathed cystoscopy group: 53.8 minutes saved compared to the standard group; 99.01% of the tested sheaths, after their use, had no breaches. Urinary tract infections rate were similar in the two groups. The average cost of a sheathed cystoscopy compared to the standard was significantly cheaper in Lyon and almost equivalent in Marseille. The FCSDS allows significant saving over the disinfection duration, consumable costs and staff costs, while ensuring patient bacteriologic safety similar to SFC.

Cost Savings of Using Laparoscope for Cystoscopy Following Hysterectomy

Cost Savings of Using Laparoscope for Cystoscopy Following Hysterectomy

A Randomized, Single-Blinded Pilot Study Evaluating Use of a Laparoscope or a Cystoscope for Cystoscopy During Gynecologic Surgery

Study ObjectiveTo prospectively evaluate time required to perform cystoscopy with a laparoscope or a cystoscope after laparoscopic hysterectomy. Urinary tract symptoms, infection, adverse events, and expense were also evaluated. DesignRandomized, single-blind pilot study (Canadian Task Force classification I). SettingSuburban private gynecology group practice and local community hospital. SubjectsSixty-six subjects scheduled to undergo laparoscopic hysterectomy between January and July 2009. InterventionEither cystoscopy with a laparoscope or a cystoscope. Measurements and Main ResultsSubjects were randomized to undergo either form of cystoscopy, and events were reported. Each subject completed self-reported urinary tract symptom questionnaires before surgery and at 2 weeks after surgery. Clean-catch urine samples were obtained before surgery and postoperatively at day 1 and 2 weeks. In the group who underwent laparoscope cystoscopy, a suction-irrigator device, a 5-mm needle-nose suction irrigator tip, and a 5-mm 0-degree video laparoscope were required. In the group who underwent traditional cystoscopy, a 70-degree video telescope with a 17F sleeve, irrigation fluid, and a light source were required. Subjects were followed up for 6 weeks postoperatively. Adverse events were minimal, with 1 in the laparoscope group and 6 in the traditional cystoscope group. Two postoperative urinary tract infections occurred in the traditional cystoscopy group. The mean total procedural time for laparoscope cystoscopy of 137 seconds was statistically less (p < .001) compared with the 296 seconds in the traditional cystoscopy group. Improvements in urinary tract symptom scores improved from baseline, but were not statistically significantly different between the groups. Traditional cystoscopy equipment cost approximately $60 more per subject. ConclusionThe study results suggest that laparoscope cystoscopy is more time-efficient and cost-effective than traditional cystoscopy and that the incidence of urinary tract symptoms, infection, and injury did not increase.