Diagnostic Cystoscopy Research Articles

Urologic Problems in Spina Bifida Patients Transitioning to Adult Care

To identify the urologic needs of adult patients with spina bifida (SB) at the time of their transition from pediatric to adult care. We hypothesized that delays in transition to adult care would be associated with higher rates of active problems. We retrospectively reviewed patients seen at adult dedicated SB clinics at the Universities of Utah and Minnesota from April 2011 to April 2012. We reviewed bladder management, urologic problems, time from last urologic care, and necessary interventions. We identified 65 patients from these clinics with SB. The mean age was 30.6years (standard deviation, 11.3). The median time since last urologic evaluation at Utah and Minnesota was 17months and 12months, respectively (range 1month-10years). Fifty-five patients (85%) reported a urologic problem at the time of their visit. Urinary incontinence was most common in 34 (52%), followed by recurrent urinary tract infection in 22 (34%), catheterization troubles in 8 (12%), and calculi in 6 (9%). Sixty-three patients (97%) required some sort of intervention. These were diagnostic (cystoscopy, ultrasonography, computed tomography scan, urodynamics) in 50 patients (77%), surgical (urinary diversion, onabotulinum toxin A injection, stone surgery, and so forth) in 22 (34%), and medical (antimicrobial prophylaxis, bladder irrigations, anticholinergics, self-catheterization) in 16 (25%). There was no association between longer transition times and higher rates of active problems. On presentation to adult SB clinics, patients had many active urologic problems and operative management was often needed; however, there was no association between longer transition times and higher rates of active problems.

Low incidence of bacteriuria with outpatient flexible cystoscopy.

To evaluate the incidence of bacteriuria after outpatient diagnostic flexible cystoscopy utilising sterile catheter urine collection technique in women. This is a prospective observational study on 78 women who had outpatient flexible cystoscopy for various indications between March and December 2011. Urine for culture was collected by transurethral catheterisation three to five days before cystoscopy, and a second urine sample was collected five to seven days after the procedure. Antibiotic prophylaxis was not administered. Significant bacteriuria was defined as 10(2) cfu/mL or more of a single organism cultured. Five (6.4%) had significant bacteriuria and were asymptomatic. The most common organism cultured was Escherichia coli in 4 (80%) of the infected women. No other cystoscopic complication was observed. The mean age was 54.7years (range 27-80), mean parity was 2.8 (range 0-7). In the study group, 54 (69.2%) women were postmenopausal, 9 (11.5%) had diabetes mellitus, 42 (53.8%) had pelvic organ prolapse and 22 (28.2%) had a prior hysterectomy. Most common indications for cystoscopy were hematuria and recurrent UTI, 48 (61.5%) and 22 (28.2%) women respectively. The cystoscopic findings were normal in 59 (75.6%) women. The procedure was completed within five minutes in all participants. The incidence of bacteriuria following outpatient flexible cystoscopy is low.

MP22-09 FLEXIBLE PHOTODYNAMIC DIAGNOSIS OF THE BLADDER – READY FOR THE OUTPATIENT SETTING?

You have accessJournal of UrologyBladder Cancer: Detection & Screening1 Apr 2014MP22-09 FLEXIBLE PHOTODYNAMIC DIAGNOSIS OF THE BLADDER – READY FOR THE OUTPATIENT SETTING? Alexander Karl, Patrick Weidlich, Christoph Adam, Peter Stanislaus, Thomas Hoffmann, Stefan Tritschler, Christian Stief, and Dirk Zaak Alexander KarlAlexander Karl More articles by this author , Patrick WeidlichPatrick Weidlich More articles by this author , Christoph AdamChristoph Adam More articles by this author , Peter StanislausPeter Stanislaus More articles by this author , Thomas HoffmannThomas Hoffmann More articles by this author , Stefan TritschlerStefan Tritschler More articles by this author , Christian StiefChristian Stief More articles by this author , and Dirk ZaakDirk Zaak More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.857AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the feasibilty and detection rate of flexible HAL-cystoscopy using a new chip-on-the-tip technology in patients with the suspicion of bladder cancer. In this study the performance of photodynamic diagnosis (PDD) and white light (WL) endoscopy using flexible and rigid cystoscopes were compared. METHODS In total 30 patients were included in this two-center study. The flexible chip on the tip endoscope (Storz) and the rigid system (Storz) were both used for diagnostic cystoscopy in the same patient. In preparation for PDD Hexylaminolevulinate (HAL) was used. Two experienced surgeons in each participating institution were involved. In every patient one of these surgeons performed the examination in white light and PDD using a rigid instrument first. Then another blinded surgeon performed a flexible cystoscopy using WL and PDD in the same patient again. All blinded findings were captured on a specially designed documentation sheet. RESULTS In all 30 patients flexible cystoscopy could be performed without any technical problems. In the WL setting the overall sensivitiy for flexible cystoscopy was 92% (22/24) vs. 83% (20/24) with the rigid endoscope. The specificity was 50% for flexible WL vs. 33% for rigid WL. The accuracy of flexible WLwas higher (83%) compared to rigid (73 %). There was an accordance of the two methods of 83% (25/30) with a Cohen's kappa of k=0.44 (p=0.007). Respecting only the results that were acquired in PDD mode, there was no difference in sensitiviy, specificity and accuracy between the two methods (p <0.001). The quality of fluorescence was judged by every examiner for flexible and rigid PDD. For quality assessment four different subjective levels for fluorescence (no, low, medium, high) were used. In 24 of 30 cases there was the same level documented in flexible and rigid. This represents an accuracy of 80% (p<0.001). During the whole study there were observed no side effects caused by the PDD or the flexible approach. Tangential views of the bladder resulting in false positive fluorescence could be avoided using the flexible endoscope. CONCLUSIONS Flexible PDD using the chip on the tip technology was feasible with an excellent picture quality. Sensitivity of flexible PDD was equivalent to the current gold standard – the rigid endoscopy. There was no loss in fluorescence intensity or diagnostic information using the flexible cystoscope. Therefore the outpatient use of flexible PDD seems reasonable in the diagnosis and follow up of bladder cancer patients. However larger clinical studies need to further verify the efficiency of this new equipment. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e237-e238 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alexander Karl More articles by this author Patrick Weidlich More articles by this author Christoph Adam More articles by this author Peter Stanislaus More articles by this author Thomas Hoffmann More articles by this author Stefan Tritschler More articles by this author Christian Stief More articles by this author Dirk Zaak More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effect of Intraurethral Dwell Time of Local Anesthetic Jelly on Pain Perception in Men Undergoing Outpatient Rigid Cystoscopy: A Randomized Prospective Study

To determine optimum duration of intraurethral 2% lidocaine jelly for pain relief during outpatient rigid cystoscopy. This prospective randomized study was conducted between June 2012 and November 2013. Four hundred consecutive adult males requiring diagnostic rigid cystoscopy were randomized into four groups depending on intraurethral 2% lidocaine jelly dwell time before rigid cystoscopy: jelly was instilled 5, 10, 15, and 20 minutes before start of the procedure in group A, B, C, and D patients, respectively. The patients' age, patient-reported preoperative anxiety score, patient-reported intraoperative pain score, the surgeon-reported patient's pain score, and the duration of rigid cystoscopy were recorded and analyzed. The mean age, patient-reported preoperative anxiety score, and duration of rigid cystoscopy were similar between the four groups with no significant difference noted between them. The least and highest mean patient-reported and surgeon-reported intraoperative pain scores were reported in group C (1.49±0.82 and 1.58±0.67) patients and group A (4.86±1.24 and 4.04±1.11) patients, respectively, while no significant difference was found in these scores between group C and D patients. For male patients undergoing diagnostic rigid cystoscopy, an intraurethral dwell time of 15 minutes (of 20 mL 2% lidocaine jelly) provided optimum pain relief.

Training Community Gynecologists to Perform Intraoperative Cystoscopy

This study aimed to pilot a cystoscopy training program for community gynecologists that is validated by posttraining examination. Twenty-eight gynecologists were trained to perform cystoscopy using a competency-based training approach. Baseline information included years in practice and number of incontinence procedures and/or cystoscopies performed per month. Three 5-hour workshops were administered that included applied practice. After learners individually trained until they felt comfortable with their skills on a model, they were individually tested on a cadaver. Performance was evaluated with 2 instruments, namely, a task-specific checklist and a global rating scale based on the objective structured assessment of technical skill model. Failure was defined as inability to independently complete elements of the task-specific checklist for cystoscopic examination. Likert-type self-report scales were used during pretesting and posttesting, assessing confidence to perform component tasks for diagnostic cystoscopy. Twenty-four of 28 trainees successfully performed a systematic cadaveric bladder examination during the primary posttest. After debriefing, the 4 trainees who initially failed successfully performed cystoscopy during a second trial. Median age was 51 years and median time in practice was 19.5 years. All participants reported high confidence in identifying ureteral injury at the course's conclusion. A task-specific training program can successfully improve the confidence and skill of community gynecologists to perform intraoperative diagnostic cystoscopy. Professionals may not be able to define when they have received enough instruction in terms of hands-on training with models, before acquisition of technical skills. Formal evaluation of technical skills is recommended after training to ensure competence.

Do lubricants with 2% lidocaine gel have an effect on patient comfort in diagnostic cystoscopy?

Patients undergoing both rigid and flexible cystoscopic evaluation suffer from a great deal of pain and discomfort. In this study, we aimed to investigate the effect of lidocaine gel anestesia on patient comfort on diagnostic rigid cystoscopy. 11 mL of lubricant gel applied to each patient via the external meatus in 10 s. Patients were randomized into three groups. In group 1, liquid glycerine was applied and cystoscopy was immediately performed, in group 2 lidocaine gel (Aqua Touch™: İstem Tıbbi Cihaz Ve Sanayi Ltd.Şti, Ostim, Ankara, Türkiye) was applied and the procedure undergone immediately and in group 3, lidocaine gel was applied and penis was clemped for 10 minutes before the procedure. VAS forms were filled to determine the discomfort and pain during cystoscopy and the first micturation after. After the evaluation between groups, VAS scores were significantly lower in Group II and III than Group I and in Group III than in Group II (p < 0.05). When post micturation VAS scores were evaluated, VAS scores were significantly lower in Group II than Group I and in Group III than in Group II (p < 0.05). The application of local anesthetic lidocaine gel in rigid cystoscopy, is a practical, safe and efficient method to improve patient comfort when applied in appropriate dose and waiting duration.

Which one is safer - performing a laparoscopic hysterectomy with a tissue fusion device involving diagnostic cystoscopy or traditional abdominal hysterectomy with ureteral dissection?

IntroductionIt still remains an unanswered question whether, in the absence of gynecological malignancy and under elective conditions, to perform abdominal hysterectomy (AH), offering a safer approach, or to perform a laparoscopic hysterectomy (LH) procedure.AimWe aimed to compare LH operations performed with a tissue fusion device accompanied by intraoperative diagnostic cystoscopy with traditional AH operations involving bilateral ureteral dissection.Material and methodsThe integrity of the ureters, ureteral peristalsis and the diameter of the ureters were examined during AH by inspection. At the end of LH, the bladder wall was systematically evaluated by cystoscopy and a jet of urine spurting was noted from both ureteral orifices.ResultsThe operation time was longer in patients who underwent LH + CYS (p = 0.0001). The decline in hematocrit and hemoglobin levels in the postoperative period was significantly higher in patients who underwent AH + UD (p = 0.0001 and p = 0.002, respectively). No significant difference was found between the two groups in terms of ureteral injury, bowel injury or bladder injury (p = 0.378, p = 1.000 and p = 1.000, respectively). There was no statistically significant difference between the two groups in terms of mean body temperature and postoperative blood transfusion requirements (p = 0.051 and p = 0.210, respectively). Mean parenteral analgesic requirement and length of hospital stay were significantly different between the groups (p = 0.005 and p = 0.0001). No statistically significant difference was found between the two groups in terms of postoperative cardiopulmonary complications, re-operation rate or occurrence of genitourinary fistula (p = 1.000, p = 1.000 and p = 1.000, respectively).ConclusionsWe concluded that LH performed with a tissue fusion device involving diagnostic cystoscopy yields major and minor complication rates similar to safely performed AH operations preserving ureters.

Delayed complications of intravaginal slingplasty multifilament tape: two case reports

We would like to present two cases of delayed complications of intravaginal slingplasty (IVS) suburethral sling in Penang, Malaysia. There were two patients who were referred to us for problems subsequent to suburethral sling surgery using the IVS sling. These patients were reviewed and subsequently treated. The first patient presented with a bleeding granuloma. She underwent surgery and intra operatively the granuloma was excised. On exploration there was remnant of the tape bilaterally. The tape was easily excised with traction. A diagnostic cystoscopy did not show any abnormality. The second patient presented with a severe sling exposure. This patient also had surgery to excise the sling. It was easily dislodged with traction and removed completely. There were pus collections on one side. On subsequent review both patients were well with no more vaginal bleeding or discharge. Both patients however remained continent. This report is to show IVS sling complications may present in different manner and the need for attending physician to be aware of these presentations. They should be aware of the delayed presentation of these complications.

A microbiological evaluation of level of disinfection for flexible cystoscopes protected by disposable endosheaths

BackgroundFlexible cystoscopy is used in urological outpatient departments for diagnostic cystoscopy of bladder cancer and requires a high-level disinfection between each patient. The purpose of this study was to make a microbiological post disinfection efficacy assessment of flexible cystoscopes (FC) using disposable sterile endosheaths.MethodsOne hundred endosheaths underwent a leak-test for barrier integrity after cystoscopy. Microbiological samples from these cystoscopies were obtained; after removal of the endosheath, and after cleaning the scope with a detergent cloth, rinsing with tap water followed by 70% ethanol disinfection and subsequent drying. The number of colony forming units (cfu) from the samples was counted after 72 hours and then divided in three categories, Clean FC (<5 cfu/sample), Critical FC (5–50 cfu/sample) and High-risk FC (>50 cfu/sample). The result was compared with data of 10 years continuous control sampling recorded in the Copenhagen Clean-Endoscope Quality Control Database (CCQCD) and analyzed with a Chi-square test for homogeneity.ResultsAll 100 endosheaths passed the leak-test. All samples showed a Clean FC and low means of cfu. A query to the CCQCD, showed that 99.8% (1264/1267) of all FC with a built-in work-channel reprocessed in a WD were clean before use.ConclusionThe reprocessing of FC using endosheaths, as preformed in this study, provides a patient-ready procedure. The results display a reprocessing procedure with low risk of pathogen transmission, high patient safety and a valid alternative to the recommended high-level disinfection procedure of FC. However, the general impression was that sheaths slightly reduced vision and resulted in some patient discomfort.

Comparison of narrow-band imaging cystoscopy and white-light imaging cystoscopy to detect bladder lesions – Northern Ireland initial experience

Comparison of narrow-band imaging cystoscopy and white-light imaging cystoscopy to detect bladder lesions – Northern Ireland initial experience

Can Reproductive Characteristics Predict Bladder Cancer in Women with Haematuria?

Among women with haematuria, defining individuals under high risk for bladder cancer based on reproductive factors prior to cystoscopy would be of great benefit in the management of this condition. The aim of this study was to compare age and reproductive factors such as menopausal status, parity, age at first delivery and age at the last delivery between women who have haematuria with or without bladder cancer. A total of 463 patients underwent diagnostic cystoscopy in Duzce University Faculty of Medicine between 1 June 2008 and 1 June 2013. Female patients who presented with persistent microscopic or macroscopic haematuria and underwent standard evaluation for haematuria including urinalysis, urine culture, urine cytology, urinary tract imaging with excretory urography or computerized tomography with contrast enhancement and endoscopic evaluation of the urethra and bladder were included in this study. Exclusion criteria were tobacco use and high risk occupations for bladder cancer such as textile, dry cleaning, painting and etc. Fourteen women had hematuria due to benign conditions, and 18 due to bladder cancer. Data were retrospectively retrieved from the medical records of Duzce University Hospital. Patients with haematuria due to benign reasons did not significantly differ from patients who were found to have bladder cancer in terms of age (p=0.28), menopausal status (p=0.29), mean parity (p=0.38), being nulliparous (p=0.57), parity ≥ 3 (p=0.22), age ≤ 18 years at first delivery (p=1.00), age ≥ 30 years at last delivery (p=0.26), age ≥ 35 years at last delivery (p=0.23) and percentage of the patients with advanced age (≥ 65 years) (p=0.18). It is difficult to predict a high risk for developing bladder cancer in women with haematuria based solely on reproductive factors.

AsymptomaticSchistosoma haematobiumInfection in a Traveler With Negative Urine Microscopy and Late Seroconversion Presumably Linked to Artemisinin

We describe a Schistosoma haematobium infection with asymptomatic eosinophilia, persistently negative urine microscopy, and late seroconversion (7.5 months) in a traveler returning from Mali. After initial negative parasitological tests, travel history led to diagnostic cystoscopy, allowing final diagnosis with urine microscopy after the bladder biopsy. The patient was successfully treated with praziquantel. Difficulties in making the diagnosis of schistosomiasis in asymptomatic returning travelers are discussed; we propose a trial treatment in these cases.

Intraurethral tramadol alleviates rigid cystoscopy‐related pain in men

AbstractConsidering the effectiveness of tramadol in alleviating pain following major operations, trauma, labour and even chronic neuropathic pain, this study was designed to evaluate the efficacy of intraurethral administration of the drug in alleviating cystoscopy‐related pain in men. Sixty male candidates of diagnostic cystoscopy, aged between 20 and 50 years, in ASA physical status I or II were included in the study. Patients were randomized into intervention [who received tramadol (100 mg) and lidocaine gel] or control group (in whom distilled water and lidocaine was administered) based on a permuted block randomization method. The severity of pain and the incidence of adverse effects were measured during and following the cystoscopy. The urologist' satisfaction was also assessed. Total pain score in the intervention group was significantly lower than the control group (P = 0·037). The urologist was more satisfied with the ease and convenience of performing the cystoscopy in the intervention group. No significant side effect was reported in either group. Adding 100 mg tramadol to lidocaine gel is more effective than using lidocaine gel alone in alleviating the pain associating with male rigid cystoscopy.

Methylcap-seq reveals novel DNA methylation markers for the diagnosis and recurrence prediction of bladder cancer in a Chinese population.

PurposeThere is a need to supplement or supplant the conventional diagnostic tools, namely, cystoscopy and B-type ultrasound, for bladder cancer (BC). We aimed to identify novel DNA methylation markers for BC through genome-wide profiling of BC cell lines and subsequent methylation-specific PCR (MSP) screening of clinical urine samples.Experimental DesignThe methyl-DNA binding domain (MBD) capture technique, methylCap/seq, was performed to screen for specific hypermethylated CpG islands in two BC cell lines (5637 and T24). The top one hundred hypermethylated targets were sequentially screened by MSP in urine samples to gradually narrow the target number and optimize the composition of the diagnostic panel. The diagnostic performance of the obtained panel was evaluated in different clinical scenarios.ResultsA total of 1,627 hypermethylated promoter targets in the BC cell lines was identified by Illumina sequencing. The top 104 hypermethylated targets were reduced to eight genes (VAX1, KCNV1, ECEL1, TMEM26, TAL1, PROX1, SLC6A20, and LMX1A) after the urine DNA screening in a small sample size of 8 normal control and 18 BC subjects. Validation in an independent sample of 212 BC patients enabled the optimization of five methylation targets, including VAX1, KCNV1, TAL1, PPOX1, and CFTR, which was obtained in our previous study, for BC diagnosis with a sensitivity and specificity of 88.68% and 87.25%, respectively. In addition, the methylation of VAX1 and LMX1A was found to be associated with BC recurrence.ConclusionsWe identified a promising diagnostic marker panel for early non-invasive detection and subsequent BC surveillance.

V251 LAPAROENDOSCOPIC SINGLE-SITE SURGERY (LESS) EXTRAVESICAL REPAIR OF VESICOUTERINE FISTULA

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction and Incontinence)1 Apr 2012V251 LAPAROENDOSCOPIC SINGLE-SITE SURGERY (LESS) EXTRAVESICAL REPAIR OF VESICOUTERINE FISTULA Aly Abdel-Karim, Mostafa Elmissery, Ahmed Moussa, Waleed Dawood, and Salah Elsalmy Aly Abdel-KarimAly Abdel-Karim Alexandria, Egypt More articles by this author , Mostafa ElmisseryMostafa Elmissery Alexandria, Egypt More articles by this author , Ahmed MoussaAhmed Moussa Alexandria, Egypt More articles by this author , Waleed DawoodWaleed Dawood Alexandria, Egypt More articles by this author , and Salah ElsalmySalah Elsalmy Alexandria, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.307AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this video we describe for the first time the technique of laparo-endoscopic single-site surgery (LESS) extravesical repair of vesicouterine fistula (VUF). METHODS The case that we present in this video is a 32 years old female that presented with Youssef's syndrome following her 3rd cesarean section. Computed tomography (CT) of the abdomen and pelvis revealed a supratrigonal VUF with a localized reaction between the bladder and uterus. Diagnostic cystoscopy revealed a foreign body (gauze) that was protruding into the bladder at the site of the fistula and it was removed cystoscopically. However, the patient's symptoms were not resolved. CT cystography and cystoscopy showed persistence of VUF. The fistula was repaired through extravesical LESS using the quadri-port that was inserted at the umbilicus and pre-bent and straight instruments. The fistulas tract was identified and completely excised extravesically using sharp dissection. The edge of the bladder was trimmed at the site of fistulas tract. The uterus was closed by one 3/0 vicryl suture in a figure of 8 fashion, while urinary bladder was closed in 2 layers using 3/0 vicryl suture. An additional 5-mm extraport was added at time of suturing to allow triangulation and hand-free intracoprporeal suturing. An omental flap was interposed between the bladder and uterus. The urinary bladder was drained by an indwelling urethral catheter for 3 weeks. RESULTS The operative time was 150 minutes. Blood loss was 90 c.c. There were no intraoperative or postoperative complications. Postoperative hospital stay was 2 days. There was no postoperative urinary leakage. Follow up of the patient (10 months) showed complete clinical cure and no recurrence of vesicouterine fistula. CONCLUSIONS LESS extravesical repair of vesicouterine fistula is technically feasible and effective procedure that adheres to the principles of transabdominal open surgical repair. However, the procedure is technically challenging and it requires advanced laparoscopic skills. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e102 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aly Abdel-Karim Alexandria, Egypt More articles by this author Mostafa Elmissery Alexandria, Egypt More articles by this author Ahmed Moussa Alexandria, Egypt More articles by this author Waleed Dawood Alexandria, Egypt More articles by this author Salah Elsalmy Alexandria, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Reported Cystoscopic Experience Correlates Poorly With Objective Assessment of Cystoscopic Skills

Although gynecologists perform a large number of surgeries in close proximity to the ureters and the urinary bladder, traditionally, Obstetrics and Gynecology resident physicians are not formally taught to perform cystoscopy. The primary objective was to document resident physicians' performance in diagnostic cystoscopic instrumentation and technique. The secondary objective was to examine if reported prior cystoscopic experience was associated with superior performance. Fifty-one postgraduate year 4 residents with reported experience with cystoscopy were evaluated using an operation-specific checklist and a global ratings scale based on the Objective Structured Assessment of Technical Skill model. Before evaluation, they attended a formal training session in cystoscopy, which included practice on a bench model of a simulated bladder. Forty-three of the 51 residents were able to successfully perform a thorough diagnostic examination immediately after the course. Six of the 8 failures were re-evaluated 2 weeks later and successfully performed a complete examination at that time. Before the course, the residents had performed a mean of 12.2 cystoscopic examinations as the primary surgeon (median, 12; range, 2-33). The number of reported cystoscopic examinations performed before the course did not correlate with the ability to perform a thorough cystoscopic examination (r = -0.109; P = 0.496). For this group of residents, there was poor correlation between the number of reported cystoscopic examinations and the ability to perform diagnostic cystoscopy. Trainees may not be able to determine when they have received enough instruction in hands-on training with models before acquisition of technical skills.

The Canadian Bladder Cancer Network: efforts to improve patient care

The Canadian Bladder Cancer Network (CBCN) should be applauded for their reports on the experience at a national level with radical cystectomy for bladder cancer.1 Such reports identify deficits for us, as urologists and allied physicians, to improve the care of our patients with bladder cancer. In this paper, the CBCN has addressed the outcomes of one of the most challenging patient groups (clinical T1 bladder cancer); in so doing, the paper has identified a particularly glaring need for improvement.1 The authors determined that 48% of patients were upstaged to pT2-4 and 26% were found to be node positive. Five- and 10-year overall survival was only 71% and 60%, respectively. The results are not markedly different from other published series. While the authors recognize the poor outcomes and attribute these primarily to understaging, this is only one possible explanation. Nobody would argue the need for better staging tools or biomarkers to predict more aggressive disease. Unfortunately, the data set does not allow any conclusions to be made, but one can speculate on other contributing factors. The apparent understaging is likely a reflection of disease progression on a bladder-preserving regimen. These results add more fuel to the ongoing debate for immediate versus delayed cystectomy. Nonetheless, it would be relevant to ascertain the rate of administration of second-line intravesical treatment in Canada in this patient population to see if this is overused in patients who would be better managed with cystectomy. The rate of progression after failing intravesical Bacillus Calmette-Guerin (BCG) is high, so that further bladder preservation should only be offered to patients with a prohibitive surgical risk.2 Another particularly Canadian question relates to wait times and treatment delays. Bladder preservation in T1 bladder cancer involves many different steps from referral to diagnostic cystoscopy, to transurethral resection of a bladder tumour (TURBT) and re-TURBT, and to intravesical therapy and further diagnostic and therapeutic interventions – not to mention the potential delay prior to cystectomy. In the Canadian system, there is ample room for multiple delays which may adversely affect the outcome of this difficult cohort.3 One must also consider that our poor adherence to treatment guidelines could contribute to the disappointing survival rates of these patients.4 We have seen how poorly we adhere to standards of care defined for bladder cancer.5 For T1 bladder cancer, are re-resections being performed, as advocated, after the initial diagnosis? Are we following induction BCG with maintenance BCG for these patients with T1 disease? Addressing these shortcomings is the low hanging fruit with which we can potentially make some immediate positive impact. Beyond this, this report underscores the need for more research on biomarkers and novel therapies for bladder cancer, as well as prospective randomized trials comparing existing treatment modalities.

Comparison of the sensitivity and specificity of urine cytology, urinary nuclear matrix protein-22 and multitarget fluorescence in situ hybridization assay in the detection of bladder cancer

This study aimed to compare the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of urine cytology, BladderChek® nuclear matrix protein-22 (NMP22) and UroVysion™ fluorescence in situ hybridization (FISH) tests in patients with newly diagnosed bladder cancer, those with recurrent bladder cancer, and those with bladder cancer but in remission during surveillance. Voided urine samples obtained from 178 patients with suspected or known bladder cancer about to undergo diagnostic or surveillance cystoscopy and 25 control subjects without the disease were divided into four and used for urine culture and cytology, NMP22 BladderChek and UroVysion FISH tests. The sensitivity, specificity, PPV and NPV for each test were calculated. Comparison was made between the ability of each test to detect bladder cancer in the three category of patients listed. Of the 178 patients with bladder cancer, 43 were newly diagnosed, 58 had recurrent disease and 77 were in remission. The sensitivity of each test in newly diagnosed patients was: urine cytology 28%, NMP22 88% and FISH 80%; and in patients with recurrent disease: urine cytology 33%, NMP22 57% and FISH 85%. The mean specificity for urine cytology, NMP22 and FISH was 95%, 67% and 48%, respectively. Of the tests used in the study for detection of bladder cancer, NMP22 appeared to be most cost-effective and rapid, with relatively high sensitivity and specificity in all categories of patients. The NMP22 test may be considered a new gold standard for the assessment of patients with known or suspected bladder cancer.

Misconceptions and Miscommunication Among Aging Women With Overactive Bladder Symptoms

To better understand aging women's experience with overactive bladder (OAB) symptoms and the care they receive, with the ultimate goal of improving the quality of care provided to aging women with overactive bladder. Women seen in outpatient female urology clinics were identified by ICD-9 codes for OAB and recruited. Patients with painful bladder syndrome, mixed stress and urge incontinence, prolapse, or recent pelvic surgery were excluded. Patient focus groups were conducted by trained nonclinician moderators incorporating topics related to patients' perceptions of OAB physiology, symptoms, diagnostic evaluation, treatments, and outcomes. Qualitative data analysis was performed using grounded theory methodology. Five focus groups totaling 33 women with OAB were conducted. Average patient age was 67 years (range, 39-91). Older women with OAB lacked knowledge about the physiology of their disease and had poor understanding regarding the rationale for many diagnostic tests, including urodynamics and cystoscopy. The results of diagnostic studies often were not understood by older patients. Many women were dissatisfied with the care they had received. This lack of knowledge and understanding was more apparent among the elderly women in the group. Findings demonstrated a poor understanding of the physiology of overactive bladder and the rationale for various diagnostic modalities and treatments. This was associated with dissatisfaction with care. There is a need for better communication with older women experiencing OAB symptoms about the physiology of the condition.

Makrohämaturie als Primärsymptom eines extramedullären IgM-Plasmozytoms der Harnblase

Haematuria is the most common clinical symptom of bladder cancer. Besides antibiotic treatment of a probably existing urinary tract infection, ultrasonography of the urinary organs, diagnostic cystoscopy (with biopsy if needed), and radiologic evaluation of the upper urinary tract (intravenous urography, computed tomography or magnetic resonance urography, retrograde pyelography) should be done for further evaluation. Atypical manifestations of systemic diseases with bladder infiltration could feign the clinical appearance of chronic cystitis and hinder determination of the correct diagnosis. The case of a 40-year-old man with recurrent gross haematuria due to extremely rare bladder infiltration through an IgM plasmacytoma is presented.