ObjectiveThe clinical application of transurethral laser lithotripsy (TUL) for lower urinary tract stone removal in dogs is constrained by factors such as body weight, stone size, and stone number. This study evaluated the safety and efficacy of TUL and percutaneous laser lithotripsy (PL) in cases where TUL alone was not feasible.Study designRetrospective study.Animal populationForty-one dogs (24 males, 17 females) were included between June 15, 2017, and January 26, 2023. Among them, 13 males were castrated and 14 females spayed.MethodTUL was performed using a holmium:yttrium-aluminum-garnet (Ho:YAG) laser, an 8.5Fr flexible ureteroscope, and a 9.5Fr rigid cystoscope for urethral and bladder stone fragmentation. PL was conducted using a Ho:YAG laser in combination with percutaneous cystolithotomy (PCCL).ResultsTUL was performed in 34 dogs, including 22 males (64.7%) and 12 females (35.2%). Laser lithotripsy was categorized by endoscope type and stone location. Of these, 33 dogs (94.1%) completed the procedure, while one male (2.9%) required conversion due to excessive bleeding. PL was performed in seven dogs (two males, 28.5%; five females, 71.4%), all of whom (100%) completed the procedure without conversion. Complications from laser lithotripsy occurred in five males (12.1%) of 41 dogs.ConclusionTUL is a minimally invasive urethral procedure, but its feasibility is limited in underweight dogs where endoscope insertion is impractical.Clinical significanceWhen TUL alone is unviable, combining it with PL provides a safe and effective laser lithotripsy approach for bladder and urethral stones, regardless of the dog's weight or sex.

Background/Objectives: Bulkamid® (Axonics, Irvine, CA, USA) is a non-particulate polyacrylamide hydrogel used in the treatment of urinary incontinence. While its effectiveness is well-documented in female stress urinary incontinence (SUI), there is limited data on its role in male stress urinary incontinence, particularly post-prostatectomy incontinence (PPI). This study evaluates the efficacy of Bulkamid as a primary or adjunctive treatment for male PPI. Methods: A retrospective chart review was conducted on male patients who developed PPI and underwent Bulkamid injections between 2016 and 2021. Data collected included pre- and post-procedure pad usage, the volume of Bulkamid injected, prior and subsequent incontinence treatments, and patient-reported satisfaction. Bulkamid was injected transurethrally in four quadrants near the vesicourethral anastomosis using a rigid cystoscope. Results: Twenty-one men with a history of radical prostatectomy (six open and fifteen robotic), including four who received adjuvant radiotherapy, were included. Fifteen underwent Bulkamid injection as a primary treatment, with five (33%) requiring repeat injections due to initial improvement. Eight (54%) subsequently underwent an AdVance XP® sling placement, while two (13%) required no further treatment. Six patients received Bulkamid as an adjunct to prior incontinence surgery, with 80% of post-sling patients reporting improved continence. Bulkamid was less effective in men with detrusor overactivity or prior radiation. Conclusions: Bulkamid demonstrated a higher success rate as an adjunct to the AdVance XP sling, with 80% of men experiencing improved continence. As a primary treatment for PPI, success was modest, with only 33% achieving improvement, often requiring repeat injections or conversion to a sling. Bulkamid presents a low-risk option for select male PPI patients, particularly those with prior sling placement, but durability and long-term effectiveness remain concerns.

Objective: Ureteral stents are commonly used, especially in the treatment of ureteral stones, and are removed endoscopically after a certain period following the procedure. The removal of these stents under local anesthesia, particularly in male patients, can cause pain. Rigid cystoscopes are typically used, but the use of thinner and more flexible endoscopic instruments is considered an alternative to reduce pain. This study aims to compare the pain experienced during Double-J stent removal using a rigid cystoscope versus a semirigid ureterorenoscope (URS). Materials and Methods: Our study included patients who underwent unilateral endoscopic ureteral stone treatment followed by Double-J stent placement. Patients were divided into two groups based on whether their stent removal was performed using a rigid cystoscope or a semirigid URS. All stent removals were performed by the same surgeon. Immediately after the ureteral stent removal, the pain score was evaluated and recorded by the operating physician using the Visual Analog Scale (VAS). Results: Among the 120 patients included in the study, 57 (47.5%) were in the cystoscopy group (group 1) and 63 (52.5%) were in the URS group (group 2). There was no significant difference between the groups in terms of stent side (p=0.47) and average age (p=0.16). However, group 1 had a significantly higher VAS score (3.6±1.7) compared to group 2 (1.9±0.8) (p

A technique that enables real-time diagnosis of bladder cancer is needed. Optical coherence tomography (OCT) is a promising technique, but a forward-looking OCT catheter is necessary for OCT to enable bladder cancer diagnosis. This study aims to describe the design of a novel forward-looking microelectromechanical systems (MEMS)-based OCT catheter, assess the performance characteristics, and evaluate its ability to identify histopathological characteristics of bladder specimens. A description of the OCT catheter and systems used is provided. Performance characteristics were measured with a beam profiler and microscopy slide (mirror for dispersion and thickness for lateral calibration). Ex vivo measurements were performed on resected bladder tissue from patients undergoing a radical cystectomy. A forward-looking OCT probe with an outer diameter of 2.52 mm and a rigid length of 17 mm was designed and evaluated. The focus position was measured as 10.9 mm from the MEMS mirror, with a Rayleigh length of 2.55 mm. Several histopathological features could be correlated to OCT features of the ex vivo measurements. In conclusion, a forward-looking OCT probe that can be inserted in the working channel of a rigid cystoscope was designed and evaluated. Performance characteristics were overall in line with simulated expectations.

BackgroundFlat erythematous “red patches” (RPs) identified during flexible cystoscopy are common and often benign, yet they have historically prompted rigid cystoscopy and biopsy under general anesthesia. This practice can lead to unnecessary procedures with low diagnostic yield, added morbidity, and increased healthcare burden.ObjectiveTo evaluate the local practice regarding rigid cystoscopy and biopsy for RPs and to assess the impact of a targeted departmental intervention.MethodsThis was a single-center, retrospective, two-cycle quality improvement audit at a UK district general hospital. Cycle 1 included all flexible cystoscopies between March and June 2024 and Cycle 2 between November 2024 and February 2025. Data collected included demographics, cystoscopy indication, smoking history, urinary tract infection (UTI) status, biopsy decisions, histology, antibiotic use, and relook outcomes. Following Cycle 1, an intervention was introduced comprising mandatory red-patch image capture, consultant review prior to biopsy listing, and structured teaching on morphology, risk stratification, and benign mimics.ResultsIn Cycle 1, 63 RP cases were identified; 37 (58.7%) underwent biopsy, with three malignancies detected (8.1%). Relook cystoscopy was performed in 26 patients, with resolution in 20 (76.9%); of six persistent cases, three underwent biopsy (one malignancy) and three were observed safely. In Cycle 2, 73 cases were identified; 23 (31.5%) underwent biopsy, with one malignancy (4.3%). Relook was performed in 48 patients, with resolution in 32 (66.7%); of 16 persistent cases, eight underwent biopsy (one malignancy) and eight were managed conservatively. Across both cycles, all malignancies occurred in patients >60 years; three of four had a smoking history, and one coincided with proven UTI. Antibiotic prescribing remained frequent, including in patients without culture-proven infection. ConclusionIn our center, a consultant-led, image-supported, risk-stratified pathway appeared to reduce unnecessary rigid cystoscopy and biopsy requests for RPs, with no observed delays in cancer detection during the audit period. Most lesions resolved spontaneously or after UTI treatment, and several persistent but low-risk patches were managed safely without biopsy. However, with only four malignant cases identified, oncological safety cannot be definitively established, and these findings should be regarded as exploratory. This study is further limited by its single-center, retrospective design and small event rate. Future work should prioritize antibiotic stewardship, standardization of relook intervals, and evaluation of urine cytology in high-risk patients.

Congenital obstructive hydrocephalus (HCP) causes progressive, irreversible fetal brain damage through ventricular enlargement and increasing fetal cerebral tissue compression. Postnatal treatments of choice include ventriculoperitoneal shunting or endoscopic third ventriculostomy (ETV). Intrauterine treatments, such as ventriculoamniotic shunting, were attempted unsuccessfully 4 decades ago and failed to improve postnatal outcomes, likely due to inadequate fetal patient selection. The aim of this study was to evaluate the efficacy of prenatal ETV for early ventricular decompression and potential prevention of fetal brain damage in hydrocephalic fetal lambs. HCP was induced in 24 fetal lambs by injecting BioGlue into the cisterna magna at E85. Three weeks later (E105-110), fetal ETV was successfully performed on 8 fetuses using a small rigid cystoscope. Fetal brain lateral ventricular diameters and cerebral mantle thicknesses were monitored by prenatal and postnatal ultrasounds and fetal MRI. According to the Cincinnati HCP Severity Scale, moderate and severe HCP subgroups responded positively to fetal ETV with reduced cerebral ventricular diameters. Ten days post-ETV, severe HCP fetal lambs improved to moderate levels, whereas those with moderate HCP normalized by birth. A similar improvement pattern was seen for the mechanical compression threshold (ventricular diameters/biparietal diameter). Biparietal diameter values did not significantly differ among nontreated, treated, and normal control groups during pregnancy. MRI revealed a significant increase in brain mantle thickness in the prenatally treated fetuses. Prenatal ETV is feasible in hydrocephalic fetal lambs and effectively reverses ventriculomegaly and brain compression in cases of severe or moderate fetal HCP in this ovine model.

Introduction and Objectives: To evaluate the indications and clinical outcomes of local anesthetic stenting in urological procedures, assessing its effectiveness, adverse effects, and patient tolerance. Materials and Methods: The systematic review was conducted in line with Cochrane and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. MEDLINE, CINAHL, EMBASE, and the Cochrane Central Register were searched up to September 2024 (PROSPERO-CRD42024596866). Studies with at least five patients, focusing on Double-J stent placement or exchange under local anesthesia, published in English, were included. Case reports, reviews, pediatric studies, and redundant older data were excluded. Data on study characteristics, patient demographics, procedural details, and outcomes, including success and complication rates, were extracted. Results: A total of 1725 patients and 1873 ureteral units were included, with studies that varied in sample size (6-463 patients) and included both stent placements (77.6%) and exchanges (22.4%). The overall success rate for local anesthetic stenting was 89%, with failure rates averaging 11%. Of reported studies, complications were reported in 8.68% (n = 76), predominantly Clavien-Dindo Grades I-II (5.94%) and III-IV (2.74%). Lidocaine jelly was the primary local anesthetic, with adjunct pharmacological interventions in some studies. Fluoroscopic guidance was used in 86.3% of cases, and both flexible and rigid cystoscopes were employed. Cost analysis consistently demonstrated significant cost savings with local anesthesia compared to general anesthesia. Patient satisfaction and pain scores showed variability, with many studies highlighting minimal discomfort and a strong willingness among patients to undergo the procedure again. Conclusions: Local anesthetic stenting is an effective alternative to general anesthesia, achieving a good success rate with a low risk of major complications. Although it offers significant cost savings and patient satisfaction is usually high, it does highlight the need for careful patient selection and counseling.

Cystoscopy is routinely done in urological practice. It may be for diagnostic or therapeutic purpose. Generally, it is done to rule of urethra and bladder pathology. Many of time cystoscopy is performed under local anesthesia, however sometime patient need spinal or general anesthesia. DJ stent is another surgery which is routinely practiced after many endourological as well as open surgery in Urology. It is general practice to remove DJ stent within 6 weeks to 3months but this duration may vary on type of surgery, need of DJ stent and development of complications like lower urinary tract symptoms(LUTs) due to DJ stent. Cystoscopy is done to remove all DJ stent. Its surgeon’s choice to remove DJ stent with either rigid cystoscopy or flexible cystoscopy. This observational study was conducted in Nepal Medical College Teaching Hospital with objective to evaluate the tolerability of flexible versus rigid cystoscopy in women during DJ stent removal and to find out the pain (VAS SCORE); intraoperative, post-operative and need for analgesia following Cystoscopy. Total 64 patients fulfilling the inclusion criteria were included and were randomly divided into 2 groups i.e. group A and group B. Storz 18 Fr flexible cystoscopy was used for group A and 18 Fr rigid cystoscopy was used for group B. Cystoscopy was done in both group, DJ stent was identified and removed. VAS score was calculated during and after the procedure. Mean age for group A was 40.84 years and group B was 36.8 years. VAS score intraoperative for group A was 3.7±1.4 and for group B was 6.1±0.7. Postoperative VAS score for group A was 2.4±1.2 and group B was 5.3±0.7, VAS showing P value <0.001 for both intraoperative and postoperative which is statically significant. In addition, need of analgesia was less in flexible cystoscopy during and after cystoscopy (P value <0.0001).

Introduction: Ureteral stents are regularly used after different urological procedures to keep the ureter patent. They are commonly removed by rigid cystoscope under local anesthesia, and patients often experience significant pain during and after stent removal. Due to its small caliber, a rigid ureteroscope may cause less pain and discomfort. The authors compared the pain scores during ureteral stent removal by rigid cystoscope and rigid ureteroscope. Methods: In this prospective comparative study, 105 patients undergoing ureteral stent removal under local anesthesia were randomly assigned to two groups. In group A (55 cases), the stent was removed by rigid cystoscope, while a rigid ureteroscope was used in group B (50 cases). The pain experienced during the procedure, at first void, and at 24 hours was noted using a visual analog scale (VAS) pain score (0 to 10). The lower urinary tract symptoms and other complications were also recorded. Results: The VAS pain score during the procedure and at first void was significantly higher in group A as compared to group B (3.65±1.9 vs 2.60±0.7, p<0.001; and 1.91±1.2 vs 1.24±0.8, p=0.002). The irritative voiding symptoms were also more in the rigid cystoscope group than the rigid ureteroscope group (2.65±2.0 vs 1.56±1.1, p=0.001). However, the pain, urinary symptoms at 24 hours, and other complications were comparable in both groups. Conclusions: Ureteral stent removal by rigid ureteroscope is less painful and more tolerable by patients as compared to rigid cystoscope. Thus, the use of a rigid ureteroscope is a safe and effective method for ureteral stent removal.

Abstract Ureteral herniation to the sacral foramen is an extremely rare cause of distal ureteric obstruction that can lead to urosepsis and renal failure. Retrograde JJ ureteric stenting is used in the acute and definitive management. A 75-year-old female presented with long standing history of recurrent urinary tract infections and left sided flank pain that had worsened. She reported mild dysuria associated with nausea but no fever. She did not have any significant past medical history or surgical history. She had a NEWS of 0 with mild tenderness in the left flank. A white cell counts of 17. Haemoglobin was 106. CRP was 382, Creatinine 138 and eGFR of 32. Non contrast CT KUB showed left hydroureteronephrosis and obstruction of the distal left ureter with herniation into sacral tuberous ligament. Rigid cystoscopy and retrograde JJ stent insertion showed pus in the left ureteral orifice. Left retrograde pyelogram showed a kink in the left distal ureter and PUJ which was straightened with a guidewire. Pus was drained from the left kidney and washed to completion and a 6F 26 cm JJ stent inserted. She was put on Piperacillin-tazobactam for 5 days which was escalated to meropenem due to poor response. She improved and was discharged home on co-amoxiclav. Ureteral-sacral herniation with distal ureteric obstruction should be considered as a probable cause in patients presenting with long-standing recurrent urinary tract infection. Retrograde JJ stenting of the ureter is useful for acute and definitive management.

Use of Indocyanine Green for Intraoperative Ureteral Identification in Difficult Hysterectomies for Gynecologic Malignancies.

To describe a novel condition in rabbits characterized by the development of septa in the urinary bladder leading to partial urinary outflow obstruction. A multicenter retrospective case series was designed, including 7 rabbits presented from 2017 to 2023 that met 2 inclusion criteria: (1) underwent histopathology of the urinary bladder, and (2) had clinical evidence of membranes and septa in the urinary bladder through diagnostic imaging and/or necropsy. Clinical signs of urinary outflow obstruction and bladder distension were observed in all cases. Abdominal radiographs and ultrasound identified abnormalities consistent with septa in 5 of 7 and 1 of 3 cases, respectively. In all 7 rabbits, the septa were visible via rigid cystoscopy. In 6 cases, the septum developed in a dorsoventral/laterolateral plane, causing variable degrees of narrowing of the lumen of the bladder neck and accumulation of sediment cranial to it. In 1 case, the septum developed in a craniocaudal/laterolateral plane, dividing the bladder neck into dorsal and ventral portions. The most common histopathological findings in the septum included urothelial hyperplasia (7 of 7) and heterophilic, lymphocytic, and plasmocytic inflammation (5 of 7). One rabbit died while recovering from cystoscopy. In the remaining 6 cases, endoscopic removal of the septum resolved the clinical signs consistent with urinary outflow obstruction and urinary retention. Rabbits can develop septa inside their urinary bladder. These benign proliferations can result in urinary outflow obstruction and urinary retention. Rigid cystoscopy was effective for the diagnosis and treatment of urinary outflow obstruction and urinary retention.

To (1) develop a minimally invasive technique for endoscopic-assisted retrograde catheterization (EARC) of the major duodenal papilla (MDP) in dogs and (2) pilot a safe method of endoscope-guided laser sphincterotomy of the intramural segment of the common bile duct (ICBD). Descriptive study. Twenty fresh canine cadavers. Following mini-midline celiotomy and exteriorization of the distal duodenum, endoscopy of the duodenal lumen was performed under saline irrigation via a 5 mm cuffed endoscopic port using a 2.7 mm 30° rigid cystoscope and HoYag laser fiber. Endoscopic-assisted retrograde catheterization of the MDP and laser sphincterotomy extended to the end of the ICBD was performed. The duodenal segment was dissected under magnification following the endoscopic procedure. The length of the ICBD and the incidence of iatrogenic injury were recorded. The EARC of the MDP and laser sphincterotomy were successful in 18 of 18 attempts. The ICBD segments ranged from 10 to 21 mm long (n = 20) (body weight 6.6-37.0 kg). There was no correlation between body weight and length of the ICBD (Pearson's rho = .06, p = .79). Partial thickness lateral perforations occurred in two specimens. Division of the submucosal layer during ablation heralded the start of the extramural segment and could be identified consistently (16/18; 88%). Endoscopic-assisted retrograde catheterization and extended laser sphincterotomy appeared feasible and safe in canine cadavers. Further evaluation in a live-animal setting is warranted. Endoscopic-assisted retrograde catheterization may have advantages over current open techniques for accessing the duodenal papilla and endoscopic laser sphincterotomy may assist resolution of ICBD obstructions.

Onabotulinum toxin A injection is recommended for overactive bladder (OAB) resistant to medical treatments. However, success is not universal, and factors influencing outcomes remain unclear. This study evaluates the factors affecting the success of onabotulinum toxin A injection in refractory idiopathic OAB. Data from patients with resistant idiopathic OAB treated with 100 IU onabotulinum toxin A (BOTOX®, Allergan, Dublin, Ireland) between January 2019 and August 2023 were analyzed. Demographic data and symptom duration were recorded. Patients were evaluated pre- and post-procedure using the overactive bladder symptom score (OABSS) and 3-day bladder diaries. A ⩾50% improvement in OABSS was considered treatment success. Botox was injected at 20 sites (5 IU per site) via 22 Fr rigid cystoscope under sedoanalgesia. A total of 210 patients (80.5% female, n = 169) with a mean age of 53.76 ± 14.90 years were included. Symptom duration averaged 39.82 ± 22.28 months. Wet OAB was diagnosed in 83.3% (n = 175), while 16.7% (n = 35) had dry OAB. Pre-procedure mean OABSS was 9.18 ± 1.31, daily micturition 8.67 ± 1.52, urge incontinence 2.57 ± 1.28, nocturia 1.87 ± 0.75, and pad use 2.44 ± 1.24/day. Treatment success was achieved in 82.4% (n = 173). The degree of patient complaints, particularly daily micturition frequency, significantly affects treatment success. Patients with higher daily micturition may require advanced interventions beyond Botox.

Urinary tract infections (UTIs) are one of the most common reasons for seeking medical review worldwide. Women are disproportionately affected, with a life-time incidence of 50%. Women presenting with clinical symptoms of UTI such as dysuria and urinary frequency can often have negative urine culture results, especially if they have been taking multiple courses of antibiotics. This can make the diagnosis and management of recurrent or chronic UTI challenging. In this study we compared the culture results of urine and bladder tissue in women undergoing rigid cystoscopy presenting with lower urinary tract symptoms. We hypothesise that a biopsy of the bladder wall might be more likely to reveal a causative uropathogen on culture than urine. Women had clean-catheter urine samples sent for urine culture and then bladder biopsies taken at cystoscopy cultured for uropathogens. Culture results from urine and bladder tissue were analysed and compared. We found that under 10% of urine cultures were positive (n = 30), whereas 51% of bladder tissues cultures grew a uropathogen (n = 155). Analysis showed that the culture results of urine and bladder tissue did have a statistically significant relationship (p = 0.008). Culture of bladder tissue revealed a wider variety of uropathogens. This study proposes that cystoscopy with a bladder biopsy for culture might be a useful adjunctive tool in selected women with refractory symptoms of urine infection.

Background Neuraxial anesthesia is the gold standard for urological operations. Hence, this study examined whether dural puncture epidural (DPE) anesthesia provides better pain reduction than traditional spinal anesthesia (SP) during rigid cystoscopy. Objectives This study set out to evaluate if DPE anesthesia offers improvement in pain relief compared to traditional SP for rigid cystoscopy. Methods This randomized controlled trial included 76 adults of both genders undergoing elective rigid cystoscopy. The participants were randomly divided into two equal-sized groups. Group SP received 3 ml of hyperbaric bupivacaine (0.5%0 and 25 mcg of fentanyl (0.5 ml). Group DPE received a 15-ml mixture of bupivacaine (0.25%) and 50 mcg of fentanyl over 5 minutes. Results The time to first request rescue analgesia was delayed in group DPE compared to group SP. The Group SP showed faster sensory block than the Group DPE. The Group DPE exhibited longer sensory and motor blocks than SP. Pain score, number of patients who required rescue analgesia, and total dose of morphine consumption in the first 24 hours were significantly lower in group DPE than in group SP. Mean arterial pressure (MAP) was significantly lower at 5min, 10min, and 15min in group SP than in group DPE. Conclusion DPE provides superior analgesia than SP as it offers prolonged duration sensory and motor block, better pain control, lower need for rescue analgesia, and better hemodynamic stability; however, SP has a rapid onset of sensory block.

In the field of urology, cystoscopy is one of the most common operations. A rigid cystoscope was used for each cystoscopy in this investigation. Given its dual function as a lubricant and local anesthetic, topical lignocaine gel is the most often utilized agent. However, there is currently no established protocol that evaluates the patient's tolerance to lignocaine gel alone or in conjunction with tramadol throughout the treatment. It was a prospective comparative observational study with 200 male participants, conducted at the department of urology, a tertiary care hospital. Male patients who came for rigid cystoscopy were divided into 2 groups. In Group A (n = 100) 10 ml 2% lignocaine gel and in group B (n = 100) 1 ml tramadol (50 mg) solution added to +10 ml 2% lignocaine gel and it was instilled transurethrally 10 min before the procedure respectively in both groups at room temperature. The patient's tolerance during the procedure was assessed using Visual Analog Score (VAS) score. In Group A and Group B there was no significant difference between the groups in terms of age (p = 0.393). There was a significant difference in terms of VAS score (p = < 0.001), with the median Score being lower in the Lignocaine gel + tramadol group and higher when lignocaine gel + tramadol used among patients with Diabetes mellitus. The instillation of lignocaine gel in conjunction with tramadol in urethra could decrease pain perception during the procedure except in people with diabetes mellitus, hence make men undergoing rigid cystoscopy more comfortable during the procedure there by increase diagnostic and therapeutic outcome.

TPS903 Background: Sub-urothelial injection of durvalumab presents a novel therapeutic approach for bladder cancer. SUBDUE-1, a first-in-human Phase Ib dose escalation study presented at ASCO 2022, demonstrated the safety and tolerability of sub-urothelial durvalumab in patients with bladder cancer scheduled for radical cystectomy, with no treatment-related adverse events and preliminary evidence of immunomodulation in the tumour microenvironment 1 . SUBDUE-3 will use radiolabelled 89 Zirconium-durvalumab ( 89 Zr-durvalumab) to define local and systemic biodistribution following sub-urothelial injection. Methods: SUBDUE-3 is an open-label, non-randomized Phase 0 trial sponsored by ANZUP (ANZUP 2402, ACTRN 12624001245583p). Ethics approval has been obtained for this study which is currently recruiting patients diagnosed with either high-risk non-muscle-invasive bladder cancer (HR-NMIBC) or muscle-invasive bladder cancer (MIBC), scheduled for radical cystectomy. 25mL of sub-urothelial 89 Zr-durvalumab will be injected in 1mL aliquots throughout the bladder using a 5Fr Bonee needle via 22Fr rigid cystoscope at a GA cystoscopy performed 2 weeks pre-cystectomy. After injection, PET imaging will be performed at several time points over 7 days. At each imaging time point, blood samples will be collected to evaluate the systemic bioavailability of 89 Zr-durvalumab using a gamma counter. Additionally, the urinary radiation dose will be measured during the first imaging session. Quality control measures will assess dissociation of 89 Zr from durvalumab. Dosimetric analyses will determine the distribution and radiation dose of 89 Zr-durvalumab both within the bladder and systemically, providing critical insights for future therapeutic strategies in bladder cancer treatment. Primary endpoint: visual and semi-quantitative assessment of 89 Zr-durvalumab distribution within the bladder wall and systemic organs (liver, kidney, lung, bone marrow) via PET imaging. Secondary endpoints: bladder and other organ tracer biodistribution; comparison of dosimetry data with cohorts receiving systemic 89 Zr-durvalumab; safety; feasibility. The trial has a one-year recruitment strategy aiming to recruit up to 3 patients and is expected to finish recruiting in 2025.

加热治疗对硬性膀胱镜检查患者疼痛、焦虑、生理指标和满意度的影响

Urethral stricture disease is a common and at times unsatisfying condition that can lead to complications severely impacting a patient's quality of life. Open urethroplasty remains the gold standard treatment; however, it is an invasive and highly specialized procedure. Strictures between 2 to 4 cm in length have been shown to recur at a rate of 50% within 12 months, a rate that typically decreases with each subsequent treatment. The Laborie Optilume drug-coated balloon (DCB) is the first of its kind developed for adjunct treatment of urethral strictures in men. The DCB initially treats the stricture through balloon dilatation and subsequently aims to prevent recurrence via the localized application of Paclitaxel. Our study assesses the safety and efficacy of the DCB in an Australian population with strictures exceeding 2 cm who have undergone at least two prior procedures for urethral stricture disease. Patients were prospectively recruited from November 2019 to September 2021. International prostate symptom score (IPSS), IPSS quality of life (QOL) and voiding parameters were collected at baseline, and again at 1, 6, 12 and 18 months. The drug coated balloon was applied by a single consultant urologist under rigid cystoscope with shallow direct vision internal urethrotomy with a cold knife prior to application of the DCB. 17 patients were recruited with an average of 7.7 prior urethral procedures for recurrent stricture disease. 76% were stricture free at 30 months follow-up. There were improvements in almost all parameters including max flow, average flow, IPSS and IPSS QOL scores at 12 and 24 months. There were no complications. The DCB is a safe and effective method at reducing the rates of recurrence for high-risk stricture disease and can delay or prevent the need for urethroplasty in what remains a very challenging cohort of patients.