Rigid Cystoscopy Research Articles

Does office-based flexible cystoscopy provide better pain perception than rigid cystoscopy: a systematic review and meta- analysis

The aim of our study is to determine whether flexible cystoscopy (FC) leads to less pain perception than rigid cystoscopy (RC). Eligible studies were identified through three common databases, including PubMed, the Cochrane Library and Embase. We systematically reviewed studies comparing FC to RC, and extracted data from randomized trials from December 1, 1984 to January 12, 2021, with no language restrictions. Methodological rigor, and risk of bias were evaluated by two independent reviewers using Cochrane Collaboration's tools. The analysis was completed via STATA version 14.2. We initially identified 463 studies, and four articles met the criteria for inclusion. Overall, we did not observe a significant difference between FC and RC regarding pain perception [standard mean difference (SMD): -1.19; 95% CI: -2.69 to 0.32], and there was significant heterogeneity among studies (I2=97.6%, P<0.001). This was consistent with the results stratified by gender (male patients, SMD: -0.96, 95% CI: -2.50 to 0.59; female patients, SMD: -1.42; 95% CI: -4.49 to 1.64). Our study revealed that RC is a tolerable procedure, and FC may not be more comfortable than RC. However, further larger well-designed trials are warranted to demonstrate our findings, and explore whether FC is more beneficial to patient sexual function, anxiety, quality of life, and lower urinary tract symptoms than RC.

Ex vivo validation of a real-time multispectral endoscopic system for the detection and biopsy of bladder tumors.

BackgroundReal-time multispectral imaging (rMSI) simultaneously provides white light (WL), photodynamic diagnosis (PDD) images, and a real-time fusion of both. It may improve the detection of bladder tumors. However, rMSI has not been used for transurethral biopsy or resection so far. The aim of this ex vivo study was to test the feasibility of bladder tumor biopsies using the rMSI system and compare it to a conventional endoscopic system.MethodsA 3D printed rigid bladder phantom was equipped with small and flat (5 mm × 1 mm) mock-bladder-tumors made of silicone and fluorescent Qdots655 (Thermo Fisher Scientific, Germany). Urologists (n=15) were asked to perform a rigid cystoscopy and biopsy of all identified lesions (n=6) using a prototype rMSI system and the Image1 S system (Karl Storz, Tuttlingen). Success rate and completion time were measured. The image quality of both systems and the usability of the rMSI system according to the system usability scale (SUS) were evaluated with a task-specific questionnaire.ResultsTumor detection and biopsy rate were 100% (90/90) for the rMSI system and 98.9% (89/90) for the Image1 S system (P=0.3). The biopsy completion time did not differ significantly between the systems (P=0.48). Differentiation between healthy and suspect mucosa with the rMSI system was rated as comparable to the Image1 S system by 53% of surgeons and as better by 33% of the surgeons. The median SUS score for the rMSI system was 87.5%.ConclusionsAccurate transurethral biopsies are feasible with the rMSI system. Furthermore, the rMSI system has an excellent SUS. This study paves the way to the first in-human transurethral resections of bladder tumors (TUR-B) using rMSI technology.

Efficiency of intracavitary levobupivacaine infusion for pain management during cystoscopic procedures: A randomised study.

This study evaluated the effect of intracavitary levobupivacaine infusion diluted with locally applied isotonic solution for pain control in cystoscopy. Included in this study are 100 patients who had previously undergone transurethral tumour resection for bladder tumour and were followed up by cystoscopy. The patients were randomised into five groups (n=20). In the first, second, third, and fourth groups, 4, 6, 8, and 10mL of levobupivacaine HCl (5.0mg/mL) were mixed with 26, 24, 22, and 20mL of isotonic solution, respectively. Hence, the total mixture was 30mL for each group. The fifth group was the control group. In this group, the standard method commonly used in most clinics was utilised. That is, a gel containing Cathejell-2% lidocaine (25mg lidocaine) was applied for local analgesia. Cystoscopic interventions were performed with a 17.5 Fr rigid cystoscope and 0°, 30°, and 70° lens. During cystoscopy and 30min later, the pain status of patients was assessed using the Visual Analogue Scale (VAS) and patient satisfaction was questioned. The mean VAS score during and after the cystoscopy procedure was significantly lower in the levobupivacaine groups compared with the lidocaine group. In addition, patient satisfaction in the levobupivacaine groups was significantly higher than in the lidocaine group. No drug-related side-effects were observed in all groups. Thus, levobupivacaine is a more effective drug than lidocaine alone to control pain during cystoscopy. The use of levobupivacaine is recommended to prevent possible complications of general anaesthesia by eliminating the need for the aforementioned as well as its cost-saving advantage.

English

BACKGROUND Cystoscopy is a commonly performed routine outpatient procedure and an essential diagnostic tool in urology. It may be performed using either rigid or flexible cystoscopes. From the clinical perspective, it might appear that flexible cystoscopy causes less discomfort than rigid cystoscopy, but remarkably head-to- head comparisons of these two devices are sparse. We wanted to compare rigid cystoscopy with flexible cystoscopy in men with lower urinary tract symptoms (LUTS), in terms of the post-procedure outcomes defined as discomfort / pain experienced by the patient using the visual analogue score (VAS) scoring and duration of the procedure. METHODS A total of 60 male patients with LUTS were randomised to flexible and rigid cystoscopy groups (N = 30 each group). Cystoscopy was done using appropriate rigid and flexible cystoscope. Post procedure, patient was assessed with VAS scaling for pain. The duration of the procedure and any post-procedure discomfort and complication were also noted. RESULTS The mean age of patients of flexible cystoscopy group was comparable to that of a rigid cystoscopy group (39.43 ± 11.45 vs. 41.7 ± 10.8, P = 0.433). The mean duration (minutes) for flexible cystoscopy was significantly less than that of rigid cystoscopy (8.53 ± 1.81 vs. 9.77 ± 2.14, P = 0.019). The mean VAS score for flexible cystoscopy was significantly less than that of rigid cystoscopy (2.57 ± 0.97 vs. 3.97 ± 1.1, P &lt; 0.0001). There was no significant difference between groups in terms of diagnosis (P = 0.796). Post-procedure complications were also comparable between the two groups. CONCLUSIONS Flexible cystoscopy caused less pain and discomfort as compared to rigid cystoscopy. Duration of procedure was also less for the flexible cystoscope. KEY WORDS Cystoscopy, Flexible Cystoscopy, Lower Urinary Tract Symptoms, Pain, Rigid Cystoscopy

Sub-urothelial durvalumab injection-1 (SUBDUE-1): A novel approach to immunotherapy for bladder cancer.

TPS503 Background: Bladder cancer progression may be influenced by the host immunological response to the tumour. Cells strongly associated with this immunological response include Tumour Infiltrating Lymphocytes (TILs) and Tumour-Associated Macrophages (TAMs). Several solid tumours, including bladder cancer can demonstrate good responses to systemic immuno-oncology (IO) agents, however, the efficacy of IO agents in localised bladder carcinoma remains less clear, although numerous trials are underway. One such IO agent is durvalumab, an antibody against the immune checkpoint protein programmed cell death ligand 1 (PD-L1). The sub-urothelial administration of immune therapeutic agents has not been reported. This method of administrating other agents such as Botulinum toxin has shown excellent feasibility and efficacy. Local delivery could have a number of therapeutic advantages and aligns more closely with the intra-vesical therapies commonly adopted in this clinical scenario. It remains unknown whether systemic effects (both beneficial and adverse) of PD-L1 blockade would be reduced by this mode of delivery. Our aim was to establish: a protocol for the sub-urothelial administration of durvalumab. the safety and tolerability of sub-urothelial administration of durvalumab to identify an appropriate dose for future phase II studies the local immunological efficacy of sub-urothelial administration of durvalumab by assessing the quantity and distribution of TILs and TAMs in pre- and post-administration biopsies Methods: This dose-finding Phase Ib trial is currently recruiting patients with invasive, high-grade bladder cancer (≥pT1) already scheduled for radical cystectomy. Cystoscopy under general anaesthesia and sub-urothelial injection of durvalumab will be performed a minimum of 2 weeks prior to cystectomy, utilising a 3+3 dose escalation design (25mg, 75mg, 150mg). The selected dose of durvalumab is diluted into 25mL of normal saline, and administered to the bladder using a 5Fr Bonee needle via 22Fr rigid cystoscope. PROMS, blood specimens, and tumour histopathology and immunohistochemistry at allocated times pre- and post-cystectomy are being collected for translational end-points. Analysis of safety and tolerability will be primarily descriptive in nature. This trial is registered with the Australian Clinical Trials Registry (ACTRN12620000063910, funded by ANZUP Below the Belt and has been approved by the appropriate institutional HREC. To date, four patients have been recruited. This study has a two-year recruitment target and is expected to finish recruiting in 2022. Clinical trial information: ACTRN12620000063910.

Dorsal penile nerve block alleviates pain in men undergoing rigid cystoscopy: A single-center, randomized, double-blind, and placebo-controlled trial.

ObjectiveTo assess the effectiveness and safety of dorsal penile nerve block (DPNB) compared with tetracaine gel in analgesia for men undergoing rigid cystoscopy.Patients and methodsThis study was conducted as a prospective, randomized, double‐blind, placebo‐controlled, and single‐center trial. Men undergoing diagnostic rigid cystoscopy were randomly allocated into one of three groups (n = 86 each): (1) tetracaine gel group (DPNB with saline), (2) DPNB group (DPNB with ropivacaine + plain lubricant), and (3) combination group (DPNB with ropivacaine + tetracaine gel). The primary outcome was visual analog scale (VAS) for pain at cystoscopic inspection of the external sphincter.ResultsVAS (median [interquartile]) at inspection of the external sphincter was significantly lower in both DPNB and combination groups than that in tetracaine gel group (4 [3–6] and 4 [3–5] vs 6 [5–7], P < .0001), with a 33% reduction of median VAS. Overall pain level during procedure was significantly alleviated in the DPNB and combination groups with more stabilized HR and MAP when compared with tetracaine gel group. No adverse events were observed during DPNB including penile hematoma, erection, local anesthetic toxicosis or incompletion of cystoscopy.ConclusionOur study suggests analgesia provided by DPNB with or without tetracaine gel instilled is superior to that provided by tetracaine gel alone in men undergoing diagnostic rigid cystoscopy.Clinical Trials RegistrationClinicalTrials.gov registration number: NCT02502487.

Pain modulation by audiovisual distraction during cystoscopy.

Introduction:Cystoscopy is one of the most common urological procedures used for either diagnostics, therapeutics, or for surveillance. It may be performed under local or general anesthesia. The procedure is associated with pain and discomfort.Aims:The aim of the study was to compare the levels of perceived pain during local cystoscopy with and without audiovisual distraction (AVD).Methodology:A randomized control study was performed at our academic hospital local cystoscopy theater of the urology division. Approximately half the patients already booked for the local rigid cystoscopy procedure were exposed to a distracting musical video during the procedure (study group), while the control group was not.Statistical Analysis:Descriptive statistics were used to determine percentage, mean, and standard deviation (SD) for categorical data. The Mann–Whitney U-test for nonparametric data was used for comparing pain levels.Results:A total of 91 patients participated in the study with 48 patients in the study group and 43 patients in the control group. The visual analog scale (VAS) ranged between 1 and 5/10 in the study group and 1–8/10 in the control group, while the mean VAS was 2.52 ± 1.2 SD in the study group and 4.97 ± 1.35 SD in the control group. The AVD intervention was statistically significant (P < 0.0001).Conclusion:AVD during local rigid cystoscopy is highly recommended, especially in patients undergoing the procedure for the first time.

A Randomized Controlled Trial to Study the Rationale of Antibiotic Prophylaxis in Diagnostic Rigid Cystoscopy: A Relook in The Era of Antibiotic Stewardship.

Background:In the era of widespread antibiotic (AB) resistance, the role of prophylaxis in diagnostic cystoscopy is controversial.Aim:This study aimed to compare the incidence of postcystoscopy positive urinary culture (PC-PUC) and urinary tract infection (UTI) in patients undergoing diagnostic rigid cystoscopy with and without prophylaxis with preprocedural single-dose intravenous AB.Materials and Methods:This prospective study was done in patients with preprocedural sterile urine undergoing elective diagnostic rigid cystoscopy. Patients were randomized into two groups, with one group receiving preprocedure single dose of intravenous cefuroxime sodium as prophylaxis half to 1 h before the procedure (Group AB prophylaxis) and the other group receiving no antibiotic prophylaxis (Group NAB). All patients were followed up till 1-month postprocedure, for any symptoms of urinary infection, mandatory urine microscopy and culture at 24–48 h, 1 week and 4 weeks post procedure, and addition sample in case of any urinary symptoms or fever.Results:A total of 225 patients were studied, with 110 in AB prophylaxis and 115 in NAB groups. The use of prophylaxis did not decrease the incidence of PC-PUC (8.7%–3.6%; P = 0.167) or UTI (6.1%–1.8%; P = 0.102). Females and diabetics had significantly higher risk of PC-PUC, on univariate and multivariate analysis, not affected by prophylaxis.Conclusion:Preprocedural AB prophylaxis does not decrease the incidence of postcystoscopy bacteriuria significantly. Females and diabetics have significantly increased risk, but prophylaxis has no role in them either.

Comparison of pain, quality of life, lower urinary tract symptoms and sexual function between flexible and rigid cystoscopy in follow-up male patients with non muscle invasive bladder cancer: A randomized controlled cross section single blind study.

To compare pain, quality of life (QoL), sexual function and lower urinary tract symptoms (LUTS) between rigid (RC) and flexible cystoscopy (FC). Forty-one patients who were planned control cystoscopies were enrolled the study. At the first cystoscopy, 20 patients (Group 1) and other 21 patients (Group 2) were performed by flexible (15.5 Fr) and rigid cystoscope (15.5 Fr), respectively. At the second cystoscopies, the patients in group 1 and group 2 were performed by rigid and flexible cystosacope, respectively. In all the patients, pain was measured with visual pain scale (VPS) shortly after cystoscopy. Also, SF, QoL and LUTS were assessed by IIEF, SF-36 and MLUTS forms, respectively. While 22 of the patients preferred FC, the other 19 preferred RC (P>0.05). There were no statistical differences between VPS, IIEF, SF-36 and MLUTS scores of the two groups. In multivariate analysis regarding the quality of life, although sexual function, pain and cystoscopy type did not affect QoL, voiding symptoms affected independently QoL. After both cystoscopy type, IIEF, SF-36 and MLUTS scores did not change statistically. The results showed that the effects on pain, sexual function, QoL and LUTS of RC and FC were similar. In general, cystoscopy did not affect negatively on QoL, sexual function and LUTS of the patients.

Robotic pelvic exenteration and extended pelvic resections for locally advanced or synchronous rectal and urological malignancy.

PurposeTo describe the surgical technique and examine the feasibility and outcomes following robotic pelvic exenteration and extended pelvic resection for rectal and/or urological malignancy.Materials and MethodsWe present a case series of seven patients with locally advanced or synchronous urological and/or rectal malignancy who underwent robotic total or posterior pelvic exenteration between 2012–2016.ResultsIn total, we included seven patients undergoing pelvic exenteration or extended pelvic resection. The mean operative time was 485±157 minutes and median length of stay was 9 days (6–34 days). There was only one Clavien–Dindo complication grade 3 which was a vesicourethral anastomotic leak requiring rigid cystoscopy and bilateral ureteric catheter insertion. Eighty-five percent of patients had clear colorectal margins with a median margin of 3.5 mm (0.7–8.0 mm) while all urological margins were clear. Six out of seven patients had complete (grade 3) total mesorectal excision. Three patients experienced recurrence at a median of 22 months (21–24 months) post-operatively. Of the three recurrences, one was systemic only whilst two were both local and systemic. One patient died from complications of dual rectal and prostate cancer 31 months after the surgery.ConclusionsWe report a large series examining robotic pelvic exenteration or extended pelvic resection and describe the surgical technique involved. The robotic approach to pelvic exenteration is highly feasible and demonstrates acceptable peri-operative and oncological outcomes. It has the potential to benefit patients undergoing this highly complex and morbid procedure.

Intraureteral indocyanine green augments ureteral identification and avoidance during complex robotic-assisted colorectal surgery.

Up to 10% of patients who undergo nonurological abdominopelvic operations suffer a ureteral injury. While preoperative ureteral stenting to facilitate identification of the ureter is common, it does not reduce the incidence of intraoperative ureteral injury and is not without risk. As we continue to broaden the application of minimally invasive surgical techniques, a new form of ureteral identification and avoidance that does not rely on tactile feedback is needed. We report our initial experience with intraureteral indocyanine green (ICG) for ureteral identification and avoidance during complex robotic-assisted colorectal surgery. Patients undergoing adjunctive ureteral identification during robotic-assisted colorectal surgery were prospectively identified. Each patient underwent intraureteral ICG administration using rigid cystoscopy (22 Fr). A 5-Fr open-ended ureteral catheter was inserted up to 20cm and used to inject 5ml of 2.5mg/ml ICG as the catheter was withdrawn to the ureteral orifice. Intraureteral ICG was then detected using near-infrared laser fluorescence technology (Firefly®). Successful ICG-enhanced ureteral identification and avoidance was performed in 15 of 16 (94%) patients undergoing robotic-assisted colorectal surgery. The median ICG instillation time was 11.5min (range 4-21min) and the median operative time with ICG visualization was 489min (8h 9min) [range 268-738min (4h 28min-12h 18min)]. No patient experienced intraoperative ureteral injury and there were no adverse sequelae or complications associated with intraureteral ICG administration. Intraureteral ICG is a safe and effective method of intraoperative ureteral identification and avoidance during complex robotic-assisted colorectal surgery. Precise and prolonged ureteral visualization was achieved, allowing for long operative times compatible with complex robotic-assisted operations.

Role of Flexible Cystoscopy and Ultrasound Together in the Detection of Recurrent Superficial Bladder Tumors; A Comparison With Rigid Cystoscopy

Objective: To evaluate the role of flexible cystoscopy and ultrasound together in thedetection of recurrent superficial bladder tumors Method: This hospital based prospective comparative study was carried out in theDepartment of Urology, National Institute of Kidney Diseases and Urology, Sher-E-Banglanagar, Dhaka from January 2013 to June 2014. A total of 85 patients of post transurethralresection (TUR) and post chemotherapy state for superficial bladder tumors were includedin this study. Transabdominal ultrasonography of the bladder was performed for all casesby a consultant radiologist. Flexible cystoscopy was performed by a trained urologist forall. Finally conventional rigid cystoscopy with or without biopsy was performed at thesame setting to confirmed the findings. Result:The mean age was found 62.9±9.7 years with range from 41 to 80 years. Majority(82.4%) patients were male and 15(17.6%) patients were female. Male female ratio was4.7:1. It was observed that majority (54.1%) patients was found pT1 stage and 39(45.9%)was pTa stage. It was observed that more than two third (67.1%) patients had grade-Iand 28(32.9%) had grade-II.Sensitivity, specificity, accuracy, positive and negativepredictive values of combine USG and flexible cystoscopy for identification of recurrenttumors were 92.7%, 33.3%, 90.6%, 97.4% and 14.3%. Conclusion: Ultrasonography and flexible cytoscopy together can detect recurrentsuperficial bladder tumors as accurate as conventional rigid cytoscopy. Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.41-46

Experience using multielectrode cardiac catheters for detection of electrophysiologic activity of the human urinary bladder.

To determine the feasibility of commercially available multielectrode cardiac electrophysiology catheters to detect electrical activity in the human bladder. Ten subjects requiring cystoscopy for the evaluation of lower urinary tract pathology were eligible for participation in our study. After routine rigid cystoscopy with a 70° cystoscope, various multielectrode cardiac electrophysiology catheters were introduced into the bladder. One of three catheters with different electrode configurations was used per subject. Electroanatomical images of the bladder were created and spontaneous electrical activity was recorded. Subjective response to electrical stimuli delivered across the electrodes (20 mA at 5 ms pulse width, rate 100 ms) was also recorded. The responses were qualitatively compared with that from a prior study. Electrical activity recorded at the dome of the bladder was less than 0.5 mV and low frequency. Myopotentials resembling smooth muscle were detected at electrodes near or within the trigone. A sensory response was reported with the use of pacing stimuli, with the sensation in the trigone being reported more often than the dome of the bladder. Stimulation in the trigone triggered sensory urgency and voiding in a patient with a history of overactive bladder. The use of multielectrode catheters to measure human bladder electrophysiologic activity is feasible. Issues with noise reduction still exist, though to a lesser extent with the multielectrode basket design than simple quadripolar one. Sensory responses to pacing stimuli may be useful for diagnostic and therapeutic purposes in the future.

A Randomized Clinical Trial on the Effect of Hypnosis on Anxiety and Pain in Rigid Cystoscopy Patients.

Introduction: Cystoscopy is one of the most common procedures in outpatient urology. Although flexible cystoscopes are more tolerable, rigid cystoscopes have still been used in many clinics because of their lower costs, better visual performance, and easier handling. It can be difficult to achieve optimal relief of pain and anxiety during rigid cystoscopy. The aim of the present prospective randomized study was to evaluate the efficacy of hypnosis as an adjunct to routine local anesthesia in reducing pain and anxiety in rigid cystoscopy patients. Materials and Methods: Ninety male patients undergoing rigid cystoscopy for the first time were randomized into two groups: (1) Hypnosis Group (Group H) patients underwent cystoscopy with hypnotic communication as an adjuvant approach for periprocedural analgesia and anxiety, (2) Standard Care Group (Group SC) patients underwent cystoscopy with routine local anesthesia and lubrication as control group. The data were collected using visual analog scale (VAS) for pain, State-Trait Anxiety Inventory (STAI) for anxiety and hemodynamic parameters. Furthermore, a VAS was also completed by the urologist to assess his satisfaction. Results: Baseline characteristics, STAI, hemodynamic parameters, and recovery duration were statistically similar between the two groups. The procedure duration was shorter in Group H (p = 0.018). The postprocedural STAI and VAS scores of patients in Group H were significantly lower than those of Group SC (p = 0.006; p = 0.02, respectively). Heart rate and mean arterial pressure after positioning of the patient (p = 0.000; p = 0.004, respectively) and insertion of the cystoscope (p = 0.000; p = 0.000) were statistically lower in Group H, whereas baseline, postprocedural, and predischarge hemodynamic measurements were similar. Urologists were also more satisfied in Group H (p = 0.000). Conclusion: Hypnosis as an adjunct therapy to local anesthesia during rigid cystoscopy significantly reduces pain and anxiety, provides more stable hemodynamic conditions, shortens procedure duration, and thus appears attractive for pain and anxiety management.

Does Watching a Relaxing Video During Cystoscopy Affect Pain and Anxiety Levels of Female Patients? A Randomized Controlled Trial

BackgroundCystoscopy is noted to be more painful in men. Research has been done to support the use of video in men to reduce pain; it would follow that video would be useful in reducing pain in women as well. AimsThe aim of this study was to evaluate the effect of watching a relaxing video during cystoscopy on the pain and anxiety levels of female patients. DesignThe study was a single-center, parallel, randomized, controlled, nonblinded trial. SettingThis study was carried out in the cystoscopy unit of a training and research hospital in Turkey. ParticipantsSixty female patients aged 18 years and older undergoing rigid cystoscopy for the first time and under local anesthesia. MethodsThe participants were randomized into two equal groups: video and control. Data were collected with Visual Analog Scale, State-Trait Anxiety Scale, and hemodynamic parameters. ResultsA statistically significant difference was found between the two groups in terms of pain levels during and after cystoscopy (p < .001). Pain levels were significantly lower in the video group during and after the procedure. A statistically significant difference was also found between the groups in terms of anxiety levels before and after cystoscopy (p < .05). Anxiety levels were significantly lower in the video group after the procedure. Satisfaction levels were higher in the video group (p < .001). ConclusionAccording to this study, watching a relaxing video during cystoscopy had a positive effect on pain, anxiety, satisfaction levels, and hemodynamic parameters of the patients.

Does cystoscopy method affect the investigation of bladder pain syndrome/interstitial cystitis?

Introduction and hypothesisCystoscopic investigation to identify associated histological findings of increased mast cells in the detrusor muscle has been recommended by the European Society for the Study of Bladder Pain Syndrome (ESSIC) in the investigation of bladder pain syndrome/interstitial cystitis (BPS/IC). The aim of this study was to identify if the cystoscopy approach impacts the biopsy results when investigating women presenting with symptoms of BPS/IC.MethodsWe performed a single-centre retrospective analysis of 300 bladder biopsy reports from 2015 to 2018 from women undergoing cystoscopy for BPS/IC. Biopsies obtained using closed cup forceps through a flexible (FC) or rigid cystoscope (RC) were compared.ResultsFifty-eight FC biopsies were compared with 242 RC biopsies. FC biopsies had a smaller mean diameter (1.6 mm vs 2.9 mm p < 0.01) and volume (4.1 mm3 vs 9.6 mm3p < 0.001) compared with RC biopsies. There was no significant difference in the histological depth of sampling to the muscularis propria. A total of 292 samples had CD117 immunohistochemical staining for mast cell count (MCC) analysis. The MCC/mm2 was significantly lower in FC biopsies (p < 0.01). Sixteen percent of FC samples compared with 60% of RC samples had a high MCC >28/mm2 (p < 0.01). There was no significant difference in positive microbiology culture between FC (21%) and RC (28%) sampling.ConclusionRigid and flexible cystoscopy can be used to investigate BPS/IC as recommended by international societies. However, the biopsy method impacts the mast cell count analysis, which can influence diagnosis and management. Therefore, RC would be the optimal investigation.

Is Meatal Analgesia Necessary for Pain Reduction During Cystoscopy in Females? A Prospective Randomized Study

ObjectiveTo evaluate whether anesthesia of the meatal orifice reduces pain during cystoscopy in women, known to cause significant pain, discomfort and anxiety in women. Secondary end-point was to compare pain between rigid and flexible cystoscopy. MethodsA total of 120 women, median age 66 (interquartile range 57-69), referred for office cystoscopy were prospectively randomized into 2 groups according to meatal orifice exposure: (1) 5-minute meatus exposure with 2% lidocaine gel; (2) 5-minute meatal exposure with water soluble gel. In each group a pad soaked by the gel was externally placed on the meatal orifice. Each group was further divided to flexible or rigid cystoscopy. Exclusion criteria included urethral stricture, urinary tract infection, chronic pain disease (e.g., IC/PBS), neurogenic disorder, allergy to lubricant, and concurrent pain medication. In all patients, a water-based lubricant applied on the cystoscope, was used for lubrication. A 0-10 visual analogue scale was performed at 4 checkpoints: before examination, immediately following urethral penetration, immediately at end of procedure and 15 minutes after completion ResultsStudy groups did not significantly differ in clinical or demographic parameters. Pain level prior to procedure was 0 in all patients. Mean visual analogue scale immediately after urethral penetration was 4.2 ± 2.3 in both groups 1 and 2 (P= 1). No significant differences in other checkpoints was reported. Further subanalysis by cystoscope type did not demonstrate significance. ConclusionMeatal analgesia does not increase tolerance to cystoscopy in females. Pain level is not reduced by the use of flexible cystoscope in the female population.

Urinary and sexual function after treatment with temporary implantable nitinol device (iTind) in men with LUTS: 6-month interim results of the MT-06-study.

To evaluate the functional outcomes as they relate to the preservation of urinary continence and sexual function after treatment with the temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Israel); a novel minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Men with symptomatic BPH (IPSS ≥ 10, Qmax < 12ml/s, and prostate volume (PV) < 120ml) were invited to participate in this single-arm, prospective multicenter study (MT06). Patients were not washed out of BPH medications before the procedure. The iTind was implanted through a 22F rigid cystoscope under intravenous sedation and was removed 5-7days later through a 22F Foley catheter under local anesthesia. Post-operative VAS and complications (Clavien Dindo-Grading System) were recorded. Preservation of urinary continence and erectile and ejaculatory function were assessed according to ISI, MSHQ-EjD and SHIM questionnaires. Post-operative IPSS, QoL, Qmax and PVR were also assessed at 1, 3, and 6months post-operatively. This interim report includes data out to 6months on the first 70 patients enrolled in the study. The median age was 62.31years, and the mean prostate volume was 37.68ml (15-80ml). Baseline and follow-up data are reported in Table 1. No intraoperative complications were observed, the average post-operative VAS score was 3.24 ± 2.56. On average patients returned to daily life after 4.3days following the retrieval procedure. Sexual function and urinary continence were preserved in all subjects according to the ISI, SHIM and MSHQ-EjD questionnaires and significant improvements (p < 0.0001) from baseline levels were recorded in IPSS, QoL and peak flow. iTind is a well-tolerated, minimally invasive treatment for BPH-related LUTS which preserves sexual function and urinary continence, offers a rapid recovery and return to daily life, and a significant improvement of symptoms and urinary flow at 6-month follow-up.

Comparison of Pain Scores During Retrieval of Ureteral Stents Using Rigid Cystoscope Versus Rigid Ureteroscope in an Office Setting: A Prospective Study

Comparison of Pain Scores During Retrieval of Ureteral Stents Using Rigid Cystoscope Versus Rigid Ureteroscope in an Office Setting: A Prospective Study

OnabotulinumtoxinA is a well tolerated and effective treatment for refractory overactive bladder in real-world practice

Introduction and hypothesisIn randomized clinical trials onabotulinumtoxinA was demonstrated to be an effective and well-tolerated treatment for overactive bladder (OAB) with urinary incontinence (UI). However, data reporting onabotulinumtoxinA use in everyday clinical practice are limited. Here, we present the results from a large, first-of-its-kind real-world study in patients with OAB.MethodsThis was a prospective, observational, multinational study (GRACE; ClinicalTrials.gov, NCT02161159) performed in four European countries. Patients (N = 504) aged ≥ 18 years with OAB inadequately managed with ≥ 1 anticholinergic received onabotulinumtoxinA per their physician’s normal clinical practice.ResultsPhysicians primarily used rigid cystoscopes for onabotulinumtoxinA injection; anesthesia/analgesia was utilized during most treatment procedures. Significant reductions in UI episodes/day from baseline to weeks 1 and 12 were observed as well as in micturition, urgency, and nocturia episodes/day. These improvements in urinary symptoms corresponded to higher scores on the treatment benefit scale at week 12. The use of other OAB medications dropped from baseline to weeks 1 and 12 and was sustained to week 52, which paralleled a reduction in the number of incontinence products used during that time frame. Adverse reactions were reported in 2.6% of patients throughout the study.ConclusionsIn this real-world study, significant improvements in urinary symptoms were seen following onabotulinumtoxinA treatment as early as week 1 and sustained to at least week 12. This was accompanied by a reduced reliance upon incontinence products and reduction in concomitant OAB medication use. OnabotulinumtoxinA was well tolerated with no new safety signals.