Cystoscopy Research Articles

Limited Value of Bladder Wash Cytology During Follow-Up of Patients With Non-muscle Invasive Bladder Cancer.

Aims We aimed to assess the performance of bladder wash cytology (BWC) in daily clinical practice in a pure follow-up cohort of patients previously diagnosed with non-muscle invasive bladder cancer (NMIBC). Materials and methods We analyzed 2064 BWCs derived from 314 patients followed for NMIBC (2003-2016). Follow-up investigations were performed using cystoscopy (CS) in combination with BWC. Patients with suspicious CS and/or positive BWC underwent bladder biopsy or transurethral resection. BWC was considered positive if malignant or suspicious cells were reported. Sensitivity (Sn) and specificity (Sp) were calculated for the entire cohort and separately for low-grade (LG) and high-grade (HG) tumors, and carcinoma in situ (CIS) subgroups. Results A total of 95 recurrences were detected, of which only three were detected by BWC alone. Overall, Sn and Sp of BWC were 17.9% and 99.5%, respectively. For LG disease, these numbers were 14.0% and 100%, and for HG disease, these were 22.2% and 99.1%, respectively. For patients with CIS at initial diagnosis, Sn and Sp were 11.0% and 71.4%, respectively. For isolated primary CIS, Sn was 50.0%, and Sp was 98.2%. Conclusion Routine use of BWC in the follow-up for NMIBC is of limited value even in HG tumors. In the presence of isolated primary CIS, adjunct BWC might be justified.

Costs and profitability of cystoscopy depend on number of procedures performed

Costs and profitability of cystoscopy depend on number of procedures performed

Soft Urinary Bladder Phantom for Endoscopic Training

Bladder cancer (BC) is the main disease in the urinary tract with a high recurrence rate and it is diagnosed by cystoscopy (CY). To train the CY procedures, a realistic bladder phantom with correct anatomy and physiological properties is highly required. Here, we report a soft bladder phantom (FlexBlad) that mimics many important features of a human bladder. Under filling, it shows a large volume expansion of more than 300% with a tunable compliance in the range of 12.2 ± 2.8 – 32.7 ± 5.4 mL cmH2O−1 by engineering the thickness of the bladder wall. By 3D printing and multi-step molding, detailed anatomical structures are represented on the inner bladder wall, including sub-millimeter blood vessels and reconfigurable bladder tumors. Endoscopic inspection and tumor biopsy were successfully performed. A multi-center study was carried out, where two groups of urologists with different experience levels executed consecutive CYs in the phantom and filled in questionnaires. The learning curves reveal that the FlexBlad has a positive effect in the endourological training across different skill levels. The statistical results validate the usability of the phantom as a valuable educational tool, and the dynamic feature expands its use as a versatile endoscopic training platform.

Emergency department and hospital revisits after ambulatory surgery for kidney stones: an analysis of the Healthcare Cost and Utilization Project

Our objective was to identify the rate of revisit to either emergency department (ED) or inpatient (IP) following surgical stone removal in the ambulatory setting, and to identify factors predictive of such revisits. To this end, the AHRQ HCUP ambulatory, IP, and ED databases for NY and FL from 2010 to 2014 were linked. Cases were selected by primary CPT for shock-wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL) with accompanying ICD-9 for nephrolithiasis. Cystoscopy (CYS) was selected as a comparison group. The risk of revisit was explored using multivariate models. The overall unplanned revisit rate following stone removal was 6.4% (4.2% ED and 2.2% IP). The unadjusted revisit rates for SWL, URS, and PNL are 5.9%, 6.8%, and 9.0%, respectively. The adjusted odds of revisit following SWL, URS, and PNL are 1.93, 2.25, and 2.70 times higher, respectively, than cystoscopy. The majority of revisits occurred within the first two weeks of the index procedure, and the most common reasons for revisit were due to pain or infection. Younger age, female sex, lower income, Medicare or Medicaid insurance, a higher number of chronic medical conditions, and hospital-owned surgery centers were all associated with an increased odds of any revisit. The most important conclusions were that ambulatory stone removal has a low rate of post-operative revisits to either the ED or IP, there is a higher risk of revisit following stone removal as compared to urological procedures that involve only the lower urinary tract, and demographic factors appear to have a moderate influence on the odds of revisit.

Effect Analysis of Comfort Nursing on Pain in Patients with Cystoscopy

Effect Analysis of Comfort Nursing on Pain in Patients with Cystoscopy

Rare Surgical Complication of In Vitro Fertilisation Treatment: Bladder Injury During Oocyte Retrieval

Current literature suggests that surgical complications from oocyte retrievals (ORs) are uncommon. Here, we present a rare case of bladder injury during OR and its subsequent management. A 37-year-old nulliparous woman underwent assisted reproductive therapy (ART) for primary infertility secondary to anovulatory cycle. During OR, there was an inadvertent puncture of the bladder, with active intra-bladder bleeding seen on transvaginal ultrasound. Bladder washout followed by continuous drainage was instituted with antibiotic coverage over several days. Bladder integrity ascertained through computer tomography urogram and cystoscopy were unremarkable. She was discharged well and continued with her fertility treatment. Transvaginal OR is associated with few complications. Bladder injury, albeit rare, can present with massive hematuria and hemodynamic instability. Early identification of the injury is key to management with insertion of the indwelling urinary catheter, hemodynamic resuscitation and bladder irrigation. With a urological multi-disciplinary approach, most bladder injuries can be resolved non-invasively. J Med Cases. 2021;12(3):102-106 doi: https://doi.org/10.14740/jmc3632

Pain reduction methods during transurethral cystoscopy.

Transurethral cystoscopy (CS) is a common urological procedure, performed mostly for diagnostic but also for therapeutic purposes. Although CS is generally well tolerated, some patients describe the pain related to the procedure as high or even “unbearable”. As a result, many patients fear and avoid both primary and/or follow-up cystoscopies. This may lead to uncontrolled progression of neoplastic disease. Therefore, it is crucial to maximally increase the comfort of the patient and to implement safe and effective analgesia before the procedure. Providing the patients with appropriate care during CS can encourage them to comply with diagnostic schedules and improve their prognosis. The aim of this review is to analyze the available literature on various methods of pain reduction during transurethral CS. The PubMed electronic database limited to English articles published until January 2021 was used in the process. Meta-analyses, systematic reviews, randomized controlled trials, clinical trials, prospective randomized studies, multicenter comparisons, reviews and retrospective comparisons were used. As a result, 65 articles were included in this review.

The nephrogenic adenoma of the bladder: 8 cases and literature review

Objective To analyze the clinical characteristics of nephrogenic adenoma of the bladder. Methods The clinical and pathological data of 8 patients with bladder nephrogenic adenoma, during the period from July 2016 to June 2019, were retrospectively analyzed. Patients’ age were 33 to 71 years old and the average age was 55, including 5 males and 3 females. The clinical manifestations were hematuria in 7 cases, urinary tract irritation in 6 cases, and no obvious symptoms in 1 case. There were 7 cases with cystitis, 3 cases with urolithiasis, 2 cases with bladder cancer, 1 case with invasive colonic mesentery fibroma, and 1 case without other complications. 5 cases had the history of urological operation. The predilection site was the lateral wall with 5cases; 5 cases were solitary; the average maximum diameter of the tumor was 0.9 cm (range 0.1-1.8 cm). Under cystoscope, papillary mass can be seen, the surface is bright red, the pedicle is not obvious, the papilla is thick and short, easy to bleed when touching; some of them are scattered and lichen like changes. All patients received transurethral resection of bladder mucosa. Results Pathological examination shows that the bladder mucosa showed chronic inflammation, interstitial edema, granulation tissue hyperplasia, eosinophil infiltration and metaplasia of mesonephroid epithelium. All of the 8 patients were followed up by telephone for 2 to 38 months, with an average of 17.1 months. So far, neither recurrence has been detected. Conclusions The diagnosis of nephrogenic adenoma of the bladder depends on pathological examination. It must be totally removed during operation. The recurrence and malignancy should be treated in time after operation. Key words: Urinary bladder neoplasms; Nephrogenic adenoma; Pathology

Clinical study on internal or external diversion for the treatment of ureteral calculi complicated with urinary sepsis

Objective To compare the clinical effects of internal and external diversion in the treatment of ureteral calculi complicated with urinary sepsis. Methods From May 2014 to May 2017, 38 patients with urinary sepsis caused by ureteral calculi obstruction in our hospital were randomly divided into internal diversion group(cystoscopy or ureteroscopic double-J tube insertion) and external diversion group(percutaneous nephrostomy under the B-ultrasound guidance). The success rate, the time of urinary sepsis control, the incidence of urinary sepsis and septic shock after operation were compared between two groups. Results There was no significant difference in the success rate between the two groups, and the control time of urinary sepsis in the external drainage group was relatively short, and no patient developed urinary sepsis after operation.There were 5 cases of recurrent urinary sepsis after ureteroscopic lithotripsy in internal diversion group. Conclusions External diversion is more advantageous in patients with ureteral calculi and urinary sepsis. Key words: Ureteral Calculi; Sepsis; Drainage

The feasibility and efficacy of total laparoscopic radical cystectomy with intracorporeal Xing's orthotopic neobladder

Objective To explore the feasibility and clinical effect of laparoscopic radical cystectomy with intracorporeal Xing's orthotopic neobladder. Methods Forty-one patients who underwent laparoscopic radical cystectomy with intracorporeal Xing's orthotopic neobladder from July 2013 to August 2019. There were 31 cases performed in Beijing Chaoyang hospital and 10 cases in National Cancer Center. Mean age was 59(range 44-78) years, mean BMI was 25.3(range 20.1-34.7)kg/m2 , and mean CCI was 3 (range 2-6). No urethral stricture or urinary incontinence was found by preoperative examination. No distant metastasis was identified by bone scans, chest X-ray and sonography. Cystoscopy or TURBT was performed on all patients and biopsy was taken to confirm the diagnosis. Preoperative pathology showed 30 cases (73.2%) of MIBC, 9 cases of NMIBC (22.0%) and 2 cases (4.9%) of in-situ cancer. Laparoscopic radical cystectomy and lymphadenectomy were performed under general anesthesia. Urinary diversion was completed in the peritoneal cavity, by intercepting the terminal ileum about 60 cm, and taking the proximal ileum 10 cm as input loop on the right side with proximal to distal way, and the middle 40 cm ileum was detubated. After u-shaped suture, the ileum was folded back and stitched into a sphere building a novel orthotopic neobladder with bilateral isoperistaltic afferent limbs. The prognosis of perioperative data and postoperative satisfaction regarding continence were analyzed, continence was defined as 0-1 pad/day. The 41 patients were divided into two groups to compare the difference in term of operation time and blood loss between the first 21 patients and the last 20 patients. Results Mean total operative time was 324.9 mins (range 210-480) mins, and mean estimated blood loss was 177.6(range 50-700) ml. There were significant statistical differences in term of total operation time, construction time and blood loss between the first 21 patients and the next 20 patients (P<0.05). Postoperative pathological results were urothelial carcinoma in 40 cases (2 in situ carcinoma) and small cell carcinoma in 1 case. Mean number of dissected lymph nodes was 19 (range 11-58), with 7 cases(17.1%)of positive lymph nodes, and 3 cases(7.3%)had positive surgical margin. At a mean follow up of 17.6(range 2-64) months, 36 patients (87.8%) survived, including 2 patients (4.9%) with metastasis and 1 patient (2.4%) with recurrence, and 5 cases (12.2%)died. All patients were able to urinate without catheterization. Thirty-seven patients (90.2%) were satisfied with voiding control during the daytime (0-1 urinal pad), and 29 patients (70.7%) were satisfied with voiding control at nighttime (0-1 urinal pad) by the follow-up 12 months after the operation. Conclusions Total laparoscopic radical cystectomy combined with Xing's orthotopic ileum neobladder is a simple method with fewer postoperative complications and a satisfactory continence rate. Key words: Urinary bladder neoplasms; Totally Laparoscopes; Xing′s orthotopic neobladder; Urinary diversion

Clinical analysis of intrauterine device ectopic into bladder and formation bladder stones

Objective To explore the cause diagnosis and treatment of bladder stones that caused by intrauterine device ectopic. Methods The clinical data of 24 patients with intrauterine device ectopic to bladder and formation bladder stones in our hospital from January 2007 to October 2018 were retrospectively analyzed. SPSS 19.0 statistical software was used for analysis. Results The age of the patients ranged from 30 to 67 years, average age was(40.12±2.24)years. The time of intrauterine device placement, postpartum 3-20 months, average (7.01±1.03)months. The time between implantation of intrauterine device and diagnosis of bladder stones was 5 to 24 years, average (8.12±2.12)years. CRP 6-40 mg/L, average(15.12±1.21)mg/L. Urinary leukocytes were 80-348 /UL, average (150.51 ±1.83)/UL. Creatinine was 70-127 μmol/L, average (95.21±2.31)μmol/L. Stones size was 1.0-5.4 cm, average (1.82±0.15)cm. Frequent micturition, urgent urination odynuria were 24 cases. Lower abdomen pains were 15 cases.There were 18 cases of hematuria, 2 cases of fever, 16 cases of dyspareunia, 10 cases of complete ectopic, 14 cases of partial ectopic(more than 1/2 of the intrauterine device entering the bladder part). Transurethral urethral cystoscope holmium laser lithotripsy and removal of foreign body forceps intrauterine device were 23 cases, suprapubic cystolithotomy was 1 case. Conclusions Intrauterine device ectopic to bladder and formation bladder stones is one of the important complications of intrauterine device. Frequent micturition, urgent urination odynuria, lower abdomen pains, dyspareunia and hematuria are the main clinical manifestations. CT and 3D reconstruction of urinary system are important methods for diagnosis of localization and qualitative. Transurethral urethral cystoscope holmium laser lithotripsy and removal of foreign body forceps intrauterine device is a safe and feasible minimally invasive treatment, which is worthy of clinical application. Key words: Intrauterine Devices; Urinary Bladder; Urinary Bladder Calculi

The application of diagnostic digital flexible ureteroscopy in patient with hematuria from unilateral upper urinary tract

Objective To investigate the value of diagnostic digital flexible ureteroscopy in patient with hematuria from unilateral upper urinary tract. Methods A retrospective analysis was made in consecutive 140 cases, including 94 males and 46 females, who are considered for hematuria from unilateral upper urinary tract in Renmin hospital of Wuhan University from January 2014 to February 2019.Their age ranged from 22 to 89 years, with mean of 62.3 years. The mean BMI was 24.6 kg/m2(ranging 22.1-28.2 kg/m2). All patients complained about the continuously or intermittently gross hematuria. 29 cases (20.7%) complained about the flank pain, as well. All cases were examined by urinary sonography, CTU and voided urine cytology preoperatively. Occupying lesion was found in 47 case by sonography including suspected diagnosis. Upper tract urothelial carcinoma(UTUC) was diagnosed in 63 cases by CTU including suspected diagnosis.Voided cytology was positive in 17 cases. Concomitant bladder or urethral lesions were excluded by cystoscopy. Hematuria was confirmed from left side in 82 cases(58.6%) and from right side in 58 cases(41.4%). Diagnostic digital flexible ureteroscopy were performed under general anethesia strictly according to 'No touch technique’. Biopsy for suspicious lesions as well as selective in situ cytology were acquired during ureteroscopy. Results All patients accepted the examination successfully. The duration of follow-up ranged from 3 to 37 months, with mean of 13 month. Benign lesions were found in 71 cases(50.7%) while malignant lesions were identified in 69 cases(49.3%). Benign lesions included 39(54.9%)minute venous rupture, 12 (16.9%)hemangioma, 3 (4.2%)varix and 11 (15.5%)no obvious lesion. The overall success rate of ureteroscopic treatment was 66(93.0%) whereas recurrence rate after treatment was 8(11.3%). Malignant lesions including 67(97.1%) cases with UTUC and 2 cases with squamous carcinoma. The radical nephroureterectomy(RNU)and bladder sleeve resection was performed in all cases. To 67 cases with UTUC, the overall identification rate of urinary sonography, CTU, voided urine cytology, selective in situ cytology and diagnostic digital flexible ureteroscopy was 41(61.2%), 61(91.0%), 13(19.4%), 38(56.7%) and 63(94.0%) respectively. Identification rate of selective in situ cytology was superior to voided cytology(P<0.01) while diagnostic digital flexible ureteroscopy was no significant difference compared with CTU. The concordance of pathological grade between biopsy and final resection specimen was 73.1%.The concordance of low grade was 93.3% whereas high grade was 56.8%. Up-grading was found in 16(23.9%) cases while down-grading was found in 2(3.0%) cases. Intravesical recurrence was affirmed in 11(16.4%) cases during follow-up. Conclusions Diagnostic digital flexible ureteroscopy may not only present qualitative as well as localized evidence for etiological diagnosis of hematuria from unilateral upper urinary tract, but also provides strategy choice for treatment. Key words: Ureteroscopy; Flexible ureteroscope; Hematuria; Upper urinary tract; Upper tract urothelial carcinoma; Laser ablation

Effectiveness of transcutaneous electrical stimulation for refractory lower urinary tract symptoms in elderly female patients

Objective To assess the clinical effects of percutaneous electrical stimulation on refractory lower urinary tract symptoms in elderly female patients. Methods Elderly female patients with refractory lower urinary tract symptoms from July 2016 to December 2017 were recruited.According to cystoscopy results, patients were divided into an interstitial cystitis group, a suspected interstitial cystitis group and an overactive bladder group.All patients received 3 courses of transcutaneous low-frequency electrical stimulation treatment in the suprapubic bladder area, with 40 min per time, 4 times per day, 7 days per course.Bladder diaries, pain scores and overactive bladder symptom scores were recorded before and after treatment. Results A total of 27 patients with a mean age of 74.3 years were enrolled.Under the cystoscope with water dilatation, 9 cases were found to have mucosal bleeding, with mast cells detected in mucosal specimens examined via electron microscopy(in the interstitial cystitis group), 5 cases had superficial mucosal congestion(in the suspected interstitial cystitis group)and 13 cases showed normal imaging(in the overactive bladder group). In the interstitial cystitis group, the 24-h urinary frequency improved from 15.4±2.5 times before treatment to 11.9±2.0 times after treatment(P 0.05]. In the suspected interstitial cystitis group, the 24-h urinary frequency improved from (11.8±1.5) times before treatment to (8.4±1.1) times after treatment, and pain scores decreased from (6.4±1.1) to (4.2±1.1)(P<0.05). In the overactive bladder group, the 24-h urinary frequency improved from (19.2±2.0) times before treatment to (15.9±1.3) times after treatment(P<0.05), and the overactive bladder symptom score(OABSS)decreased from (8.9±1.6) to (5.9±1.6)(P<0.05). Conclusions Percutaneous electrical stimulation is an easy, safe and effective treatment in elderly females with refractory lower urinary tract symptoms, and should be encouraged in clinical practice. Key words: Urinary, incontinence; Electrical stimulation therapy

Operation mode to prevent obturator nerve reflex in plasmakinetic resection of bladder tumor

Objective To observe the results and reality of transurethral resection of bladder tumor with preexcitation of electric cutting loop in the prevention of obturator nerve reflex. Methods The clinical data of 186 patients with bladder tumors admitted from January 2015 to August 2018 were retrospectively analyzed. There were 112 males and 74 females aged 35 to 83 years, average(59±11)years. 76 patients were admitted because of intermittent gross hematuria and 110 patients were admitted because of physical check-up. All patients underwent ultrasound, CT (plain scan/enhancement) and cystoscopy before operation. The pathological diagnosis of cystoscopy biopsy was bladder urothelial cell carcinoma.There were 105 cases clinical stage Ta stage, 81 cases of T1 stage. There were 103 single cases and 39 multiple cases of non-muscular invasive bladder. According to the different surgical techniques, the patients were divided into two groups: the pre-excitation group and lateral incision group. There were 142 cases in pre-excitation group. In the pre-excitation group, the tumors were removed routinely by the resection ring. When the resection ring was far away from the tumors, the pedal switch was pressed to excite the resection ring. The resection ring was moved to the location of the tumors, and the tumors were cut to the muscular layer. The operation was completed after 2 cm electric cauterization around the wound and hemostasis. In the lateral incision group, the tumors were removed routinely by the electric resection ring. The operation time, incidence of obturator nerve reflex, incidence of bladder perforation, amount of bleeding, retention time of catheter, pathological grading, risk grading, hospitalization time and recurrence rate of tumors at 6 months after operation were compared between the two groups. Results The operation was successfully completed in both groups, and there was no transition to open operation. In the pre-excitation group, the operation time was 10 minutes to 56 minutes, with an average of (28±12) minutes, and the intraoperative blood loss ranged from 5 ml to 70 ml, with an average of (35±15) ml. In the lateral incision group, the operation time was 15 minutes to 65 minutes, with an average of (28±11) minutes, and the blood loss was 10 ml to 80 ml, with an average of (40±15) ml. There was no significant difference in operation time and blood loss between the two groups (P>0.05). There were only 3 cases of obturator nerve reflex in preexcitation group, the incidence was 2.1%. There were 13 cases of obturator nerve reflex in lateral resection group, the incidence was 29.5%. There was significant difference of nerve reflex incidence between the two groups (P<0.05). Conclusions In transurethral resection of bladder tumors, the method of pre-excitation of plasma resection ring can effectively decrease obturator nerve reflex and make the operation safer. Key words: Bladder tumors; Plasmakinetic resection of bladder tumor; Obturator nerve reflex

Clinical significance of standardized pathological examination of specimens for en bloc transurethral resection technique with Hybrid Knife to treat NMIBC

Objective To evaluate the pathological stage, the presence of detrusor muscle and the clinical significance for standardized examination of specimens for en bloc transurethral resection technique with Hybrid Knife to treat NMIBC (ERBT) compared with conventional TURBT. Methods This was prospective randomized controlled study. This study was approved by the Ethics Committee of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology (TJ-IRB20180604), and patients all signed informed consent. The clinical study registration number of this study: NCT03221062. The margin of the tumor was recognized and marked by with Hybrid Knife (0.5 cm away from the normal mucosa). Then water was injected into the submucosa and form a water pad, with a circular cutting layer by layer (0.5 cm away from the marked position), reaching the detrusor muscle in depth. After complete resection, the tumor was removed by specimen bag. Specimens for ERBT cohort were given standard handling. Resected specimen of ERBT stretched with pins on foam and its margin was stained. The basement of specimen was also stained. Total specimen sectioned into appropriate pieces for histological assessment in the department of pathology. TURBT cohort performed traditional surgical methods and pathological examination. All patients received postoperative intravesical instillation according to their pathology. Imaging and cystoscopy were performed every 3 months. The primary study end-point was the quality of resection, including the pathological stage and the presence of DM. Secondary outcomes were: short-term tumour recurrence rate(18 month), feasibility, and safety. Results From January 2017 to October 2017, 109 patients were enrolled. 51 patients underwent ERBT, and 58 patients underwent TURBT. The clinical characteristics of the patients in each cohort, such as average age, gender, average BMI, smoking history, the mean number of lesions and tumour size had no significant differences (P>0.05). The operation of 109 cases was completed successfully. There was no statistical difference between the operative time and the postoperative bladder irrigation time. Major intraoperative or postoperative complications (Clavien ≥Ⅱ) did not occur in all of the patients. The percentage of T1 staging was higher in the ERBT cohort vs. TURBT cohort [21/51(41.2%) vs. 13/58(22.4%), P=0.035], of which ERBT cohort accurately detected 9 cases (42.8%)of T1b patients, significantly higher than TURBT cohort (2 cases, 15.4%)(P=0.096). All the ERBT samples showed the presence of DM(100.0%), while there was only 77.4% in TURBT cohort (P<0.05). Mean follow-up (20.3±3.1) months (ranged from 18 to 24 months). Recurrence rate were 8.9% (4/45) in ERBT cohort vs.22.2% (12/54) in TURBT cohort (P=0.059). Conclusions ERBT with Hybrid Knife for treatment NMIBC is a safe, effective, and provides high-quality specimens compared to TURBT. More high-risk NMIBC patients, especially T1b patients, can be detected obviously by pathologist with the standardized treatment of specimens. Key words: Hybrid Knife; En bloc transurethral resection; Non-muscular invasive bladder cancer; Pathology stage

A Rare Presentation of Primary Small-cell Carcinoma of Urinary Bladder

Primary small cell carcinoma of urinary bladder is rare and aggressive neuroendocrine tumor. It is part of neuroendocrine tumor family that affects respiratory system, gastro intestinal tract and genitourinary system of male and female. We report a case of primary small cell carcinoma of urinary bladder treated with chemotherapy. Patient is 81 year old male who presented to emergency department with recurrent urinary retention associated with hematuria. Patient had cystoscopy and was diagnosed with small cell carcinoma of urinary bladder with no distant metastasis. Patient was treated with chemotherapy. Patient died with septic shock due to clostridium difficile colitis.

Clinical study on severe infection caused by ureteral calculus in 12 patients

Objective To explore comprehensive treatment for severe infection caused by ureteral calculus. Methods The clinical data of 12 patients with severe infection caused by ureteral calculus in the Second People's Hospital of Lianyungang from January 2016 to December 2017 were reviewed.The patients cured by anti-infective therapy received one-stage surgical treatment.The patients with ineffective anti-infective therapy received one-stage cystoscopic retrograde double J tube or B ultrasound-guided percutaneous nephrostomy first, then ureteral calculus was treated. Results Two patients were cured by empirical antimicrobial agents.One patient was successfully cured by extracorporeal shock wave lithotripsy (ESWL) and the other by retroperitoneoscopic ureterolithotomy.Ten patients were not responsive to empirical antimicrobial agents.Two patients refused treatment and requested discharge from the hospital.The other 8 patients received two-stage treatment.In the stage I, cystoscopic retrograde double J tube was accomplished in 3 patients, and 5 patients were treated successfully by percutaneous nephrostomy guided by B ultrasound.In the stage II, one patient with ureter stone-street was cured by lithagogue drugs, 2 patients were successfully cured by ESWL, one patient by holmium laser lithotripsy under ureteroscope, 2 patients by ureterolithotomy and 2 patients by percutaneous nephrolithotomy by endoscopy and holmium laser. Conclusion The therapy of retrograde double J tube at cystoscopy or percutaneous nephrostomy guided by B ultrasound combined with empirical antimicrobial agents in the satae I, combined with lithotripsy according to guidelines in the stage II in treating severe infection caused by ureteral calculus have more advantage such as simple, less injury, rapid control of infection, less complication and satisfactory effect.It is an ideal method. Key words: Ureteral calculus; Urinary tract infections; Antibiotics; Double J stenting; Percutaneous nephrostomy; ESWL

Hemorrhagic Cystitis With Low-Dose Cyclophosphamide Therapy for Breast Cancer: A Rare Occurrence

Cyclophosphamide (CP) is known to cause hemorrhagic cystitis (HC), and this adverse effect is more commonly seen in patients receiving high individual doses used in the treatment of sarcomas and conditioning regimens during hematopoietic cell transplant. There are a few reported cases of HC in doses used for breast cancer. We report the case of a 63-year-old lady with stage IIA breast cancer who was started on adjuvant CP and docetaxel therapy at a dose of 600 mg/m 2 and 75 mg/m 2 respectively. She developed gross hematuria in less than 24 h after her first cycle and was found to have evidence suggestive of HC on cystoscopy done subsequently. She went on to complete three more cycles of adjuvant chemotherapy with CP and docetaxel with concurrent mesna and hydration. She did not develop any further episodes of hematuria. We review the literature pertaining to our case, and also compare the characteristics of the patient in our case with previously described cases of breast cancer who developed HC with low-dose CP. J Med Cases. 2019;10(6):179-182 doi: https://doi.org/10.14740/jmc3321

Clinical effect of one-stage flexible cystoscope to treat calculi in calyx parallelled to puncture passage during single-channel minimally invasive percutaneous nephrolithotomy combined with holmium laser for complex renal calculi of patients with lateral decubitus position

目的 探讨软性膀胱镜在一期侧卧位单通道微创经皮肾镜钬激光治疗复杂性肾结石中处理平行盏结石的临床应用效果。 方法 选取北京大学首钢医院、北京市门头沟区医院、北京市门头沟区中医院2016年1月至2018年8月收治的复杂性肾结石患者67例，采取侧卧位单通道微创经皮肾镜钬激光碎石方法治疗复杂性肾结石，术中应用软性膀胱镜处理穿刺道平行盏结石。术后均保留F14肾造瘘管7 d，尿管2～3 d，输尿管支架管4周。 结果 手术时间(93±21)min，出血量(87±23)mL，术后住院时间(7±2)d，均无严重并发症发生。碎石成功率100.00%，一期净石率98.50%。 结论 软性膀胱镜在一期侧卧位单通道微创经皮肾镜钬激光治疗复杂性肾结石中处理平行盏结石的方法安全、有效、可行；净石率高；易于为医患双方接受。

Bladder Cancer in Patients with Asymptomatic Microscopic Hematuria

When should a patient with asymptomatic microscopic hematuria be referred for cystoscopy to screen for bladder cancer? To address this question,