Rigid Cystoscopy Research Articles

Access and Fluoroscopy Time Difference in Patients Undergoing Prone Percutaneous Nephrolithotomy (PCNL) With Ureteric Catheter Placement in Supine Versus Lithotomy Position

Objective: To compare the operative and fluoroscopy time in two different methods of ureteral stent insertion before prone percutaneous nephrolithotomy (PCNL).Materials and method: Over 12 months, 124 patients with urolithiasis who went through prone PCNL were included in our study. All the patients had kidney stones and were divided into two groups based on the method of ureteral catheter insertion. This was done with the help of flexible or rigid cystoscopy in to group A and group B, respectively. Both groups had an equal number of patients, i.e., 62. The main outcome variables assessed were access time (from intubation to placement of access sheath) and fluoroscopy time during access.Results: The categorical variables (age, gender, site of the stone) between the two groups were comparable. The access time in groups A and B were 48±4.30 and 77±10 minutes, respectively. The fluoroscopy times in groups A and B were 52±14.63 and 116±47.77 seconds, respectively. A statistically significant difference (p-value < 0.05) was observed for both the access and fluoroscopy time. None of the patients in either of the groups had a misplaced ureteral catheter requiring repositioning.Conclusion: Flexible cystoscope-assisted insertion of ureteral catheter prior to PCNL significantly reduces operative time, fluoroscopy time, and consequently radiation exposure during PCNL.

Management of Inpatient Macroscopic Haematuria: A Typical Urology Emergency With a High Mortality

ObjectiveTo review the in-patient (IP) management patterns and 30-day outcomes of patients admitted with macroscopic haematuria (MH) over a 1-year-period in a single-institution, aiming to clarify management for such cases in the future. MethodsRetrospective cohort study was conducted on all patients admitted with MH in a single-institution over 1-year, excluding patients not requiring an overnight stay. A case note review was performed for patient demographics, MH investigations, and management. ResultsA total of 120 patients were admitted with MH over a span of 1-year. 89% (107/120) were males, with an average age of 78 years (36-97 years), an average ASA of 3, mean length-of-stay (LOS) was 5 days (1-31days) and 68% (82/120) had pre-existing urological conditions. 62% (74/120) required bladder irrigation for a mean duration of 3 days (1-16days). 10% (12/120) required an emergency rigid cystoscopy and washout to manage the bleeding, of which 4% (5/12) had malignancy noted. Over 8% (10/120) patients discharged had unplanned readmissions within 30 days. The 1-year mortality for this cohort was 23% (28/120) of which 21% (6/28) died within 30 days from discharge. ConclusionIP MH affects a vulnerable patient cohort. There is no specific pathway guiding the inpatient management of MH; therefore, research is required to produce standardized pathways for managing MH, considering the high-risk patient cohort, the prolonged LOS, and high 1-year mortality rate.

V09-05 NOVEL TECHNIQUE FOR INJECTION OF LIPIODOL AS FIDUCIAL MARKER FOR RADIOTHERAPY TREATMENT IN BLADDER CANCER

You have accessJournal of UrologyCME1 May 2022V09-05 NOVEL TECHNIQUE FOR INJECTION OF LIPIODOL AS FIDUCIAL MARKER FOR RADIOTHERAPY TREATMENT IN BLADDER CANCER Aoife McVey, Elvira Polo Alonso, Olivia Fraser, Daryl Lim Joon, and Gregory Jack Aoife McVeyAoife McVey More articles by this author , Elvira Polo AlonsoElvira Polo Alonso More articles by this author , Olivia FraserOlivia Fraser More articles by this author , Daryl Lim JoonDaryl Lim Joon More articles by this author , and Gregory JackGregory Jack More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002617.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radiotherapy for the primary treatment of bladder cancer is becoming increasingly common. Several studies have shown that fiducial marking of the site of the primary tumour can assist with radiotherapy planning and reduce dosimetry to surrounding benign bladder tissue. Lipiodol, which is Iodinated contrast agent can be injected cystoscopically and serve as a fiducial marker to demarcate the primary bladder tagets for radiotherapy. Few studies have looked at the ideal technique and dose of lipiodol injection. Furthermore those study is typically advise 5 mL of concentrated lipiodol injected in 1mL aliquats through a rigid cystoscope with a williams cystoscopic needle, which tends to lead to excessive urothelial migration of the lipiodol. We described a novel technique of 100uL injections of 1:3 dilute lipiodol performed via flexible cystoscopy under local anaesthesia. METHODS: After obtaining patient consent, we video-recorded a case of cystoscopic injection of Lipiodol in a patient selected for image guided radiotherapy treatment (IGRT). Using iMovie editing software we prepared a video describing this technique. RESULTS: This technique for injection has been successfully implemented at our single centre and has allowed effective delivery of targeted radiotherapy treatment using Lipiodol as a fiducial marker. CONCLUSIONS: This is a simple, reproducible, and easily performed office procedure with durable results and minimal lipiodol migration. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e806 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aoife McVey More articles by this author Elvira Polo Alonso More articles by this author Olivia Fraser More articles by this author Daryl Lim Joon More articles by this author Gregory Jack More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effect of endoscopic urethral procedures applied after robotic radical prostatectomy on urinary incontinence: A prospective cohort pilot study.

The most common complications after radical prostatectomy (RP) are erectile dysfunction (ED) and urinary incontinence (UI). After RP, patients may require endoscopic urethral procedures (EUP) for other urological diseases such as hematuria, urinary system stone disease, and suspicion of bladder tumor. In clinical practice we observed that EUP performed after robot assisted RP (RARP) can cause an increase in the UI level. In this study, we investigated whether there is a change in the UI level in patients that underwent EUP after RARP and whether this change was affected by the duration of the procedure and type of endoscopic device used. Twenty-six patients were included who underwent EUP after RARP in this study. The patients were divided into three groups based on the endoscopic device used: group 1 rigid cystoscopy (n = 9), group 2 flexible cystoscopy (n = 7), and group 3 semi-rigid ureterorenoscopy (URS) (n = 10). The Turkish version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and the number of pads used daily was questioned before the EUP and 1 month after the procedure. While a significant increase in ICIQ-SF score was observed in group 1 (p = 0.027), no significant increase was observed in group 2 and group 3 (p > 0.05). No significant difference was observed between the number of pads used preoperatively and the postoperative first month in all groups (p > 0.05). There was no significant correlation between increased operation time and both the pad usage and ICIQ-SF score (p > 0.05). The use of small diameter endoscopic instruments and flexible instruments is important for patient comfort and to avoid damage to urethrovesical anastomosis in patients who need to undergo EUP after RP.

A Novel Telescopic Access Sheath Method to Manage Encrusted or Knotted Retained Ureteral Stents.

Purpose:Encrusted and knotted stents may cause serious urologic complications. This study aimed to develop a novel and minimally invasive technique to manage encrusted or knotted retained ureteral stents.Materials and Methods:This technique was used in nine patients with retained stents. Through rigid cystoscopy, the stents were pulled out of the urinary meatus. The access sheath was modified by cutting the distal end of its obturator. The modified access sheath was advanced over the retained stents in a telescopic manner to remove the encrusted and/or knotted stents.Results:Six patients had encrustations, two had knot formation, and one had both encrustation and knot formation. The encrustations were peeled off in the process. The knots were either undone or pulled through the lumen of the access sheath. The retained stents were removed intact from all patients without any complications.Conclusion:The access sheath method described in this article provides a simple alternative for the removal of encrusted or knotted retained stents. However, this technique requires further validation to establish its safety and efficacy.

248 Urethral Self-Insertion of a USB Cable as Sexual Experimentation: A Case Report

Abstract Introduction The insertion of a foreign body in the urethra is an uncommon urological emergency. A wide variety of inserted objects have been described, presenting either asymptomatically or with lower abdominal discomfort and lower urinary tract symptoms. Sexual experimentation and gratification as well as mental disorders are considered the main underlying causes. The aim of this report is to present the case of a USB wire self-insertion and its challenging urological management. Case Presentation A 15-year-old male patient presented to his local Accident and Emergency department with gross haematuria following self-insertion of the knotted cable of a USB wire into his urethra in the context of sexual experimentation. Endoscopic approach via rigid cystoscopy and optical urethrotomy was not effective. A suprapubic catheter was inserted, and the patient was urgently transferred to our hospital for tertiary management. Following radiological assessment to confirm the position of the wire, a longitudinal peno-scrotal incision over the palpable foreign body was made. Urethrotomy revealed the knotted cable in the proximal aspect of the penile urethra, which was cut and removed. Urethra was subsequently closed over a urethral catheter. Postoperative recovery was uneventful, and patient was discharged home with oral antibiotics. Urethral catheter was removed following normal fluoroscopic assessment of the urethra two weeks later. Conclusions The management of a foreign urethral body can be challenging and usually requires tertiary expertise to achieve optimal outcomes. Poor initial management could potentially lead to devastating long-term complications such as urethral strictures and fistulas.

Long-term results of endoscopic treatment in vesicoureteral reflux after kidney transplantation.

To assess the long-term clinical outcomes and identify factors predicting success of endoscopic treatment for symptomatic vesicoureteral reflux (VUR) after kidney transplantation. A retrospective chart review of all patients who had a symptomatic VUR after renal transplantation at our centre between January 2000 and December 2020 was performed. VUR was documented by retrograde cystography and was determined by at least one episode of acute graft pyelonephritis (AGPN). Endoscopic injections of polydimethylsiloxane (MacroPlastique™) or dextranomer/hyaluronic acid copolymer (Deflux™) were performed by expert urologists via rigid cystoscopy with a bevelled needle system. The results of endoscopic treatment were evaluated by cystography at three months. The primary endpoint was clinical efficacy as defined by the absence of AGPN during follow-up. Radiological success was defined by the absence of VUR at the three months follow-up cystography. Out of 2135 kidney transplantations, a total of 117 (5.5%) patients had symptomatic VUR: 100 (85.5%) underwent Deflux™ and 17 (14.5%) MacroPlastique™. Preoperative high-grade VUR was recorded in 71% of patients. One postoperative complication was observed, Clavien > II. After a median follow-up of 11.2years (IQR 6.5-14.4), clinical success was achieved in 73 patients (62.4%). Radiological success was obtained in 42 patients (36%). Multivariable analysis failed to identify predictors of endoscopic treatment success, which was independent of the preoperative grade of VUR and the type of bulking agent used. Endoscopic treatment of VUR is a simple and well-tolerated procedure with long-term clinical efficacy.

Virtual Reality as a distraction therapy during cystoscopy: a clinical trial.

to investigate whether virtual reality (VR) experience is associated with decreased pain sensation among patients who undergo rigid cystoscopy under local anesthesia. we performed a prospective, randomized, controlled study of 159 patients who were aleatorily enrolled into two groups: VR and control. VR experience intervention consisted of using a headset with a smartphone adapted to a virtual reality glasses where an app-video was played during the procedure. Main outcomes analyzed were pain, discomfort, heart rate variability, difficulty and duration of the cystoscopy. Statistical analyses were performed using a Student's t test, Mann-Whitney test and Chi-square test. A P<0.05 was considered to be statistically significant. among 159 patients studied (VR group=80 patients; control group=79 patients), the mean age was 63,6 years and 107 (67,3%) were male. There was no statistically significant difference in baseline characteristics between the 2 groups. VR was significantly associated to decreased heart rate variability (6,29 vs 11,09 bpm, P<0,001) and lower duration of the procedure (5,33 vs 8,65 min, P<0,001). Also, when cystoscopies due to double-J extraction were excluded, VR experience was associated with reduced pain on the visual analog score of pain (3,26 vs 4,33 cm, P=0,023). the use of VR as a distraction therapy while performing outpatient cystoscopies is safe, has no side effects, is associated with less pain and discomfort, and reduces length of procedure.

On‐table urodynamic with ureteric occlusion: A resource for measuring bladder capacity and compliance in the management of patients with gross vesico‐ureteric reflux

To describe a technique for on-table urodynamic with ureteric occlusion (OUUO) and present a case series comparing bladder capacity and pressure measurements performed with and without ureteric occlusion in patients with gross vesico-ureteric reflux (grade ≥ IV VUR) to highlight the clinical utility. We performed OUUO in seven patients who were being considered for surgical management of VUR and/or nephro-ureterectomy. We occluded the refluxing ureters using hysterosalpingogram catheters (HSG, single lumen 5.5 Fr catheter with 1.5 ml balloon), guidewires, and rigid cystoscope. A 6 Fr dual-lumen urodynamic (UD) catheter is then inserted into the bladder to perform OUUO. Bladder capacity and Compliance (C = ∆bladder volume/∆detrusor pressure) are recorded and compared with values obtained at standard UD (without ureteric occlusion). The age range of the seven patients was 2.0-15.5 years. The etiology for the gross VUR were posterior urethral valve (PUV) and neuropathic. The bladder capacity and compliance finding between UD and OUUO findings were comparable in five patients. However, there was a clinically significant difference in bladder capacity (20%-50% decrease) and compliance (50%-90%) between UD and OUUO findings in two out of seven patients. In the presence of gross VUR, OUUO allows for a potentially more accurate assessment of bladder capacity and compliance. OUUO should be considered when planning ureteric opening bulking/reimplantation and nephro-ureterectomy.

Influence of Virtual Reality Devices on Pain and Anxiety in Patients Undergoing Cystoscopy Performed under Local Anaesthesia.

Background: Bladder cancer is one of the most common malignancies. Its diagnosis is based on transurethral cystoscopy. Virtual reality (VR) is a three-dimensional world generated through the projection of images, the emission of sounds and other stimuli. VR has been proven to be a very effective “distractor” and, thus, a useful tool in managing pain. The aim of this study was to determine whether the use of VR sets is technically feasible during the cystoscopy and whether the use of VR devices would reduce the degree of ailments associated with the procedure; Methods: The study prospectively included both men and women who qualified for rigid cystoscopy due to both primary and follow-up diagnostics. The study group underwent rigid cystoscopy with the VR set and the control group underwent the procedure without the VR set. Patients enrolled in both groups were subjected to blood pressure, heart rate and saturation measurements before, during and after the procedure. Additionally, the patients were asked to describe the severity of fear, pain sensations and nausea associated with the procedure. Non-verbal pain manifestations were assessed using the adult adjusted Faces, Legs, Activity, Cry and Consolability (FLACC) scale; Results: The study population included 103 patients (74M/29F; mean age 64.4 years). Pain intensity differed significantly between the groups, reaching lower values in the VR group. In all analyzed subgroups the use of the VR set was associated with higher levels of nausea. The mean FLACC score reached higher values for patients without the VR set. Blood pressure as well as heart rate increased during the procedure and decreased afterwards. The increase in systolic blood pressure and pulse rate was statistically higher in the control group; Conclusions: This study confirmed that cystoscopy is associated with considerable preprocedural fear and severe pain. Blood pressure and heart rate rise significantly during the cystoscopy. VR sets can lower pain perception during cystoscopy, but they may cause moderate nausea.

Editorial Commentary.

No AccessUrology PracticePatient Care1 Jan 2022Editorial CommentaryThis article comments on the following:Clinical Utility of Rigid Blue Light Cystoscopy: Results from a Post Procedure User Survey in a Prospective Multicenter Registry David A. Taub David A. TaubDavid A. Taub Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, Florida More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000280.02AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 9(1), p. 100

Editorial Commentary.

No AccessUrology PracticePatient Care1 Jan 2022Editorial CommentaryThis article comments on the following:Clinical Utility of Rigid Blue Light Cystoscopy: Results from a Post Procedure User Survey in a Prospective Multicenter Registry Peter E. Lonergan Peter E. LonerganPeter E. Lonergan Department of Urology, St. James’s Hospital, Dublin, Ireland Department of Surgery, Trinity College, Dublin, Ireland More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000280.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 9(1), pp. 99–100

Intraureteral Indocyanine Green (ICG) in Benign Gynecologic Surgery

<h3>Study Objective</h3> To demonstrate the use of intraureteral indocyanine green (ICG) in gynecologic surgery <h3>Design</h3> Educational video highlighting a surgical technique. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> Women undergoing laparoscopic pelvic surgery for benign gynecologic indications including both conventional and robotic approaches. We use this in our practice in cases where significant distortion of anatomy from presenting pathology is anticipated or in the setting of patient factors including multiple prior surgeries, radiation, active inflammation, or congenital anomalies. <h3>Interventions</h3> At the start of the procedure, rigid cystoscopy is performed using a 22 French rigid cystoscope. We combine 25 mg of ICG with 10 mL of sterile water (concentration of 2.5 mg/mL). A 5 French ureteral catheter is passed into the ureter up to 20 cm and 5 mL of ICG is gradually injected as the catheter is slowly withdrawn. This process is repeated in the contralateral ureter. Using specialized equipment, near infrared light or laser penetrates the ureter causing the ICG molecules fluoresce and emit near infrared light that is captured and electronically converted to give the ureter a green color. <h3>Measurements and Main Results</h3> The fluorescence of the ICG allows for quick identification of the ureter. The catheter used may have a smallerdiameter than stents, potentially reducing risk of ureteral edema, injury, and obstruction. Indwelling stents also have greater likelihood of thinning the ureteral wall. ICG allows for detection of small full thickness injury that may be missed by stents as extravasation will present in the surrounding tissues. There are fewer externalized foreign bodies intraoperatively for a shorter duration of time, potentially reducing risk of infection or inadvertent injury. Limitations include the need for specialized equipment and possible washout effect with ICG used intravenously or intracervically. <h3>Conclusion</h3> Intraureteral ICG helps identify the ureter intraoperatively during benign gynecologic surgery with low risk of complications and potential benefits in comparison to stents.

742 Transurethral LASER Ablation (TULA): A Safe and Well Tolerated Procedure for The Treatment of Bladder Tumours Up To 4cm In Diameter in An Outpatient Setting

Abstract Aim Traditionally the management of recurrent non-muscle invasive bladder cancer (NMIBC) involves rigid cystoscopy and bladder biopsies/tumour resection under general/regional anaesthesia. As a result, many frail patients endure frequent anaesthetics and therefore are at increased risk of adverse outcomes including cognitive decline. Discontinuation of anti-platelet/anti-coagulation is not required for TULA. An outpatient TULA service was recently started at our trust. We present a case series of our first 4 months data. Method All TULA cases (n = 39) performed between Aug-Dec 2020 were included. Data was gathered prospectively including patient demographics, co-morbidities, initial cancer diagnosis and number of subsequent recurrences, post-procedural complications, and patient procedural satisfaction. Results Median age was 82 years (range 34-96) and median number of co-morbidities were 4 (range 0-10). Previous bladder cancer diagnosis was present for 85% with the most common initial stage G2pTa (n = 11). Median number of recurrences was 1 (range 1-5). Median patient perceived pain score was 3 (range 1-7) with 100% of patients preferring TULA over TURBT. Reasons included reduced procedural time (n = 18) and enhanced recovery (n = 15). Only 1 patient was readmitted post-procedure due to haematuria, however urine was clear after catheterisation and the patient was discharged. Conclusions TULA is safe for all low risk NMIBC, particularly for frail patients. It is well tolerated and facilitates improved patient experience. It also alleviates demand on theatre capacity and inpatient beds which has a positive effect on surgical waiting lists. Further audit of clinical outcomes should continue as recommended by NICE.

853 Post-BCG Surveillance – General Anesthetic Rigid Cystoscopy in Intermediate/High-Risk Bladder Cancer. A Quality Improvement Project Done at A District General Hospital in South-East England

Abstract Aim High/ intermediate risk bladder cancer is treated with BCG immunotherapy and cystoscopy surveillance is the standard of care. Performing a General Anesthetic Rigid Cystoscopy (GARC) enables resection or sampling of suspicious lesions. We aim to evaluate its benefits while the alternative is Local Anesthetic Flexible Cystoscopy (LAFC). Method A retrospective analysis of patients that underwent rigid cystoscopy under GA over 2 years from January 2018-December 2019, post induction &amp; maintenance cycles of BCG following primary TURBT. Overall inference (cystoscopy outcomes) was based on intra-operative findings, BCG cycle, suspicious lesions, recurrence/disease progression based on histology. Results A total of 53 patients had 114 procedures. Mean age of 72.29±8.98. 14 inpatient admissions due to GA/procedural complications or social reasons. 58.2% of patients primarily had G3T1 disease, 22.6% G2, 14.3% G1 &amp; 4.9% had primary CIS. T1 &amp; Ta disease were 42% &amp; 43% respectively. GA cystoscopy showed normal findings in 57.1%, 33.33% suspicious lesions &amp; 9.6% visible recurrence. 88% suspicious lesions upon biopsy showed benign findings on histology and only 12% malignant. 24% of lesions thought to be recurrence showed benign findings on histology, 56% as G3T1 disease and 20% as G3Ta disease. No one had stage progression and 3 patients had grade progression. Sub-analysis of various stages and grades showed an average of about 10% malignant findings only. Conclusions LAFC as first line for post-BCG surveillance can be recommended which aim to prevent GA complications, extra admissions, overall cost reduction in management of bladder cancers and GARC can be reserved for second line

PD18-11 THE "BUTTERFLY", A NOVEL MINIMALLY INVASIVE TRANSURETHRAL RETRACTION DEVICE FOR BPH

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD18)1 Sep 2021PD18-11 THE "BUTTERFLY", A NOVEL MINIMALLY INVASIVE TRANSURETHRAL RETRACTION DEVICE FOR BPH Ran Katz, Ali Safadi, Muhamad Abu Ahmed, Shmuel Roizman, Amnon Zisman, Maharan Kabha, Yoram Dekel, Jack Baniel, and shachar Aharoni Ran KatzRan Katz More articles by this author , Ali SafadiAli Safadi More articles by this author , Muhamad Abu AhmedMuhamad Abu Ahmed More articles by this author , Shmuel RoizmanShmuel Roizman More articles by this author , Amnon ZismanAmnon Zisman More articles by this author , Maharan KabhaMaharan Kabha More articles by this author , Yoram DekelYoram Dekel More articles by this author , Jack BanielJack Baniel More articles by this author , and shachar Aharonishachar Aharoni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002007.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Butterfly Prostatic Retraction Device is a novel minimally invasive, non-surgical implant that is delivered into the prostatic urethra in order to retract the lateral lobes of the prostate, increase the diameter of the prostatic urethra thus treating symptoms associated with BPH. The device is made of nitinol and consists of two lateral wings connected by several transverse rails and is available in five sizes. It is folded into a 5 mm introducer, inserted via rigid cystoscopy and deployed in the prostatic urethra between the verumontanum and the bladder neck. In body temperature the device expands, pushes the prostate lobes laterally, opening a wide path in the prostatic urethra while preserving the bladder neck. It is designed for day surgery or in office settings. We present our results in the management of men suffering from BPH. METHODS: A prospective, Open-Label clinical study for assessing the safety and efficacy of the Butterfly device in male patients suffering from LUTS due to BPH was performed enrolling up to date 50 men who were treated for BPH for at least one year and were candidates for prostatectomy. All patients had Qmax≤ 13 ml/sec and IPSS > 12. Patients with previous prostate procedure, prostatitis, cystolithiasis, prostate median lobe, urethral/bladder neck stricture and atonic bladder were excluded. The study was approved by the hospitals’ IRBs. Insertion of the device was performed under sedation in a day care setting. No catheter was left. Follow up visits were performed at 2 weeks, 1, 3, 6, and 12 months and included uroflowmetry, IPSS, QoL and sexual function questionnaires. Cystoscopy was performed on 3 and 12 months. RESULTS: Patient age range was 50-82 years. 23 patients completed a 1 year follow up and median follow up was 9 months. In one-year Qmax improved by 33%, IPSS score by 40% and QoL score improved by 38% compared to baseline. No patient reported deterioration of sexual function and all sexually active patients reported antegrade ejaculation. On cystoscopy, gradual coverage of the device with urethral mucosa was observed and there were no cases of encrustation. No unanticipated device related AE occurred. In one patient the device was re-positioned. Five patients elected to remove the device and returned to alpha blocker therapy. Seven patients underwent TURP. One patient developed a bulbar urethral stricture. CONCLUSIONS: The butterfly device is simple and efficient minimally invasive device for the management of LUTS due to BPH with a low complication rate, comparable to other minimally invasive devices, and good tolerability. Source of Funding: Butterfly Medical - Yokneam, Israel © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e359-e359 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ran Katz More articles by this author Ali Safadi More articles by this author Muhamad Abu Ahmed More articles by this author Shmuel Roizman More articles by this author Amnon Zisman More articles by this author Maharan Kabha More articles by this author Yoram Dekel More articles by this author Jack Baniel More articles by this author shachar Aharoni More articles by this author Expand All Advertisement PDF downloadLoading ...

MP67-16 LONG-TERM IMPACT OF THE ENDOCKSCOPE SYSTEM: A GLOBAL ASSESSMENT

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-16 LONG-TERM IMPACT OF THE ENDOCKSCOPE SYSTEM: A GLOBAL ASSESSMENT Andrew Afyouni, Mitchell O'Leary, Zhamshid Okhunov, Akhil Peta, Andrew Brevik, Maged Ayad, Renai Yoon, Roshan Patel, Benjamin Dolan, Jaime Landman, and Ralph Clayman Andrew AfyouniAndrew Afyouni More articles by this author , Mitchell O'LearyMitchell O'Leary More articles by this author , Zhamshid OkhunovZhamshid Okhunov More articles by this author , Akhil PetaAkhil Peta More articles by this author , Andrew BrevikAndrew Brevik More articles by this author , Maged AyadMaged Ayad More articles by this author , Renai YoonRenai Yoon More articles by this author , Roshan PatelRoshan Patel More articles by this author , Benjamin DolanBenjamin Dolan More articles by this author , Jaime LandmanJaime Landman More articles by this author , and Ralph ClaymanRalph Clayman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Traditional endoscopic equipment is expensive (i.e., >$40,000 for state-of-the-art camera, visual towers, and high-powered light source). This cost limits the practice of endoscopy by many urologists in underserved countries. The Endockscope System (ES) is a $45 smartphone alternative to conventional endoscopic equipment. It consists of a 3D printed set of smartphone-to-endoscope attachments, 8x lens, and a portable, self-contained, detachable 1,000-lumen diode (LED) light source. METHODS: Forty complimentary ES kits were distributed to urologists from 23 countries at the 2019 Congress of Société Internationale d'Urologie (8-month group) and at the 2016 World Congress of Endourology (4-year group) (Figures 1 and 2). Each participant was trained on how to use the ES. In 2020, questionnaires were sent to all 40 urologists regarding the use of the ES in their practice. RESULTS: All 18 urologists (100%) in the 8-month group and 10/22 urologist (45%) in the 4-year group completed the questionnaire. ES was utilized by 83% (15/18) of urologists in the 8-month group and by 80% (8/10) of urologists in the 4-year group. Among the urologists who used the ES, 67% of the 8-month group and 57% of the 4-year group noted that the ES performed equal or better than their traditional endoscopic equipment. Of note, the greatest impact was among urologists from the most impoverished countries; in the 8 month and 4-year groups, 100% of urologists from these countries reported using the ES system. Lastly, although specifically developed for use with a fiberoptic cystoscope, participants also used the ES for rigid cystoscopy, rigid and flexible ureteroscopy, and laparoscopy. CONCLUSIONS: The Endockscope System is an inexpensive and practical advance that empowers urologists in underserved countries to successfully expand their endoscopic services. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e515-e516 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Afyouni More articles by this author Mitchell O'Leary More articles by this author Zhamshid Okhunov More articles by this author Akhil Peta More articles by this author Andrew Brevik More articles by this author Maged Ayad More articles by this author Renai Yoon More articles by this author Roshan Patel More articles by this author Benjamin Dolan More articles by this author Jaime Landman More articles by this author Ralph Clayman More articles by this author Expand All Advertisement Loading ...

Nurse‐led one stop hematuria clinic: Outcomes from 2,714 patients

ObjectivesObjective of this study is to report the results of nurse led hematuria clinic service outcome of 2,714 patients.Subjects and methodsWe conducted a retrospective, single center review of 2714 patients with visible and nonvisible hematuria managed by a well‐trained nurse specialist in a rapid access clinic (RAC) between 2014 and 2020. All patients received a full review, flexible cystoscopy performed by a nurse, and ultrasound of urinary tracts. After investigations, patients were reassured and discharged or referred for rigid cystoscopy, TURBT, and CT urography.ResultsIn total, 2714 patients attended the RAC between October 2014 and March 2020. Of these, 1684 (62%) were males and 1030 (38%) females. The median age of patients was 68.3 (IQR 58‐79). Of the 1030 females, 500 (48.5%) presented with nonvisible hematuria (NVH), and 530 (51.5%) presented with visible hematuria (VH). The median age was 66 (IQR 56‐76). The number of females diagnosed with any form of malignancy was 72 (7% of all females). Of the 1684 males, 288 (17.1%) presented with NVH, and 1396 (82.9%) presented with VH. The median age was 72 (IQR 59‐81). The number of males diagnosed with some form of malignancy was 258 (15.3% of all males). Overall, 1926 patients presented with VH and 788 patients presented with NVH. After investigations, 290 patients (15.1%) with VH and 40 (5.1%) patients with NVH had some form of malignancy. The highest number of malignancies found in VH was bladder cancer (n = 222, 11.5%), followed by prostate (n = 28, 1%), renal (n = 23, 0.8%), UT urothelial (n = 17, 0.6%), gynaecological (n = 7, 0.3%), and gastrointestinal (n = 5, 0.2%) cancer. The highest number of pathologies found in NVH was infection (n = 44, 5.6%). Cancer detection rate for symptomatic NVH was more than double that of asymptomatic NVH, 6.5% versus 3.1%, respectively.ConclusionOverall, 15.1% with VH and 5.1% with NVH present with malignancy. Nurse‐led rapid access hematuria clinic and flexible cystoscopy investigation by trained nurse is safe and feasible.

PENs in the PENis: a case report and brief review of the literature

BackgroundAccording to the literature, there have been reports of introduction of foreign bodies into the urethra predominantly in males, both adults and children. Erotic stimulation, intoxication, assault and psychiatric conditions are the most frequent contributors.Case presentationA 70-year-old male presented with difficulty in passing urine for one week after having inserted two plastic ballpoint pens into his urethra. The patient had a failed attempt at removal using a rigid cystoscope and biopsy forceps. A Liga-clip applicator allowed successful blind removal of both pens while the patient was under a general anaesthetic.ConclusionsRemoval of urethral foreign bodies can be challenging as endoscopic removal may fail, and open or blind procedures may be required. Moreover, complications can be significant. On occasions, improvisations in techniques may be helpful, such as in our patient. A psychiatric review is vital to try and ensure the prevention of repeat incidents.

Pattern of Lower Urinary Tract Symptoms (LUTS) and satisfaction among patients having diagnostic cystoscopy

Aims: To study the pattern of LUTS during diagnostic cystoscopy and to evaluate patient’s satisfaction using rigid cystoscopy with intra-urethral lignocaine gel.&#x0D; Methods: Hospital based cross-sectional observational study done in all patients attending Department of Obstetrics and Gynecology with LUTS. Diagnostic cystoscopy was performed after using intra-urethral lignocaine gel. Patients profile and indications for cystoscopy were recorded; and VAS (Visual Analogue Scale) was used to assess procedure related pain. Data stored in MS Excel and descriptive analysis performed using SPSS 21.&#x0D; Result: Forty-three patients were included in the study. The mean age of presentation was 45.77 years. Majority of the patients were pre-menstrual and with symptoms less than 5 year duration. Twenty-seven (62.8%) patients had urgency as indication for cystoscopy followed by cystitis and recurrent urinary infection each (16.3%). Only 2 patients had mixed urinary incontinence. Thirty- one (72.1%) had mild discomfort, seven (18.7%) moderate and 5(9.2%)severe in visual analogue scale.&#x0D; Conclusions: Urgency was found to be a frequent indication for diagnostic cystoscopy and use of rigid cystoscope using inra-urethral gel showed only mild discomfort to majority of patients.