Cystoscopy In Women Research Articles

Imaging-Guided De Novo Retrograde Ureteral Access and Stent Placement without Cystoscopy in Women

PurposeTo evaluate the feasibility of a new technique for imaging-guided de novo retrograde ureteral double J (DJ) stent placement without cystoscopy in women. Materials and MethodsEighty-four women referred for ureteral stent placement between April 2019 and January 2022 were included. In all the patients, the initial attempt for stent placement was performed in a retrograde fashion. Successful ureteral catheterization and DJ stent placement were considered as technical success. The fluoroscopy time required to catheterize the ureter and that for the entire procedure were recorded. Factors affecting the technical success rate and fluoroscopy time were examined. ResultsA total of 108 ureteral stent placement procedures in 84 women, with a mean age of 57.5 years (range, 19–85 years), were performed. The most common underlying pathologies were cervical (n = 33, 31%) and ovarian (n = 32, 30%) carcinomas. The most commonly involved segments of the ureter were the lower half (n = 44, 40%) and trigone (n = 39, 36%). The technical success rate was 81.5%, and it reached 93% in the case of lower-half ureteral obstruction. Distorted trigonal anatomy caused by external compression of the bladder wall by a mass was associated with a higher rate of technical failure (90.6% vs 47.8%; P < .001). The use of ultrasound guidance to guide the sheath to the ureteral orifice allowed for a significant decrease in the fluoroscopy time for ureteral catheterization (4.6 minutes ± 3.91 vs 2.26 minutes ± 2.32; P = .003) and that for the entire procedure (9.42 minutes ± 4.95 vs 5.93 minutes ± 4.06; P = .001). ConclusionsImaging-guided de novo retrograde ureteral catheterization and stent placement can be successfully performed in a high percentage of patients within a reasonable fluoroscopy time without the need for cystoscopy in women.

Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection after Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study

Objectives: The objective of the study was to determine practice patterns of prescribing prophylactic antibiotics against urinary tract infection (UTI) for urodynamic studies (UDS) and outpatient cystoscopy in women. Design: A cross-sectional survey study was conducted of North American female pelvic medicine and reconstructive specialists (FPMRS). Methods: An online survey was used to assess prophylactic prescribing patterns of FPMRS that perform UDS and outpatient cystoscopy. This survey was developed and then electronically disseminated through the American Urogynecologic Society to 699 eligible physicians. Results: A total of 138 surveys were completed. Approximately half of physicians did not prescribe any antibiotic prophylaxis for UDS or for cystoscopy (54% and 43%, respectively). For patients with perceived risk factors (recurrent UTIs, immunosuppression, known neurogenic lower urinary tract dysfunction, indwelling catheter use, elevated postvoid residual/bladder outlet obstruction, genitourinary anomalies, and diabetes), 32% and 41% of physicians prescribed antibiotic prophylaxis for UDS and cystoscopy, respectively. A minority of physicians always prescribed antibiotics for UDS and cystoscopy (13% and 17%, respectively). Limitations: The response rate was a limitation of the study; however, this rate is in keeping with other physician survey studies published within this subspecialty. Selection and response biases may have contributed to the results of this survey study. Conclusion: There was no uniform approach to UTI prophylaxis for UDS and outpatient cystoscopy in women which reflects the lack of current guidelines and the low level of evidence on which they are based. This nonuniform practice calls for more research to better define an evidence-based standard of care.

Comparison of the diagnostic yield of routine versus indicated flowmetry, ultrasound and cystoscopy in women with recurrent urinary tract infections

Introduction and hypothesisTo quantify and compare the outcomes of routine vs. urologist-requested diagnostic testing for recurrent urinary tract infections (rUTI).MethodsA retrospective cohort study of patients with rUTI referred to a large non-academic teaching hospital between 2016 and 2018 (Hospital A) and a university hospital between 2014 and 2016 (Hospital B). Electronic medical records were reviewed for baseline and diagnostic data. Women underwent the following assessments routinely: urinalysis, voiding diary, flowmetry in Hospital A and urinalysis, voiding diary, flowmetry, ultrasound, abdominal x-ray and cystoscopy in Hospital B. All other diagnostics were performed by indication in each hospital.ResultsWe included 295 women from Hospital A and 298 from Hospital B, among whom the mean age (57.6 years) and mean UTI frequency (5.6/year) were comparable, though more were postmenopausal in Hospital A. We identified abnormalities by flowmetry or post-void residual volumes in 134 patients (Hospital A: 79; Hospital B: 55), cystoscopy in 14 patients (Hospital A: 6; Hospital B: 8) and ultrasound in 42 patients (Hospital A: 16; Hospital B: 26), but these differences were not significant. Diagnostics altered treatment in 117 patients (e.g., pelvic floor muscle training, referral to another specialist, surgical intervention), mostly due to flowmetry and post-void residual volume measurement. The retrospective design and absence of follow-up data limit these results.ConclusionsThe routine use of cystoscopy and ultrasound in female patients with rUTIs should not be recommended as they yield few abnormalities and lead to additional costs.

Is Meatal Analgesia Necessary for Pain Reduction During Cystoscopy in Females? A Prospective Randomized Study

ObjectiveTo evaluate whether anesthesia of the meatal orifice reduces pain during cystoscopy in women, known to cause significant pain, discomfort and anxiety in women. Secondary end-point was to compare pain between rigid and flexible cystoscopy. MethodsA total of 120 women, median age 66 (interquartile range 57-69), referred for office cystoscopy were prospectively randomized into 2 groups according to meatal orifice exposure: (1) 5-minute meatus exposure with 2% lidocaine gel; (2) 5-minute meatal exposure with water soluble gel. In each group a pad soaked by the gel was externally placed on the meatal orifice. Each group was further divided to flexible or rigid cystoscopy. Exclusion criteria included urethral stricture, urinary tract infection, chronic pain disease (e.g., IC/PBS), neurogenic disorder, allergy to lubricant, and concurrent pain medication. In all patients, a water-based lubricant applied on the cystoscope, was used for lubrication. A 0-10 visual analogue scale was performed at 4 checkpoints: before examination, immediately following urethral penetration, immediately at end of procedure and 15 minutes after completion ResultsStudy groups did not significantly differ in clinical or demographic parameters. Pain level prior to procedure was 0 in all patients. Mean visual analogue scale immediately after urethral penetration was 4.2 ± 2.3 in both groups 1 and 2 (P= 1). No significant differences in other checkpoints was reported. Further subanalysis by cystoscope type did not demonstrate significance. ConclusionMeatal analgesia does not increase tolerance to cystoscopy in females. Pain level is not reduced by the use of flexible cystoscope in the female population.

Clinical manifestations and results of cystoscopy in women with interstitial cystitis/bladder pain syndrome.

OBJECTIVE:Interstitial cystitis/bladder pain syndrome (IC/BPS) refers to diseases that are challenging to identify, diagnose and treat. Thus, there is a need to study the clinical and cystoscopic picture of IC/BPS. The present research aims to study the clinical manifestations and results of cystoscopy with hydrodistension in women with IC/BPS.METHODS:One hundred twenty-six women with clinically diagnosed IC/BPS were examined – their mean age was 46.7±14.0 years. Patients were surveyed on pelvic pain and urgency/frequency patient symptom score (PUF), visual analogue scale (VAS) and urgency severity scale (USS). All patients underwent a potassium test (PST) and cystoscopy with hydrodistension. Statistical analysis was performed using SPSS software version 15.0 (SPSS Inc., Chicago, Illinois, USA).RESULTS:The average PUF score was 8.14±1.76 points, VAS – 5.45±0.93 points and USS – 2.63±0.91 points. A positive potassium test was detected in 91.3% of cases. The maximum average anatomical capacity of the bladder was 308.0±77.5 ml. The maximal cystometric capacity in women with mild pain was higher than among women with moderate and severe pain by 30.9% (p<0.05) and 53.0% (p<0.01), respectively. In most cases, mucosal changes were diffuse (n=57) or located in two parts of the bladder. One of the most common symptoms was the diffuse bleeding of the bladder mucosa (III degree). A statistically significant inverse correlation (r=-0.57, p<0.01) was found between the maximal cystometric bladder volume and the severity of the bladder mucosa changes. At the same time, a positive correlation was found between the severity of the bladder mucosa changes and the sum of points on the PUF questionnaire (r=+0.61, p=0.0003), the sum of points on the VAS questionnaire (r=+0.59, p=0.0008) and the USS questionnaire (r=+0.66, p=0.005).CONCLUSION:A relationship has been established between the clinical manifestations of IC/BPS among examined women and changes in the wall of the bladder. The data obtained from our investigation can help increase IC/BPS diagnostics and improve IC/BPS treatment results.

Randomized trial comparing office flexible to rigid cystoscopy in women

The objective of the study was to compare office rigid cystoscopy (RC) versus flexible cystoscopy (FC) in women. This was a prospective randomized trial comparing FC to RC. Aims were to assess 1-week post-procedural complications, compare procedure pain scores, and to assess physician perception of patient discomfort. Pain scores were assessed by visual analogue scale (VAS) and 5-point verbal descriptor scale (VDS). Chi-square was used for categorical comparison and t tests or Wilcoxon test for continuous variables. One hundred women were enrolled. The mean age of participants was 59.7 years (± SD 14.6), and 91 % were Caucasian. This was the first cystoscopy for 86 % of participants. On the 1-week post-procedure questionnaire (85 % response rate), participants in the FC group reported urinary frequency more often than in the RC group (p = 0.041). The FC group reported urgency with urination lasting 1-2 days (p = 0.030) and burning with urination lasting >3 days (p = 0.026), more than the RC group. These symptoms did not persist at 7 days. The duration of the procedure was slightly faster for the FC group (4.6 ± 1.8 min vs 5.7 ± 3.4 min, p = 0.046). Median VAS scores were 0.9 (0.1-2.72) for the FC group and 0.5 (0-2.4) for the RC group (p = 0.505). There were no significant differences between patient or physician perception of pain in either group. Urinary frequency and duration of urinary burning post procedure occurred more frequently in the FC group, although these symptoms were transient. Both office FC and RC are generally well tolerated in women with overall low morbidity.

Is routine cystoscopy justified in female stress urinary incontinence?

The investigation of women with SUI the Serbian urologist traditionally begins with cystoscopy to reduced risk of bladder tumor. There is no doubt regarding its ability to detect bladder cancer presented with characteristic symptoms or pathologic results of urinalyses. We discuss its routine use in patients presenting with symptomatology of SUI. The retrospective study was performed in order to evaluate clinical justifiability and cost/benefit ratio of routine cystoscopy in women with stress urinary incontinence (SUI) whose were surgically treated. We reviewed records of 95 female, mean age 56,5 years (rang 46-78) who underwent SUI surgery at eight-year period. The clinical variables, including urinary symptoms, results of urinalyses, ultrasound records and cystoscopic findings, were obtained from the hospital reports. Insignificantly abnormal cystoscopic findings were reported in 31% patients (vagina-like epithel, trigonitis, uterus wall impression, hyperemia, polypoid proliferation and mild trabeculation). No cases of malignancy were incidentally discovered. In female SUI cystoscopic finding was insignificantly abnormal and was not influenced further therapy and contraindicated the planned SUI surgery. Routine cystoscopy in women with SUI cannot be justified only by customary practice or tradition of older generation urologists.

Efficacy of lidocaine spray as topical anaesthesia for outpatient rigid cystoscopy in women: A prospective, randomized, double-blind trial

Efficacy of lidocaine spray as topical anaesthesia for outpatient rigid cystoscopy in women: A prospective, randomized, double-blind trial

Efficacy of Lidocaine Spray as Topical Anesthesia for Outpatient Rigid Cystoscopy in Women: A Prospective, Randomized, Double-Blind Trial

To determine the efficacy and feasibility of urethral lidocaine spray for rigid cystoscopy in female outpatients, compared with lidocaine gel for patient tolerance of pain. A total of 144 consecutive women scheduled to undergo rigid cystoscopy were randomized to receive either 10 mL of lidocaine gel (group 1, n = 48), five metered doses of 10% lidocaine spray (group 2, n = 48), or 10 mL of plain lubricating gel (group 3, n = 48). Patients recorded their level of pain perception during gel instillation or spray and immediately after the procedure using the visual analogue scale (VAS) and a 5-point verbal descriptor scale. The perception of pain was significantly decreased when lidocaine spray was used (mean VAS scores 1.9 +/- 1.3 for group 2 versus 3.9 +/- 2.2 for group 3; P <0.001). There was no difference in pain perception when lidocaine spray or gel was used (P = 0.113). Four patients in group 1 and 1 in group 2 but 10 in group 3 requested post-cystoscopic analgesics. There was a slight increase in pain perception on the VAS during the intraurethral application with lidocaine spray (2.2 +/- 1.5) compared with lidocaine gel (0.7 +/- 1.1) or plain gel (1.0 +/- 1.4). Lidocaine spray and lidocaine gel produce similar anesthetic effects in women undergoing rigid cystoscopy. However, concerns about the mild discomfort associated with delivery of the spray need to be resolved through future technical improvement before it gains widespread use.

Cystoscopy in women with recurrent urinary tract infection

To investigate if women with recurrent urinary tract infection (UTI) warrant cystoscopy to exclude an abnormality of the lower urinary tract. This is particularly relevant given that non-invasive imaging has often been performed to exclude abnormality. Our further aims were to correlate imaging and risk factors with cystoscopic findings to determine their predictive value in finding pathology. A database of women undergoing cystoscopy with recurrent UTI has been maintained at our institution for 10 years. We retrospectively examined this and patient records for patient demographics, and investigative and operative data. A total of 118 patients (mean 55 years) having recurrent UTI (mean 4.7 infections/year) were available. There were nine patients (8%) with significant abnormalities at cystoscopy: urethral stricture (six), bladder calculus (one), bladder diverticulum (one) and colovesical fistula (one). The negative predictive value (NPV) of imaging was 99% and significant (P < 0.01). Women with no risk factors for UTI had a NPV of 93% for normal cystoscopy (P > 0.05). The positive predictive value was low for imaging and risk factors in predicting cystoscopy findings. In our study, 8% of women had significant abnormalities detected during cystoscopy with most over 50 years. Women without risk factors for recurrent UTI and with normal imaging could have a cystoscopy omitted. Younger women are less likely to have pathology and this must be factored into decisions to perform cystoscopy.

Microscopic hematuria as a predictive factor for detecting bladder cancer at cystoscopy in women with irritative voiding symptoms

The purpose of this study was to assess microscopic hematuria as a predictive factor for detecting bladder cancer at cystoscopy in women with irritative voiding symptoms. We conducted a retrospective cohort analysis of women with irritative voiding symptoms who presented for urodynamic testing and cystoscopy. Irritative voiding symptoms were defined as urgency, urge incontinence, frequency, dysuria, and/or nocturia. Patient demographics, risk factors for bladder cancer, presence of microscopic hematuria, urodynamic findings, and cystoscopy and biopsy results were recorded. Of 735 patients with irritative voiding symptoms, 264 (35.9%) had microscopic hematuria and 471 (64.1%) had no hematuria. Bladder cancer was detected in 3 women, for an overall detection rate of 0.4%. Microscopic hematuria, urgency, frequency, dysuria, nocturia, age, and tobacco use were not significantly associated with bladder cancer. In this cohort of women with irritative voiding symptoms, microscopic hematuria was not predictive for bladder cancer.

Results of Urine Cytology Testing and Cystoscopy in Women With Irritative Voiding Symptoms

Results of Urine Cytology Testing and Cystoscopy in Women With Irritative Voiding Symptoms

Results of urine cytology testing and cystoscopy in women with irritative voiding symptoms

The purpose of this study was to assess rates of urinary cytologic abnormalities and cystoscopic outcomes in women with irritative voiding symptoms who were examined at a urogynecology clinic. All urinary cytology studies results that were sent between January 1, 2000, and July 31, 2003, for the evaluation of irritative voiding symptoms were reviewed. Data were then extracted from the charts of a subset of these patients to evaluate cystoscopic outcomes. Demographics, risk factors for urothelial cancer, laboratory results, and radiology imaging results were then analyzed and compared between patients with and without abnormal cytology and cystoscopic results. Of the 1783 total urinary cytology that were reviewed, 1661 test results were read as normal (93.2%); 112 test results (6.3%) were read as atypical, and 3 test results (0.2%) were read as unsatisfactory. Seven cytologic test results were categorized as suspicious or malignant, which accounts for only 0.4% of all cytologic test results that were sent. Of the 564 consecutive women whose cases were chosen for subanalysis, cytology was normal in 91.5% and atypical in 8.5% of cases. No cytology were suspicious or malignant. Cystoscopic findings were normal in 548 patients (97.2%). Only 1 patient (0.2%) received a diagnosis of transitional cell carcinoma. Urinary cytology and cystoscopy are low yield tests and should not be used routinely in the initial evaluation of women with irritative voiding symptoms.

Poster 41: Microscopic Hematuria as a Risk Factor for Detecting Bladder Cancer at Cystoscopy in Women With Irritative Voiding Symptoms

OBJECTIVE: The objective of this study was to assess microscopic hematuria as a risk factor for detecting bladder cancer at cystoscopy in women with irritative voiding symptoms presenting for urodynamics at a tertiary care urogynecology practice. METHODS: We conducted a retrospective cohort analysis of all women with irritative voiding symptoms who presented for urodynamic testing and cystoscopy at our institution from January 2001 to March 2004. Irritative voiding symptoms were defined as urgency, urge incontinence, frequency, dysuria, and/or nocturia. Patient demographics, risk factors for bladder cancer, presence of microscopic hematuria, urodynamic findings, and cystoscopy results were recorded. Cytology and biopsy results were collected when a lesion was detected at cystoscopy. Statistical analyses consisted of univariate statistics, Student t test, chi square, Fisher exact test, and multivariate logistic regression when appropriate. RESULTS: Of 735 patients with irritative voiding symptoms, 264 (35.9%) women with microscopic hematuria defined our cases and the remaining 471 (64.1%) without hematuria represented our control group. These 2 groups were similar in age, race, parity, tobacco use, and family history of bladder cancer. Bladder cancer was detected in 3 women for an overall detection rate of 0.4%. Microscopic hematuria, urgency, urge incontinence, frequency, dysuria, nocturia, age, and tobacco use were analyzed using both univariate analysis and multivariate logistic regression. None of these independent variables was significantly associated with bladder cancer. In fact, microscopic hematuria was absent in 2 of the 3 cases of bladder cancer. To analyze cost, we accounted for the 735 cystoscopies and 31 additional cystoscopies with biopsy needed to detect the 3 cases of cancer. We estimated costs based on Medicare global reimbursements of $195 per cystoscopy and $602 per cystoscopy with biopsy, which resulted in an average cost of $220 per patient for diagnosis. Given our bladder cancer rate of 0.4% (one case per 250 patients), the overall cost to detect a single case of bladder cancer was $55,000. CONCLUSION: In this cohort of women with irritative voiding symptoms, no risk factors for bladder cancer were identified. The cases of bladder cancer were only detected by direct visualization at cystoscopy with follow-up biopsy at a cost of $55,000 per cancer case.

Paper 11: Results of Urine Cytology and Cystoscopy in Women with Irritative Voiding Symptoms

Paper Presentations: AUGS-SGS Abstracts: 2004 Joint Scientific Meeting The American Urogynecologic Society and The Society of Gynecologic Surgeons

Randomized, Prospective, Double-Blind Study of the Effects on Pain Perception of Lidocaine Jelly Versus Plain Lubricant During Outpatient Rigid Cystoscopy

There is no clear evidence that intraurethral lidocaine jelly decreases pain and/or makes rigid cystoscopy more tolerable for patients. Since lidocaine jelly is significantly more expensive than plain lubricant, we attempted to assess the true benefit of this agent. We performed a randomized, prospective, double-blind study to compare the anesthetic effects of intraurethral 2% lidocaine jelly versus plain lubricant in patients undergoing rigid cystoscopy. Unlike previous studies, we ensured adequate urethral filling by using 30 cc of each agent and we waited 20 minutes after instillation of the agent before performing cystoscopy to allow adequate absorption. Cystoscopy was performed using a 17 to 21F rigid instrument. A total of 189 patients was entered into the study but 10 were excluded from analysis due to incomplete questionnaires. A 10-point scale (1-least to 10-most painful) was used to measure pain perception. In men pain perception was significantly decreased when lidocaine jelly was used (mean plus or minus standard error 3.00 +/- 0.21 versus 4.36 +/- 0.37 points, p = 0.002). In women there was no observed difference in pain perception when lidocaine jelly or plain lubricant was used (3.21 +/- 0.38 versus 3.11 +/- 0.30 points, p = 0.823). Patient race, performance of a related procedure, cystoscope size or history of cystoscopy did not significantly affect reported pain scores. There was a slight decrease in pain perception with increasing age (-0.23 +/- 0.10 points per decade, p = 0.021). The level of patient anxiety before cystoscopy was also significantly associated with pain perception (p < 0.001). Lidocaine jelly offers no advantage over plain lubricant in regard to pain control during rigid cystoscopy in women. However, when used in adequate amounts and allowed to dwell in the urethra for 20 minutes before cystoscopy, lidocaine jelly can significantly decrease pain in men.

Excretory urography, cystography, and cystoscopy in the evaluation of women with urinary-tract infection: a prospective study.

IT has been estimated that 10 to 20 per cent of women will have urinary-tract infection at some time during their lives1 and that about 99 per cent of those with recurrent infections will have urinary-tract reinfections, as opposed to persistent urinary-tract infections.2 The value of radiographic and endoscopic investigations of the urinary system in women with such reinfections, however, has not been clearly defined. We report a prospective study of findings with excretory urography, cystography, and cystoscopy in women with symptomatic urinary-tract infection and an analysis of the effects of the findings on treatment. The great majority of these . . .