Rigid Cystoscopy Research Articles

Management of iatrogenic cystoscopic urethral lesion associated with sequela of cuff erosion in a patient after previous AMS 800 implantation. One-step technique with revision, without cuff explantation

IntroductionIatrogenic urethral lesion with subsequent cuff erosion during cystoscopy is a rare complication. The alternative surgical strategy with in situ urethroplasty while maintaining the open cuff left in situ will be presented. Materials and methodsThe authors report 3 cases of iatrogenic urethral lesion with cuff erosion during cystoscopic evaluation to exclude stricture or cuff erosion due to new onset of obstructive lower urinary tract symptoms. All patients had a history of a AMS 800 implantation due to postprostatectomy incontinence. Rigid cystoscopy was performed, which revealed no pathologies; however, iatrogenic small urethral lesion was identified during the removal of the cystoscope at the projection of the cuff. ResultsIn situ urethroplasty was performed, and the cuff was left open in situ. Additionally a protection fat flap was placed around the urethra from the dorsolateral aspect, separating the cuff and urethra from the direct contact with each other. After 6 weeks the urethral defect was completely healed and via a primary perineal incision the cuff was readapted and closed. The device was fully functioning without any additional adjustments. ConclusionOur modification should be considered in select cases with absence of infection as part of management strategy for cases of iatrogenic urethral lesions with subsequent cuff erosion. Thereby the original cuff can be spared and the possibly difficult preparation of the urethra during reoperation can be avoided. However, additional more cases should be presented in the worldwide literature, to confirm the utility of this surgical principle.

15: Randomized controlled trial of belladonna and opiate suppository during intradetrusor onabotulinum toxin-A injection

Intradetrusor onabotulimun toxin A (BTX-A) injection can be performed in the doctor’s office under local anesthesia. We aimed to evaluate the effectiveness of belladonna and opiate (BO) suppository in adjunct to standard anesthesia for in-office BTX-A treatment. We hypothesized the addition of a BO suppository would reduce bladder injection pain. This was a prospective, randomized, double-blind, placebo-controlled study of patients undergoing BTX-A bladder injection at a single clinic. Participants were randomized by computer generated block randomization to receive a BO (belladonna alkaloid with morphine 16.2/7.5 mg) or placebo suppository. Suppositories were placed immediately prior to lidocaine-based anesthesia, which all participants received. All participants underwent a standardized injection procedure using the same rigid cystoscope, needle type, and injection pattern (20 injections total). Participants reported bladder pain using a 0-10 numeric rating scale. Pain scores were obtained before anesthesia and suppository (P0), 40 minutes after administration of anesthesia and suppository (PA), after first 10 bladder injections (P10), and immediately after completion of 20 injections (P20). Pain increase during procedure was calculated using the difference between PA and P10. Post void residuals (PVRs) were measured immediately post-procedure and two weeks later. Patient satisfaction with pain control was measured using a Likert scale. Our primary outcome was change in pain level from anesthetic baseline to mid-procedure (P10-PA). Secondary outcomes were PVR >200 mL and satisfaction with pain control. A needed sample size of 26 was calculated in order to detect a 50% difference in P10-PA with 80% power. Categorical variables and median pain scores were compared using Fisher’s exact and Kruskal-Wallis tests, respectively. An intent-to-treat approach was used for all analyses. Twenty-six participants were enrolled and randomized with 13 in each study arm. One participant was lost to follow-up. There were no statistically significant differences in demographic variables or medical comorbidities between the groups. Median P10-PA for the placebo group and treatment group was 4 (range, 1-10) and 5 (range, 0-9), respectively (p = 0.94). Median P20 scores for the placebo group and treatment group were 3 (range, 0-10) and 2 (range, 0-8), respectively (p = 0.29). There were no significant differences in pre-injection pain scores reported at P0 and PA. Post-procedure PVR >200 mL was noted in 5 (38%) of the placebo group and 3 (23%) of the treatment group (p = 0.67). Two-week post-procedure PVR >200 mL was noted in 3 (25%) of the placebo group and 2 (15%) of the treatment group (p = 0.64) for an overall rate of 20%. Eleven (84%) participants in each group reported being “mostly satisfied” or “very much satisfied” with pain control. Addition of BO suppository to standard lidocaine-based anesthesia provided no added benefit to significantly reduce bladder injection pain. Suppository use did not increase risk of urinary retention immediately post-procedure or two weeks later. Satisfaction with pain control among BTX-A injection patients is high.

192 Five Year Sexual Function Results of the Multi-Center, Prospective, Randomized Study of the Prostatic Urethral Lift (PUL)

To assess the preservation of sexual function in men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia after the Prostatic Urethral Lift (PUL) procedure. We present the 5-year sexual function data from a multicenter, randomized, sham controlled study. 206 men ≥ 50 years with International Prostate Symptom Score (IPSS) ≥ 13, peak flow rate ≤ 12 mL/s with a prostate volume between 30 and 80 cc were randomized PUL:Sham (140:66) at 19 multi-national centers as part of the L.I.F.T. pivotal PUL study. Permanent UroLift® implants were placed via transurethral access to hold the lateral lobes apart and open the urethra or a blinded rigid cystoscopy sham that mimicked procedure. Randomized groups were compared at 3 months, and PUL subjects were followed 5 years with validated instruments including IPSS, quality of life, peak flow rate, International Index of Erectile Function (IIEF-15), and Male Sexual Health Questionnaire - Ejaculatory Dysfunction (MSHQ-EjD). Individual domains of the IIEF-15 were analyzed for sexually active, per protocol patients.

Three-Year Outcomes of the Prospective, Randomized Controlled Rezūm System Study: Convective Radiofrequency Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia

To report 3-year outcomes of a prospective, multicenter, randomized, blinded control trial after treatment with convective radiofrequency (RF) water vapor thermal therapy for moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Fifteen centers enrolled and randomized 197 men ≥50 years old with International Prostate Symptom Score (IPSS) ≥13, maximum flow rate (Qmax) ≤15 mL/s, and prostate volume 30 to 80 cc to thermal therapy with Rezūm System or control (2:1). Rigid cystoscopy with simulated active treatment sound effects served as the control procedure. Convective RF thermal energy was delivered into obstructive prostate tissue including the median lobe as needed. After randomized comparison at 3 months, thermal therapy subjects were followed annually for 3 years. Convective RF thermal therapy yielded IPSS improvement of 160% compared with control subjects at 3 months (P <.0001). Maximal symptom relief of at least 50% improvement in IPSS, quality of life, Qmax, and BPH Impact Index remained durable throughout 3 years (P <.0001). Subjects with a treated median lobe had similar responses. No late-related adverse events occurred, and no de novo erectile dysfunction was reported. The surgical retreatment rate was 4.4% over 3 years. The minimally invasive convective RF thermal therapy is an office or ambulatory outpatient procedure with minimal transient perioperative side effects. It provides early effective and durable relief of BPH symptoms with preservation of sexual function in subjects followed up for 3 years and is applicable to treatment of the median lobe and hyperplastic central zone tissue.

Tratamiento de la lesión uretral cistoscópica iatrogénica asociada a secuela de la erosión del manguito en un paciente después de la implantación previa de AMS 800. Técnica de un solo paso con revisión, sin explantación del manguito

IntroductionIatrogenic urethral lesion with subsequent cuff erosion during cystoscopy is a rare complication. The alternative surgical strategy with in situ urethroplasty while maintaining the open cuff left in situ will be presented. Materials and methodsThe authors report 3cases of iatrogenic urethral lesion with cuff erosion during cystoscopic evaluation to exclude stricture or cuff erosion due to new onset of obstructive lower urinary tract symptoms. All patients had a history of a AMS 800 implantation due to posprostatectomy incontinence. Rigid cystoscopy was performed, which revelaed no pathologies; however, iatrogenic small urethral lesion was identified during the removal of the cystoscope at the projection of the cuff. ResultsIn situ urethroplasty was performed, and the cuff was left open in situ. Additionally a protection fat flap was placed around the urethra from the dorsolateral aspect, separating the cuff and urethra from the direct contact with each other. After 6 weeks the urethral defect was completely healed and via a primary perineal incision the cuff was readapted and closed. The device was fully functioning without any additional adjustments. ConclusionOur modification should be considered in select cases with absence of infection as part of management strategy for cases of iatrogenic urethral lesions with subsequent cuff erosion. Thereby the original cuff can be spared and the possibly difficult preparation of the urethra during reoperation can be avoided. However, additional more cases should be presented in the world-wide literature, to confirm the utility of this surgical principle.

What Is the Best Lens Angle for Rigid Diagnostic Cystoscopy? A Comparison of 30-Degree and 70-Degree Lenses.

A simulation was created using 3 different artificial bladder models complete with sutures representing lesions placed at different locations in each bladder. Gynecologists and urologists performed cystoscopy using both the 30- and 70-degree lenses on the bladder models in a randomized and single-blinded fashion. The physicians performed routine diagnostic cystoscopy and noted the number of lesions throughout the bladder. The number of lesions each physician identified and the time to complete cystoscopy were noted. A total of 16 physicians participated, and there were a total of 18 lesions among the 3 different bladder models. A total of 86 cystoscopy trials were obtained from all physicians and bladder models attempted. The odds of detecting a lesion with the 70-degree lens cystoscope was 1.77 times greater than the 30-degree lens cystoscope (95% confidence interval, 1.24-2.53; P = 0.002). There was also difference in the average number of lesions found between the 30- and 70-degree cystoscopes with 2.6 ± 2.7 more lesions identified using the 70-degree cystoscope compared with the 30-degree cystoscope. In terms of specific location, 2.6 ± 1.7 more lesions were found at the bladder neck using the 70-degree lens scope versus the 30-degree lens scope (95% confidence interval, 1.37-3.83; P = 0.013). The results suggested that the 70-degree lens was the better choice for the identification of bladder lesions when compared with the 30-degree lens in rigid diagnostic cystoscopy.

Design, Prototyping and Control of a Flexible Cystoscope for Biomedical Applications

Kidney stone and prostate hyperplasia are very common urogenital diseases all over the world. To treat these diseases, one of the ESWL (Extracorporeal Shock Wave Lithotripsy), PCNL (Percutaneous Nephrolithotomy), cystoscopes or open surgery techniques can be used. Cystoscopes named devices are used for in-vivo intervention. A flexible or rigid cystoscope device is inserted into human body and operates on interested area. In this study, a flexible cystoscope prototype has been developed. The prototype is able to bend up to ±40°in X and Y axes, has a hydrodynamic cavitation probe for rounding sharp edges of kidney stone or resection of the filled prostate with hydrodynamic cavitation method and contains a waterproof medical camera to give visual feedback to the operator. The operator steers the flexible end-effector via joystick toward target region. This paper presents design, manufacturing, control and experimental setup of the tendon driven flexible cystoscope prototype. The prototype is 10 mm in outer diameter, 70 mm in flexible part only and 120 mm in total length with flexible part and rigid tube. The experimental results show that the prototype bending mechanism, control system, manufactured prototype parts and experimental setup function properly. A small piece of real kidney stone was broken in targeted area.

Rapid development and recurrence of translocation renal cell carcinoma

Translocation renal cell carcinoma (RCC) is a rare aggressive malignancy in adults. A 40-year-old man presented with painless macroscopic haematuria. Initial investigations of renal ultrasound, CT scan, urine culture and...

PD27-03 THE NEW MEDITATE® TEMPORARY IMPLANTABLE NITINOL DEVICE (I-TIND) IN THE TREATMENT OF BLADDER OUTLET OBSTRUCTION DUE TO BPH: RESULTS OF ONE ARM, MULTI-CENTER PROSPECTIVE, STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV1 Apr 2017PD27-03 THE NEW MEDITATE® TEMPORARY IMPLANTABLE NITINOL DEVICE (I-TIND) IN THE TREATMENT OF BLADDER OUTLET OBSTRUCTION DUE TO BPH: RESULTS OF ONE ARM, MULTI-CENTER PROSPECTIVE, STUDY Francesco Porpiglia, Cristian Fiori, Daniele Amparore, Arya Manit, Gregor Kadner, Massimo Valerio, and Claude Shulman Francesco PorpigliaFrancesco Porpiglia More articles by this author , Cristian FioriCristian Fiori More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Arya ManitArya Manit More articles by this author , Gregor KadnerGregor Kadner More articles by this author , Massimo ValerioMassimo Valerio More articles by this author , and Claude ShulmanClaude Shulman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1224AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Temporary Implantable Nitinol Device (TIND - MediTate®) is a new device for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). We already published the feasibility and safety of TIND implantation, herein we report the results of a one-arm, multi-center, international prospective study to assess the efficacy of second generation of MediTate i-TIND in subjects with BPH. METHODS The i-TIND is comprised of three nitinol elongated struts and an anchoring leaflet and it is preloaded by crimping it into the delivery system. In expanded configuration, the struts of the i-TIND exert radial force that causes ischemic necrosis and subsequent incisions of bladder neck and prostatic urethra. i-TIND was implanted under light sedation, using a rigid 22F cystoscope. The device was removed 5 days later in an outpatient setting, with no need of anesthesia. Forty patients with LUTS were enrolled in this multi-center study from Oct 2014. Inclusion criteria were: IPSS score = 10, peak urinary flow (Qmax) < 12 ml/sec and prostate volume < 75 cc. All patients discontinued medical therapy for BPH before the implantation. Demographics, perioperative, functional results and quality of life (QoL) were evaluated. For the purpose of this study we reported the results of 3 and 6 months follow-up. RESULTS Patients’ age (mean+ SD) was 65.7 y (9.1) and BMI (mean+ SD) was 26.5 (4.1). Prostate volume (mean+ SD), IPSS score (median, range), QoL (median, range) and Qmax (mean+ SD), were 35.3 (+12.5) cc, 25(13-35), 4 (2-5), and 7.5 (2.87) ml/sec respectively. All the implantations and the removals of device were successfully concluded with no intraoperative complications. Three months after implantation IPSS score, QoL and Qmax were 7 (1-29), 1 (0-5) and 12.4ml/sec (4.9); after six months were 7 (0-29), 2 (0-4) and 14 ml/sec (+6.01) respectively. No patients reported ejaculatory dysfunction during follow-up. Differences in terms of IPSS score, QoL and Qmax when comparing preoperative and 6 months postoperative results were statistically significant (p<0.05); specifically the mean change from baseline to month 6 in IPSS score was -15.33 and the mean change of Qmax was 6.2 ml/sec. During the follow up no patients required pharmacologic treatment or surgery for BPH. CONCLUSIONS Second generation i-TIND implantation is a safe and effective minimally-invasive option for the treatment of BPH related LUTS at least at short term follow up. Further studies are required to assess durability of these results. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e512 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Francesco Porpiglia More articles by this author Cristian Fiori More articles by this author Daniele Amparore More articles by this author Arya Manit More articles by this author Gregor Kadner More articles by this author Massimo Valerio More articles by this author Claude Shulman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Post Prostatectomy Vesicourethral Stenosis or Bladder Neck Contracture with Concomitant Urinary Incontinence: Our Experience and Recommendations

Objectives: To present our experience in the management of bladder neck contracture with concomitant post prostatectomy incontinence and to provide our recommendations based on the updated literature. Materials and Methods: Between Jan 2010 and June 2015, 37 patients from our cohort of 341 patients with post prostatectomy incontinence were evaluated. Patient data were retrospectively collected. Patients with bladder neck contracture confirmed on flexible cystoscopy underwent subsequent rigid cystoscopy and deep endoscopic bladder neck incision (BNI). A follow up flexible cystoscopy would be performed 3 months later. If there was no recurrence of the bladder neck contracture, an artificial urethral sphincter (AUS) or a male sling was recommended. Results: The mean age of patients was 68 years (range 59-77) and the mean BMI was 31 (range 21-41) kg/m². Twenty-five (67.7%) patients had open prostatectomy and 12 (32.4%) patients had laparoscopic prostatectomy. Fourteen patients (37.8%) underwent adjuvant radiotherapy. Twenty-four (64.8%) patients had one BNI procedure, 8 (21.6%) patients had two procedures and 5 (13.5%) patients had more than 2 procedures. Twenty-one (91.3%) patients had AUS implantation and 2 (8.7%) patients had male sling placement. Besides, 85.7% of AUS and 50% of male sling patients managed to achieve successful outcomes with a mean follow up period of 13.1 months ( range 2-33 months). Conclusion: Initial management with aggressive BNI followed by implantation of an AUS or male sling when bladder neck is stable is essential to achieve a satisfactory urinary continence outcome.

Is confirmation of ureteric stent placement in laparoscopic pyeloplasty necessary?

Placement of an antegrade double-J (JJ) ureteric stent is an important component of pyeloplasty. Correct siting of distal end of the stent in the bladder is essential for ease of removal. To date, no studies have compared methods for confirming stent position. This study aims to address that void in the literature. Eligible patients underwent laparoscopic pyeloplasty with antegrade stent placement at our institution from 2007 to 2015 inclusive. Methods to verify distal stent position of rigid cystoscopy, artificial bladder filling or no confirmation were compared. Effectiveness was determined by the proportion of malpositioned stents detected intra-operatively compared to the total found malpositioned, both intra-operatively and during follow-up. A total of 75 patients underwent laparoscopic pyeloplasty. Forty-six (61.3%) patients had distal stent position assessed intra-operatively, comprising 27 by cystoscopy and 19 by artificial bladder filling, while for 29 (38.7%) patients no verification method was used. Cystoscopy, artificial bladder filling and no confirmation detected intra-operatively 2, 1 and 0 malpositioned stents, from malpositioned stent totals of 2, 2 and 1, respectively. Malposition of JJ ureteric stent is uncommon, and omitting intra-operative position verification appears reasonable in select cases. Artificial bladder filling can help detect malpositioned JJ stents without repositioning the patient for cystoscopy. However, our results suggest both may be unreliable. If stent malposition is suspected, certainty is desired or extended operative duration is less critical, then the surgeon should proceed with cystoscopy.

667 - 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

667 - 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

How different cystoscopy methods influence patient sexual satisfaction, anxiety, and depression levels: a randomized prospective trial

PurposeBladder cancer (BC) is one of the most common cancers worldwide. BC diagnosis and surveillance is based on cystoscopy (CS). CS impact on patient’s depression, anxiety, and sexual satisfaction (SS) is not sufficiently studied. There are no data on patient’s comfort with flexible or rigid CS.MethodsWe prospectively evaluated pain perception (PP), depression, anxiety, and SS of 100 male patients who previously underwent at least one rigid CS in our department as surveillance after TURB procedure due to non-muscle-invasive BC and were scheduled for the next CS examination. The patients were randomized for flexible or rigid CS. Before CS, patients described their recalled rigid CS-related pain by NRS and fulfilled HADS and SS questionnaires. After CS, PP was re-evaluated immediately and HADS and SS within 7–10 days following the CS.ResultsThe baseline scores include 5.2 ± 2.6 points for rigid CS recalled pain, 7.2 ± 3.0 points for HADS anxiety, 5.8 ± 3.5 for depression, and 27.8 ± 5.1 for SS. The flexible CS-related pain was approximately three times lower than the recalled pain level and also than the current rigid CS related (p < 0.001). Mean SS score was two points lowered after rigid CS (p < 0.001). One point decrease in anxiety level was observed after flexible CS (p < 0.001). Multivariate analysis supported the hypothesis of patients benefiting from flexible CS in terms of pain perception, anxiety symptoms, and SS.ConclusionsOur study demonstrates the superiority of flexible CS in terms of pain alleviation, and shifts in SS and anxiety levels.

Efficacy of preprocedural diclofenac in men undergoing double J stent removal under local anesthesia: A double-blind, randomized control trial.

Introduction:Double J (DJ) stents are often removed under local anesthesia using a rigid cystoscope. Patients experience significant pain during this procedure and also continue to have discomfort during voiding for a few days. We assessed the efficacy and safety of preemptive oral diclofenac in pain relief in patients undergoing DJ stent removal (DJSR) by rigid cystoscopy compared to placebo.Methods:Consecutive consenting male patients undergoing DJSR under local anesthesia between March 2014 and July 2015 were enrolled. Patients were randomized to receive 75 mg oral diclofenac (Group A) or placebo (Group B) 1 h before procedure by double-blind randomization. Intraurethral 2% lignocaine gel (25 ml) was used in both groups. Pain during rigid cystoscopy, pain at the first void, and at 24 h after cystoscopy was assessed using visual analog scale (VAS) (0–100). Adverse reactions to diclofenac and episodes of acute urinary retention, if any, were assessed (Trial registered at clinicaltrials.gov: NCT02598102).Results:A total of 121 males (Group A [n = 62]; Group B [n = 59]) underwent stent removal. The median (Interquartile range) VAS during the procedure in Group A was 30 (30) and Group B was 60 (30) (P < 0.001), at first void was 30 (30) and 70 (30) (P < 0.001) and at 24 h postoperatively was 20 (20) and 40 (20) (P < 0.001). The incidence of epigastric pain, nausea, vomiting, and acute urinary retention was comparable in the two groups (P > 0.05).Conclusions:A single oral dose of diclofenac administered 1 h before DJSR using rigid cystoscope under intraurethral lignocaine anesthesia decreases pain significantly during and up to 24 h postprocedure with minimal side effects.

The effect of office based flexible and rigid cystoscopy on pain experience in female patients.

PurposeRigid and flexible cystoscopies are both routinely used in female patients. Literature is conflicting whether flexible cystoscopy is less painful compared to rigid cystoscopy. The aim of this study was therefore to investigate whether using flexible cystoscopy leads to less discomfort and pain compared to rigid cystoscopy in female patients who underwent first time cystoscopy.Materials and MethodsOne hundred eighty-nine female patients, who never had undergone cystoscopy, were randomized into 2 groups: 92 patients underwent rigid cystoscopy and 97 patients flexible cystoscopy. Directly after the cystoscopy procedure all patients were asked to fill out their pain experience on a 100-mm visual analogue pain scale (VAS).ResultsMedian VAS score was significantly lower for women undergoing flexible cystoscopy (0 [0–20]) compared to rigid cystoscopy (15 [0–38], p<0.001). In addition, age was inversely associated with VAS score, indicating that younger females experienced more pain (R=−0.30, p=0.001). The use of flexible cystoscopy was associated with a decrease in VAS score and remained significant after adjustment for age, sex of urologist, performing urologist and indication (standardized β=−0.17, p=0.048).ConclusionsThe use of flexible cystoscopy resulted in a significantly lower pain experience compared to rigid cystoscopy. Based on patient's pain experience during cystoscopy, this study implicates to use flexible cystoscopy in female patients who undergo first time cystoscopy.

Cystoscopic stent removal using a guidewire loop.

Stent removal is a simple procedure performed with a rigid cystoscope and a stent removal forceps. In the rare event when the stent removal forceps does not work or breaks down, a guidewire loop can be used to remove the stent.

KIDNEY-SPARING SEGMENTAL URETERECTOMY WITH TRANSURETHRAL BLADDER CUFF EXCISION FOR DISTAL URETERAL CARCINOMA

(Introduction and objectives) Radical nephroureterectomy with complete distal ureterectomy is the standard therapy for upper tract urothelial malignancy. Segmental ureterectomy with ueteroneocytostomy is an alternative for distal ureteral carcinoma. We describe extravesical complete distal ureterectomy combined by transurethral bladder cuff excision with frozen-section analysis. (Patient and methods) Since December 2008, 11 patients (median age 77 year old, male 10, female 1, right 10, left 1) with solitary distal ureteral carcinoma who had mild hydronephrosis of ipsilateral kidney remaining renal function on enhanced CT. Under general anesthesia, the patient was placed in lithotomy position, rigid cystoscopy was inserted into the bladder. Cold punch biopsy of 4 sites of bladder mucosa 5 mm away from ureteral orifice (12, 3, 6, 9 o'clock) was carried out and sent to frozen-section analysis. Use resectoscopy with needle-type electrode, incise the bladder mucosa along the biopsy sites circumferentially and incise submucosa tissue around the ureteral orifice deeply enough to detach intramural ureter. Then lower abdominal midline incision was made. After entering the retroperitoneal space, the ureter was dissected and ureteral margin was sent to frozen-section analysis. The distal ureter was dissected until the margin of bladder mucosa incised by transurethrally. After ascertainment of no cancer cell in the frozen-section, close the defect in the bladder. Then the ureter was re-implanted into the bladder by extravesical approach. (Results) Median estimate blood loss was 150 ml (40-350 ml) and median operative time was 258 min (170-317 min.). No patients in our series required a blood transfusion. The mean tumor size was 20+/- 4.4 mm. Pathological T stage was Ta 3, T1 3, T2 2 and T3 3. No positive surgical margin was noted. Mean serum creatinine before and 1 month after surgery was 1.05+/- 0.21 mg/dl and 089+/- 0.13 mg/dl. Mean eGFR before and 1 month after surgery was 54.1+/- 11.4 and 63.4+/- 8.4. Median followup was 35 months (range 4 to 93). Although there were two patients who died from distant metastatic disease, no patients have encountered cancer recurrence in the remained ipsilateral upper urinary tract. (Conclusions) Segmental ureterectomy combined by transurethral bladder cuff excision with frozen-section analysis could perform complete resection of distal ureteral carcinoma and preserve ipsilateral renal function. This technique is feasible for patients with distal ureteral carcinoma as an optional treatment. Better preservation of renal function can lead to increased tolerance of cisplatin-based adjuvant or salvage chemotherapy.

Convective Thermal Therapy: Durable 2-Year Results of Randomized Controlled and Prospective Crossover Studies for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia

We report 2-year outcomes of a multicenter randomized controlled trial plus 1-year results of a crossover trial after treatment with convective radiofrequency water vapor thermal energy for lower urinary tract symptoms due to benign prostatic hyperplasia. A total of 197 men at least 50 years old with I-PSS (International Prostate Symptom Score) 13 or greater, maximum flow rate 15 ml per second or less and prostate size 30 to 80 cc were randomized 2:1 to thermal therapy with the Rezūm® System or a control group. Rigid cystoscopy with simulated active treatment sounds served as the control procedure. After unblinding at 3 months control subjects could requalify for crossover study. Convectively delivered radiofrequency thermal energy was delivered into obstructive prostate tissue, including the median lobe as needed. The primary efficacy end point was a change in severity of symptom scores. Convective radiofrequency thermal therapy improved urinary symptoms significantly over controls at 3 months and provided a sustained 51% reduction from baseline at 24 months (p <0.0001). This produced a 5 and 8-point or greater score decrease in 84% and 74% of subjects, respectively, at24months. Crossover subject symptoms, flow rate and quality of life measures were markedly improved after thermal therapy compared to after the control procedure (p= 0.024 to <0.0001). No de novo erectile dysfunction was reported. Convective radiofrequency water vapor thermal therapy is a minimally invasive office or outpatient procedure that provides early effective symptom relief that remains durable for 2 years and is applicable to the median lobe.

Clinical approach of botulinum toxin A (Botoxⓡ) of treatment for patients with overactive bladder

Candidates for botulinum toxin A are generally patients with overactive bladder(OAB) whose disease is in adequatelycontrolled with behavioral therapy and oral medication. All patients must be willing and able to perform cleanintermittent catheterization(CIC). Before the decision to administer botulinum toxin A is made, the clinician shouldprovide counseling to the patient regarding the agent’s indications, proposed benefis, risks, and mode ofadministration. The patient should be aware that botulinum toxin A takes effect after approximately 1?2weeks andusually lasts for 4?10months, after which repeat injections will be necessary to maintain effect. Patient preparation mayinclude pre-treatment antibiotics and withdrawal of antiplatelet therapy or anticoagulants. Preparation of the productinvolves reconstitution in sterile saline and dilution according to the planned dose. The injections are performed using aflxible or rigid cystoscope, and the procedure takes approximately 15 min. The initial follow-up visit occurs within 7?14days, when evidence of adverse effects, including urinary retention, can be evaluated. Repeat injections can bescheduled as needed, but not sooner than 3 months. Currently, the total dose of botulinum toxin A should not exceed360 U in a 3-month period for all indications, including those outside the urinary tract (i.e.,cosmetic,ophthalmologic,etc.). Overall, botulinum toxin A is effective, generally well tolerated, safe, and is relatively simple toprovide.

An optical method for reducing green fluorescence from urine during fluorescence-guided cystoscopy

Photodynamic diagnosis (PDD) of bladder tumour tissue significantly improves endoscopic diagnosis and treatment of bladder cancer in rigid cystoscopes in the operating theatre and thus reduces tumour recurrence. PDD comprises the use of blue light, which unfortunately excites green fluorescence from urine. As this green fluorescence confounds the desired red fluorescence of the PDD, methods for avoiding this situation particularly in cystoscopy using flexible cystoscopes are desirable. In this paper we demonstrate how a tailor made high power LED light source at 525 nm can be used for fluorescence assisted tumour detection using both a flexible and rigid cystoscope used in the outpatient department (OPD) and operating room (OR) respectively. It is demonstrated both in vitro and in vivo how this light source can significantly reduce the green fluorescence problem with urine. At the same time this light source also is useful for exciting autofluorescence in healthy bladder mucosa. This autofluorescence then provides a contrast to the sensitized fluorescence (PDD) of tumours in the bladder.