Flexible Cystoscopies Research Articles

Haematospermia as a presenting symptom: Outcomes of investigation in 300 men

Background and aimsThe optimum investigation of haematospermia is unknown. The association of this condition in relation to pathology and in particular prostate cancer is controversial and there is a paucity of evidence based literature regarding the above. The aim of this study was to investigate haematospermia as a presenting symptom of significant underlying pathology and to assess the diagnostic value of routine urological investigations. Methods300 consecutive patients referred from primary care to a tertiary urology referral centre presenting with haematospermia were included in this observational case series. Data on patient age, concurrent presenting symptoms and urological history were collected. Subsequent patient investigations and final diagnoses were recorded. PSA and digital rectal examination (DRE) findings were noted in the over 40 age group. ResultsOf 469 investigative episodes, comprising: 206 flexible cystoscopies, 232 renal ultrasounds, 16 intravenous urograms (IVUs) and 15 scrotal ultrasounds; only 2 (0.4%) resulted in findings of significant new pathology which required surgical intervention. 13 prostate cancers were detected (5.7%) and 2 of dysplasia, all in men over 40 years either with a PSA of >3.0 ng/dl or an abnormal DRE. ConclusionsPSA measurement and a DRE should be carried out in patients over the age of 40 years presenting with haematospermia to screen for prostate cancer. Investigation of haematospermia in the form of flexible cystoscopy, ultrasound or IVU has a very poor diagnostic yield and is not recommended routinely for an initial presentation of haematospermia.

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

Audit of safety, efficacy, and cost-effectiveness of local anaesthetic cystodiathermy

The aim of this study was to audit our experience of cystodiathermy under local anaesthetic (LA) at the time of flexible cystoscopy for recurrent superficial bladder transitional cell carcinoma (TCC). A total of 264 flexible cystoscopies were performed on patients with a past history of TCC. The number and site of recurrences were recorded and selected patients were offered cystodiathermy. Patient tolerability was noted. At follow-up, any recurrence was recorded. Eighty patients (30%) had 91 procedures showing one or more recurrences. Fifty-one of the 80 patients (64%) were treated with cystodiathermy under LA. All completed treatment. Forty-five (88%) tolerated the procedure well. Forty-seven (92%) treatments were completed within 5 min. At a median follow-up of 15 weeks, 30 (59%) treated patients had no recurrence and three (6%) had recurrence at the site of treatment. LA cystodiathermy is an effective and well-tolerated alternative to general anaesthetic cystodiathermy that enables treatment at the time of detection and may, thereby, reduce patient anxiety.

The Use of NMP22 and Urine Cytology for the Surveilance of Patients with Superficial Bladder Cancer

Aim To see if NMP22 combined with urine cytology can safely increase the interval between cystoscopies in the surveillance of superficial bladder cancers. Methods Thirty four patients with low grade superficial bladder transitional cell carcinomas were prospectively recruited and followed up with regular flexible cystoscopies over 2 years. Freshly voided urine was collected for urine cytology and NMP22 test prior to cystoscopy. Patients with suspicious cystoscopy findings or suspicious cytology underwent biopsies and/or resection of the suspicious lesions. Results 172 urine samples were collected and analyzed. The NMP 22 results were compared with voided urine cytology, cystoscopy and histological findings. Using the 10U/ml cutoff for quantitative measurement, the sensitivity, specificity, positive and negative predictive values of urinary NMP22 were 50%, 90.7%, 21.0%, and 97.3% respectively. When combined with voided urine cytology, the sensitivity, specificity, positive and negative predictive values were 71.4%, 88.5%, 25.0%, and 98.3% respectively. In comparison, the sensitivity, specificity, positive and negative predictive value of cystoscopy were 85.7%, 97.6%, 66.7%, and 99.2% respectively. Analysis with a receiver operating characteristic(ROC) curve found the ideal threshold of determinance of NMP22 for the detection of recurrences is 8.5U/ml with 100% sensitivity and 73.9% specificity. In our center, replacing alternate cystoscopy examination at 3,9,18 and 30 months with NMP22, results in a cost saving USD$740 or 37% per patient over 5 years. In the event of false positives, the patient will revert to the current surveillance schedule, with no increased costs incurred. Conclusion We propose that the optimal cutoff value for NMP22 is 8.5U/ml. At this level. the combination of the NMP22 BladderChek test and voided urine cytology is a sensitive non-invasive alternative to cystoscopy in the surveillance of patients who have had superficial low grade bladder cancer.

The Effect of Intravesical Single-Dose Mitomycin C in Recurrent Superficial Bladder Cancer

Objectives: This study was designed to evaluate the efficacy of the intravesical instillation of single-dose Mitomycin C post-ablation of purely recurrent tumours. Patients and methods: Two patient groups with small-volume, low-grade (1 or 2), superficial (pTa) recurrent disease were studied. Sixty-seven patients at one institution received a single intravesical dose of Mitomycin C following tumour ablation using a Holmium YAG Laser. The other institution provided a control patient group of 68 patients treated with laser ablation alone. Patients were reviewed with regular flexible cystoscopies throughout the study period. Results: The groups were matched for age and the number and grade of tumours. Recurrence rates were lower, yet not to statistical significance, in the group receiving Mitomycin C post-intervention (48% vs. 62% ( p= 0.14) at 12 months and 76% vs. 82% at 24 months ( p = 0.64)). The observed beneficial effect at 12 months appeared to depreciate by 24 months. There was no significant improvement in the recurrence-free interval for the Mitomycin C group (log rank test p = 0.28). Conclusions: This study has failed to demonstrate a beneficial trend for the use of single-dose of Mitomycin C after ablation of recurrent superficial bladder cancer. Further evaluation in the form of a prospective trial is indicated.

Does Increasing Hydrostatic Pressure (“Bag Squeeze”) During Flexible Cystoscopy Improve Patient Comfort: A Randomized, Controlled Study

To determine whether increased hydrostatic pressure by simple manual compression ("bag squeeze") of the irrigation solution bag (500 mL of 0.9% saline) during passage of the flexible cystoscope will reduce patient discomfort. A total of 151 male patients undergoing diagnostic and review flexible cystoscopies were randomized to "squeeze" (n = 72) or "no squeeze" (n = 79) as the cystoscope was passed from below the external sphincter until after the bladder neck was negotiated. All patients had received 10 mL of 2% lidocaine gel beforehand. A 10-point visual analog pain scale assessing cystoscopy insertion was completed by the patients after the procedure. The mean pain score was 1.38 (95% confidence interval 0.99-1.77) in the squeeze group and 3.00 (95% confidence interval 2.55-3.46) in the no-squeeze group (P < .001, Mann-Whitney U test). Patient age, procedure indication (diagnostic and review), and grade of clinician performing the cystoscopy had no effect on the findings. The results of our study have shown that the squeeze technique during insertion of a flexible cystoscope significantly decreases the discomfort of the procedure. It is strongly recommended in all male patients.

Evaluation of information leaflets for flexible cystoscopy

PurposeThe purpose of this paper is to review patient information leaflets for flexible cystoscopies and to determine the quality of information available to patients.Design/methodology/approachInformation leaflets from 20 hospitals in the region that carried out flexible cystoscopies as a day‐case procedure were evaluated against a checklist of items for inclusion in the leaflets.FindingsA total of 13 leaflets were received. There was a large variation in the information supplied between hospitals, and there was a lack of vital information in most of the leaflets. Only four leaflets provided a diagram of the urinary tract for clarity.Originality/valueMany of the leaflets evaluated fell below an adequate standard. This study shows the need for a better, more accurate and up‐to‐date leaflet for what is probably the most commonly performed urological procedure.

Computed tomography urography for diagnosing bladder cancer

To evaluate the use of computed tomography urography (CTU) for diagnosing bladder tumours in patients with macroscopic haematuria and aged >40 years. In all, 200 consecutive patients attending a fast-track haematuria clinic were assessed using 'same-day' CTU and flexible cystoscopy. Patients were aged >40 years and had macroscopic haematuria with no urine infection. CTU studies were reported by one uroradiologist and scored on a 3-point scale to quantify the probability of bladder cancer. All flexible cystoscopies were performed by the same cystoscopist with no knowledge of the findings of CTU, and scored using a 3-point scale. Cystoscopy, pathological findings and CTU were then compared. The prevalence of bladder tumours was 24%; when CTU was compared with the histopathological findings, there was one false-positive and three false-negative diagnoses, indicating a sensitivity of 0.93 and a specificity of 0.99, with a 0.98 positive and 0.97 negative predictive value for detecting bladder cancer. A review of the three false-negative cases showed that one was missed on original CTU reporting, the second had the appearance of prostate cancer on CTU and the third was a squamous metaplasia. CTU is an accurate method of detecting bladder tumours in the present patients, and is reliable and accurate for assessing the bladder. Our results support the use of CTU as a first-line screening tool for this high-risk group, the use of which will obviate the need for flexible cystoscopy in patients with a negative CTU and allow those with an obvious tumour to be referred directly for rigid cystoscopy and resection. The remaining patients should be referred for flexible cystoscopy. Such a pathway would accelerate patient assessment by using fewer tests and provide a true 'one-stop' clinic, allowing a comprehensive evaluation with a single test for the upper and lower urinary tract.

Assessment of efficacy of transcutaneous electrical nerve stimulation for pain management during office-based flexible cystoscopy

Objectives To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) for its effectiveness in eliminating or minimizing discomfort during office-based flexible cystoscopy. Methods A total of 148 patients were prospectively randomized into one of three groups: flexible cystoscopy with no analgesics, a placebo TENS, or an activated TENS. The patient data collected included patient parameters, number of previous flexible cystoscopies, visual analog pain scores during and after the procedure, surgeon’s difficulty rating of procedure, and International Prostate Symptom Score before and 24 hours after the procedure. Results No statistically significant difference was found among the three groups regarding patient parameters. The visual analog pain scores were similar before and after the procedure. At 30 seconds, the mean visual analog scale score for the control group, placebo group, and TENS study group was 3.73, 3.65, and 3.52, respectively (control versus placebo, control versus active, and placebo versus active: P = 0.97, 0.29, and 0.53, respectively). At 1 and 5 minutes, the corresponding scores were 3.44, 4.37, and 3.50 ( P = 0.88, P = 0.99, and P = 0.99) and 0.86, 1.23, and 0.88 ( P = 0.97, P = 0.35, and P = 0.56), respectively. The surgeon’s mean difficulty rating for the control procedures was 1.08 and for the placebo group was 2.30 ( P = 0.02). Conclusions All patients undergoing flexible cystoscopy in the office setting experienced discomfort. The TENS device provided no significant benefit for pain. The trend toward greater pain scores in the control group could be attributed to the greater degree of difficulty.

Urinary Infection Following Out‐patient Flexible Cystoscopy

Of 161 flexible cystoscopies performed in an out-patient endoscopy suite, the incidence of urinary tract infection was 7.5%. Infection rates were higher in patients with a history of previous urinary tract infection or where an additional procedure was also performed. No difference was noted between the infection rates in men and women.