MedWorm: Cystoscopy

Giant urethral diverticulum calculus presenting as scrotal abscess.

Hong Kong Med J — Wed, 01 Feb 2012 05:00:00 +0100

We report herein a patient with a urethral calculus associated with urethral diverticulum. A 39-year-old man presented with scrotal swelling and acute retention of urine. Computed tomography of the pelvis and cystoscopy demonstrated a giant calculus in the proximal penile urethra. Emergency in-situ lithotripsy was performed. Complete stone clearance was achieved and a large urethral diverticulum was encountered. The rare occurrence of urethral diverticulum and associated stone disease were discussed. PMID: 22302916 [PubMed - in process] (Source: Hong Kong Med J)

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Cystoscopic removal of intravesical synthetic mesh extrusion with the aid of Endoloop sutures and endoscopic scissors

International Urogynecology Journal — Tue, 31 Jan 2012 07:11:00 +0100

We present a case of intravesical polypropylene mesh extrusion following a combined mesh kit and midurethral sling placement. A novel transurethral approach, employing Endoloop sutures with endoscopic scissors, was used to resect the protruding mesh located in close proximity to a ureteral orifice. Medline was searched for other minimally invasive treatment strategies for bladder mesh extrusion. Various techniques for minimally invasive resection of extruded intravesical mesh have been described in the literature. Our strictly transurethral approach avoids the use of an energy source and eliminates the need for open or extensive surgery. Advantages of this new transurethral operative technique include decreased risk of injury associated with the use of an energy source within the bl...

Diagnosis and treatment of seminal vesicle cysts

Surgical Practice — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions: Seminal vesicle cysts are rare but should be considered in men with hematospermia and otherwise inexplicable bladder irritation symptoms, perineal discomfort, or other genitourinary complaints of unknown etiology. Diagnosis consists of digital rectal examination, transrectal and abdominal ultrasonography, computed tomography scanning, and magnetic resonance imaging. Laparoscopic excision of seminal vesical cysts produced excellent results.© 2012 The Authors. Surgical Practice © 2012 College of Surgeons of Hong Kong (Source: Surgical Practice)

Suprapubic catheter insertion using an ultrasound‐guided technique and literature review

BJU International — Wed, 18 Jan 2012 05:00:00 +0100

What's known on the subject? and What does the study add?The conventional ‘blind’ technique for suprapubic catheter (SPC) insertion relies on adequate filling of the bladder to displace bowel away from the site of needle puncture. However, in a small percentage of patients this fails to happen, which can occasionally lead to life‐threatening bowel injury. Recently published British Association of Urological Surgeons (BAUS) guidelines have recommended that ultrasonography (US) may be helpful to identify bowel loops and recommends its usage whenever possible.This paper describes the technique of US‐guided needle puncture and SPC insertion to reduce the likelihood of bowel injury. The paper addresses training, equipment and logistical issues associated with this advice. We have review...

Continuous Retroflexion Cystoscopy During Prostate Cryoablation

Journal of Endourology — Wed, 04 Jan 2012 14:46:55 +0100

Journal of Endourology , Vol. 0, No. 0. (Source: Journal of Endourology)

Laparoscopic reconstruction of iatrogenic-induced lower ureteric strictures: Does timing of repair influence the outcome?

Indian Journal of Urology — Wed, 04 Jan 2012 05:00:00 +0100

Conclusions: In hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par. (Source: Indian Journal of Urology)

Iatrogenic urethrovaginal fistula with transverse vaginal septum presenting as cyclical hematuria

Indian Journal of Urology — Wed, 04 Jan 2012 05:00:00 +0100

We present a case of iatrogenic urethrovaginal fistula with transverse vaginal septum. The patient presented with cyclical hematuria and infertility. The vagina was blind-ending. The magnetic resonance imaging (MRI) showed normal uterus with transverse vaginal septum. The cystoscopic examination during cyclical hematuria revealed bloody efflux through a small fistula below the internal urethral sphincter. Vaginoplasty and repair of the urethrovaginal fistula was done. The vagina was reconstructed using an amniotic mould. The report emphasizes the importance of MRI and cystoscopy in diagnosing such rare and complex anomalies. (Source: Indian Journal of Urology)

Investigating the relationship between virtual cystoscopy image quality and CT slice thickness.

The British Journal of Radiology — Tue, 03 Jan 2012 05:00:00 +0100

Conclusion: A slice thickness reconstruction less than 1.2 mm does not provide for better image quality at VC due to the presence of increased noise. PMID: 22215882 [PubMed - as supplied by publisher] (Source: The British Journal of Radiology)

Retrieval of proximally migrated double J ureteric stents in children using goose neck snare

Journal of Indian Association of Pediatric Surgeons — Thu, 22 Dec 2011 05:00:00 +0100

Conclusion: Our method of retrieval of stent from renal pelvis is simple, safe and minimally invasive. This technique is a useful and safe alternative option for retrieval of proximally migrated double J stents in children. (Source: Journal of Indian Association of Pediatric Surgeons)

Intrauterine device embedded into the bladder wall with stone formation: laparoscopic removal is a minimally invasive alternative to open surgery

International Urogynecology Journal — Wed, 21 Dec 2011 20:08:33 +0100

Abstract Spontaneous perforation of the uterus and intravesical intrauterine device (IUD) is very rare. The treatment options for an intravesical IUD are open surgery or cystoscopic removal. Open surgery has been used generally for the removal of IUDs with formation of big stones or partial penetration of the bladder wall. In this case, we removed an IUD (multiload Cu 375®) with calculus that had sunk deeply into the bladder wall via laparoscopic partial cystectomy. Content Type Journal ArticleCategory Case ReportPages 1-3DOI 10.1007/s00192-011-1632-8Authors Dong Gil Shin, Department of Urology, Medical Research Institute, Pusan National University Hospital, 1-10 Ami-Dong, Seo-gu, Pusan, 602-739 South KoreaTae Nam Kim, Department of Urology, Medical Research Institute...

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Laparoscopic Repair of Vesico-Vaginal Fistula Without Intentional Cystotomy and Guided by Vaginal Transillumination.

Actas Urologicas Espanolas — Mon, 19 Dec 2011 05:00:00 +0100

CONCLUSIONS: The laparoscopic repair of VVF without intentional cystotomy, by direct dissection of the fistulous tract guided by vaginal transillumination is effective; because it quickly locates the fistula in all cases, reduces the size of the bladder opening, shortens operative times and reduces irritative symptoms. PMID: 22188749 [PubMed - as supplied by publisher] (Source: Actas Urologicas Espanolas)

Diagnostic laparoscopy and preoperative planning in ischiopagus tripus conjoined twins: a surgical first, with detailed demonstration of the complex anatomical relationships

Surgical Endoscopy — Sat, 17 Dec 2011 06:43:51 +0100

Conclusions Diagnostic laparoscopy is a useful tool in evaluation of ischiopagus tripus conjoined twins. It is an important adjunct to preoperative studies in preparing for an expeditious and safe separation procedure. Content Type Journal ArticleCategory VideoPages 1-1DOI 10.1007/s00464-011-2069-3Authors Felix C. Blanco, Department of General and Thoracic Surgery, Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USAKatherine P. Davenport, Department of General and Thoracic Surgery, Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USATimothy D. Kane, Department of General and Thoracic Surgery, Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USAJoseph E. Losee,...

Cystoscopic removal of an intravesical gossypiboma mimicking a bladder mass: a case report

BioMed Central — Fri, 16 Dec 2011 05:00:00 +0100

Conclusion: Intravesical gossypibomas are rare and can mimic a bladder mass. This is one of the few reported cases of cystoscopic removal. (Source: BioMed Central)

Medical Malpractice in Endourology: Analysis of Closed Cases From the State of New York

The Journal of Urology — Fri, 16 Dec 2011 05:00:00 +0100

Conclusions: Urologists are not immune to the current medical malpractice crisis. Endourology and urological oncology generate the greatest number of lawsuits against urologists. Most malpractice claims involving endourological procedures result from urolithiasis and alleged technical errors. Therefore, careful attention to surgical technique is essential during stone procedures to reduce the risk of malpractice litigation. (Source: The Journal of Urology)

Closure and augmentation of bladder exstrophy using rectus abdominis musculo-peritoneal flap

Indian Journal of Plastic Surgery — Thu, 15 Dec 2011 05:00:00 +0100

Conclusions: The RAMP technique is a good alternative for closing bladder exstrophies and achieves an increase in bladder capacity and compliance. The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non-compliant bladder remnants and failed primary closures. (Source: Indian Journal of Plastic Surgery)

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Interstitial Cystitis—Is it Time to Look Beyond the Bladder?

The Journal of Urology — Thu, 15 Dec 2011 05:00:00 +0100

Interstitial cystitis (IC) was first described more than 95 years ago as a distinct ulcer seen in the bladder on cystoscopy (ulcerative IC). This was truly a bladder disease that was associated with inflammatory infiltrates on biopsy, and resulted in severe urinary urgency, frequency and pelvic pain. Since that time the definition was expanded to include symptoms of urinary urgency, frequency and pelvic pain without the need for cystoscopic findings. A driving force for this expanded definition came from the pharmaceutical industry. Clinicians were told that for their patients complaining of pelvic pain and urinary symptoms they only had to administer a questionnaire and perhaps instill potassium in the bladder to confirm a diagnosis of IC. This process resulted in millions of patients bei...

Complications and Long-Term Results of Salvage Cystectomy After Failed Bladder Sparing Therapy for Muscle Invasive Bladder Cancer

The Journal of Urology — Thu, 15 Dec 2011 05:00:00 +0100

Conclusions: Salvage cystectomy is associated with acceptable morbidity, although complication rates are slightly higher than for other cystectomy series. Immediate cystectomies have more cardiovascular/hematological complications while delayed cystectomies have more tissue healing complications. (Source: The Journal of Urology)

Detection and clinical outcome of urinary bladder cancer with 5-aminolevulinic acid-induced fluorescence cystoscopy: a multicenter randomized, double-blind, placebo-controlled trial

International Braz J Urol — Wed, 14 Dec 2011 02:22:41 +0100

CONCLUSION: Trimetazidine did not show protection against renal I/R injury in comparison to warm ischemia or hypothermia in a porcine model submitted to 120 minutes of renal ischemia. (Source: International Braz J Urol)

Granular cell tumor of the urinary bladder: A case report

The Chinese-German Journal of Clinical Oncology — Thu, 08 Dec 2011 18:17:26 +0100

We reported a case of a GCT of the urinary bladder and review the literature. A 23-year-old female presented with dysuria that had lasted for the previous 6 months. MRI revealed a 3 × 2.5 cm global mass in the anterior wall of urinary bladder. Cystoscopy showed a semispherical tumor approximately 3 cm in diameter that was covered with normal bladder mucosa and extended from the bladder neck to the anterior wall of the bladder. The patient underwent transurethral resection of the tumor. Histological examination and immunohistochemical staining showed a granular cell tumor (GCT). There were no features suggesting a malignant phenotype. On 6 months follow-up, the patient has remained free of bladder recurrence. We recommend careful pathologic assessment for establishing the appropriate...

Concurrent vesicoperitoneal and vesicovaginal fistulae

International Urogynecology Journal — Tue, 06 Dec 2011 06:59:03 +0100

We describe a case report of a patient with both vesicovaginal and vesicoperitoneal fistulae after a laparoscopic-assisted vaginal hysterectomy who presented with abdominal pain and anuria. Cystogram and outpatient cystoscopy were imperative in the diagnosis. She was conservatively managed with continuous bladder drainage via indwelling catheter resulting in an ideal recovery without requiring reoperation. Content Type Journal ArticleCategory Case ReportPages 1-2DOI 10.1007/s00192-011-1623-9Authors Rebecca James, MacDonald Women’s Hospital, University Hospitals Case Medical Center, Cleveland, OH, USASangeeta Tina Mahajan, Department of Female Pelvic Medicine and Reconstructive Surgery, MacDonald Women’s Hospital, University Hospitals Case Medical Center, Cleveland, OH, USA ...

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Med Sci Monit 2011; 17(12):HY36-39 "Benzalkonium bromide as a new potential instillation drug for bladder cancer: Hypothesis and pilot study"

Medical Science Monitor — Thu, 01 Dec 2011 05:00:00 +0100

We report our experience with benzalkonium bromide (BB) accidentally administered into a patient‘s bladder as saline. It caused severe hematuria and pain, but after a week of persistent administration in the bladder, the patient was cured, as supported by evidence from cystoscopy, indicating that BB destroys bladder mucosa and suggesting that BB maybe a novel agent for use in a single, immediate post-operative administration. We present preliminary data to support this hypothesis and provide discussion we hope will be useful as the foundation for further experiments. (Source: Medical Science Monitor)

Cardiovasular changes after placement of a classic endotracheal tube, double-lumen tube, and Laryngeal Mask Airway

Journal of Clinical Anesthesia — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: The LMA caused no change in Pd, HR, or MAP values during or after airway placement, but caused QTd after airway insertion. The ETT caused a sudden increase at the first minute after tube placement, without any Pd or QTd. In addition, DLT caused QTd without any serious change in hemodynamics. (Source: Journal of Clinical Anesthesia)

Routine Short-Term Ureteral Stent in Living Donor Renal Transplantation: Introduction of a Simple Stent Removal Technique Without Using Anesthesia and Cystoscope

Transplantation Proceedings — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions: Routine short-term stenting is a safe and effective technique in living donor renal transplantation. Removal of the stent is feasible without cystoscopy or anesthesia. (Source: Transplantation Proceedings)

Ketamine-snorting associated cystitis.

J Formos Med Assoc — Thu, 01 Dec 2011 05:00:00 +0100

We report on four patients who had history of ketamine abuse, presenting with dysuria, fluctuating lower urinary tract symptoms (LUTS), lower abdominal or perineal pain, and impaired functional bladder capacities. Urinalysis showed pyuria and microhematuria. Urine culture was sterile. Bladder ulceration with severe diffuse hemorrhage and low bladder capacity were noted under anesthetized cystoscopic examination. Transurethral bladder mucosa biopsy was consistent with chronic cystitis. Cessation of ketamine abuse was the milestone of treatment, followed by the administration of mucosal protective agents, such as pentosan polysulphate or hyaluronic acid. Suprapubic pain was improved in three patients during follow-up. However, the outcome of treatment depends on the severity of the disease ...

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

BJU International — Tue, 29 Nov 2011 01:29:50 +0100

CONCLUSIONS• There is a clear advantage for the diagnostic strategy using CT urography and flexible cystoscopy as a triage test for rigid cystoscopy and follow‐up (option 1), in which patients with a positive CT urography score for bladder cancer are directly referred for rigid cystoscopy, but all other patients undergo flexible cystoscopy.• Diagnostic accuracy is the same as for the additional test strategy with the advantage of a 17% reduction of the number of flexible cystoscopies performed.• The sensitivity of voided urine cytology is too low to justify its continuing use in a hospital haematuria rapid diagnosis clinic using CT urography and flexible cystoscopy. (Source: BJU International)

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Impact of different grades of microscopic hematuria on the performance of urine-based markers for the detection of urothelial carcinoma.

Urologic Oncology — Mon, 28 Nov 2011 05:00:00 +0100

CONCLUSION: The extent of microscopic HU significantly influences the performance of noninvasive urine markers for UC. False positive rates of CYT, uCyt+, and NMP22 significantly increase with the degree of HU whereas false negative results of CYT, uCyt+, and NMP22 are less frequent in patients with high grade microscopic HU. These results underline the relevance of the grade of HU for the appropriate interpretation of urine tests. PMID: 22130125 [PubMed - as supplied by publisher] (Source: Urologic Oncology)

Bravery in an Interior Battle: An Impending Encounter with Polyps

Psychology Today Anxiety Center — Tue, 22 Nov 2011 21:51:45 +0100

He has no proof—no documentary evidence. But he does have a suspicion. Yes, for sure, the Pilgrims left England to escape constraints on their faith; they sailed to the new world where they would enjoy religious freedom. Primary Topic: Health read more (Source: Psychology Today Anxiety Center)

Narrow-Band Imaging Flexible Cystoscopy in the Detection of Clinically Unconfirmed Positive Urine Cytology

Karger Publishers — Fri, 18 Nov 2011 23:00:00 +0100

Urol Int (DOI:10.1159/000333119) (Source: Karger Publishers)

Subcutaneous 5-Azacitidine Treatment of Naturally Occurring Canine Urothelial Carcinoma: A Novel Epigenetic Approach to Human Urothelial Carcinoma Drug Development

The Journal of Urology — Thu, 17 Nov 2011 05:00:00 +0100

Conclusions: Subcutaneous 5-azacitidine showed promising clinical activity in a canine invasive urothelial carcinoma model, thus meriting further development in humans with urothelial carcinoma. (Source: The Journal of Urology)

Alkalinized Lidocaine and Heparin Provide Immediate Relief of Pain and Urgency in Patients with Interstitial Cystitis

The Journal of Sexual Medicine — Mon, 14 Nov 2011 05:00:00 +0100

Conclusions. The combination of alkalinized lidocaine and heparin provides up to 12 hours of relief from urgency and pain associated with IC. This combination provides significant immediate relief of symptoms for patients with IC. Parsons CL, Zupkas P, Proctor J, Koziol J, Franklin A, Giesing D, Davis E, Lakin CM, Kahn BS, and Garner WJ. Alkalinized lidocaine and heparin provide immediate relief of pain and urgency in patients with interstitial cystitis. J Sex Med **;**:**–**. (Source: The Journal of Sexual Medicine)

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Multiple giant prostatic urethral stones with an ureteral stone in a young patient.

Urological Research — Fri, 11 Nov 2011 05:00:00 +0100

We report a case of a 40-year-old man with giant multiple prostatic urethral stones whereby the entire gland was replaced, and a big ureteral stone presented with voiding difficulty and recurrent urinary tract infections. In the literature, to our knowledge, this is the youngest case wherein giant prostatic urethral stones coexisted with a big ureteral stone. Many different-sized stones were observed endoscopically, some protruding into the urethra, and some filling different cavities on the prostate. Following cystoscopy, multiple giant prostatic stones weighing a total of 151 g were removed by the open retropubic route. We treated the big ureteral stone endoscopically. PMID: 22071961 [PubMed - as supplied by publisher] (Source: Urological Research)

Applying narrow-band imaging in complement with white-light imaging cystoscopy in the detection of urothelial carcinoma of the bladder.

Urologic Oncology — Fri, 11 Nov 2011 05:00:00 +0100

CONCLUSIONS: Compared with WLI, NBI improves UC detection. It has a higher rate of detection and a comparative rate of false-positive detection. NBI is simple and requires no dyeing. It can be conveniently applied to complement WLI. PMID: 22079940 [PubMed - as supplied by publisher] (Source: Urologic Oncology)

Multiple giant prostatic urethral stones with an ureteral stone in a young patient

Urological Research — Thu, 10 Nov 2011 06:44:19 +0100

Abstract Giant prostatic urethral stones have been reported as a very rare entity, and the etiology of these stones is not clear. We report a case of a 40-year-old man with giant multiple prostatic urethral stones whereby the entire gland was replaced, and a big ureteral stone presented with voiding difficulty and recurrent urinary tract infections. In the literature, to our knowledge, this is the youngest case wherein giant prostatic urethral stones coexisted with a big ureteral stone. Many different-sized stones were observed endoscopically, some protruding into the urethra, and some filling different cavities on the prostate. Following cystoscopy, multiple giant prostatic stones weighing a total of 151 g were removed by the open retropubic route. We treated the big...

Case report of ketamine-induced urinary tract injury

The Poison Review — Mon, 07 Nov 2011 05:00:25 +0100

3 out of 5 stars Ketamine-associated vesicopathy. Chen YC, Chen YL et al. QJM 2011 Sep 14 [Epub ahead of print] No abstract available An under-recognized complication of chronic ketamine abuse is injury to the bladder. Ketamine or a metabolite gets concentrated in the urine, causing inflammation, fibrosis, and decreased compliance. These patients — typically young males — present with severe lower urinary tract symptoms (urgency, frequency, dysuria0 and suprapubic pain. Work-up reveals a small-capacity bladder (sometimes less than 100 mL) with a thick wall. Secondary hydronephrosis can cause renal failure. Differential diagnosis includes interstitial cystitis, tuberculous cystitis, and transitional cell carcinoma. This brief case report describes an 18-year-old male who pres...

The Role of Examination under Anesthesia (EUA) and Vaginoscopy in Pediatric and Adolescent Gynecology: A Retrospective Review

Journal of Pediatric and Adolescent Gynecology — Fri, 04 Nov 2011 04:00:00 +0100

Conclusion: EUA/vaginoscopy is a safe and highly useful method in the assessment of the lower genital tract in pediatric and adolescent patients. (Source: Journal of Pediatric and Adolescent Gynecology)

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Good quality white‐light transurethral resection of bladder tumours (GQ‐WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non‐muscle‐invasive bladder cancer: validation across time and place and recommendation for benchmarking

BJU International — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSIONS• Detrusor muscle status at the first, apparently complete, TURBT and surgeon's experience independently predict the quality of TURBT.• Documented complete resection by experienced surgeons with DM presence (good quality white‐light TURBT) should be considered a benchmark for white‐light TURBT in NMIBC. (Source: BJU International)

Challenges in non‐muscle invasive bladder cancer: lessons from a regional review

ANZ Journal of Surgery — Tue, 01 Nov 2011 04:00:00 +0100

Conclusion: Surveillance patterns were inconsistent across all risk categories. The development of consensus recommendations did not significantly alter clinical practice. Implementation of clinical guidelines for this important disease represents a significant challenge in acute hospital settings. (Source: ANZ Journal of Surgery)

Diagnosis and management of congenital rectourethral fistula in a child with long tubular duplication of the colon and Klippel-Feil syndrome

Journal of Pediatric Surgery — Tue, 01 Nov 2011 04:00:00 +0100

We describe a unique association of congenital rectourethral fistula with long tubular duplication of the colon in a boy with Klippel-Feil syndrome and Sprengel deformity. He presented with a rectourethral fistula after surgical repair of a tubular duplication of the terminal ileum, colon, and proximal rectum. Preoperative identification of the fistula was challenging and was only achieved after cystoscopy with injection of methylene blue under pressure through Foley catheters placed into the anus and distal stoma of a colostomy. Surgical repair was performed through the posterior sagittal approach. The patient is doing well after 4 years of follow-up. (Source: Journal of Pediatric Surgery)

Practical and legal implications of nurse practitioners and physician assistants in cystoscopy.

Urologic Nursing — Tue, 01 Nov 2011 04:00:00 +0100

Authors: Schultz H Abstract Due to looming physician shortages and the increase in demand for quality medical care for the newly insured, as well as the aging Baby Boomer population, there has never been a more important time for physicians, administrators, and the public to endorse and develop the role that nurse practitioners (NPs) and physician assistants (PAs) will play in the future of medical practice. One way to begin to address this problem is by expanding investments in training, competencies, and certification for NPs and PAs in performing minor procedures, such as cystoscopy, which is currently being performed by NPs and PAs across the United States and United Kingdom safely and with consistently high quality outcomes. PMID: 22263444 [PubMed - in process] (Source: Ur...

The value of bladder mapping and prostatic urethra biopsies for detection of carcinoma in situ (CIS)

BJU International — Fri, 28 Oct 2011 04:00:00 +0100

CONCLUSION• Traditional cold‐cup biopsies are unreliable for detecting CIS in bladder mucosa and negative findings must be interpreted with caution. (Source: BJU International)

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Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed

Experimental Diabetes Research — Wed, 26 Oct 2011 19:24:29 +0100

When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5–10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2) Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied indiv...

Primary Carcinoid Tumor of the Ileal Efferent Limb of an Ileovesicostomy: A Case Report

Advances in Pharmacological Sciences — Wed, 26 Oct 2011 13:07:06 +0100

We report on the evaluation and management of a 47-year-old white male found to have primary carcinoid tumor of the ileal segment of his diverting ileovesicostomy thirty-five months after initial creation. Subsequent to presentation with intermittent gross hematuria, CT urogram highlights an 8 mm enhancing lesion near the enterovesical junction of urinary diversion. Office cystoscopy confirms presence of a lesion that was later endoscopically resected and found to be a well-differentiated carcinoid tumor. Evaluation with serum markers, direct visualization utilizing endoscopy, and imaging was without finding of alternate primary or metastatic lesions. The patient ultimately had the proximal ileal portion of his ileovesicostomy excised and the distal portion converted into an ileal c...

Clinical Reliability of the 2004 WHO Histological Classification System Compared With the 1973 WHO System for Ta Primary Bladder Tumors

The Journal of Urology — Mon, 24 Oct 2011 04:00:00 +0100

Conclusions: The 1973 WHO classification system predicted the risk of recurrence in primary pTa cases more accurately than the 2004 WHO system. Each classification had the same accuracy when predicting the risk of progression. Our study confirms the clinical reliability of the new histological classification in clinical practice from a prognostic point of view. (Source: The Journal of Urology)

A simple renal cyst invaded by infiltrating urothelial carcinoma mimicking a Bosniak Class IV renal cyst.

Clinical Nephrology — Sat, 22 Oct 2011 19:40:46 +0100

We report a 79-year-old woman with a left side simple renal cyst invaded by infiltrating urothelial carcinoma mimicking a Bosniak Class IV renal cyst. Computerized tomography has high accuracy for the diagnosis of renal cysts and urothelail carcinoma. But, in this case it was still difficult to distinguish a simple renal cyst with infiltrating urothelial carcinoma invasion from a Bosniak Class IV renal cyst on CT scan. The management of a Bosniak Class IV renal cyst and urothelail carcinoma is totally different. Therefore, we performed a left side nephroureterectomy. This patient will have regular follow-up with cystoscopy every 3 months for the first 2 y, every 6 months for the next 2 y, and then annually thereafter. PMID: 22000563 [PubMed - in process] (Source: Clinical Nephrology)

Robot-Assisted Laparoscopic Excision of Symptomatic Retrovesical Cysts in Boys and Young Adults

The Journal of Urology — Thu, 20 Oct 2011 04:00:00 +0100

Conclusions: In the management of retrovesical cystic anomalies robot-assisted laparoscopic excision affords a natural extension of conventional laparoscopy with the additional advantages of 3-dimensional vision and ease of instrument control. (Source: The Journal of Urology)

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Laparoscopic transvesical removal of erosive mesh after transobturator tape procedure

International Journal of Urology — Wed, 12 Oct 2011 04:00:00 +0100

AbstractWe have experienced two cases of intravesical transobturator tape (TOT) tape successfully removed by laparoscopic transvesical procedure. Patient 1 was a 67‐year‐old woman complaining of irritative symptoms of the urinary bladder. In another hospital she had undergone anterior corporrhaphy and a TOT procedure to treat a cystocele and stress urinary incontinence (SUI) 17 months before the initial consultation. A cystoscopy revealed tape extrusion and adherent calculi at the 4 to 5 O'clock position of the bladder neck. After filling the bladder with carbon dioxide, three 5‐mm ports were placed in lower abdomen directly into the bladder. The tape extruding from the bladder muscle layer was completely excised, and extirpated with the adherent calculi. The bladder mucosa and mus...

Blue-light cystoscopy for multi-disciplinary surveillance of high risk non-muscle invasive bladder cancer

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Introduction: Questions exist over the role of Photodynamic diagnosis (PDD) in surveillance of patients with high risk bladder cancer, CIS, or BCG treatment. Our aim was to establish a PDD surveillance service for this group, improve coordination of care, adherence to NICE guidance, and quality of life. (Source: International Journal of Surgery)

Compliance with European association of urology guidelines for primary non-muscle invasive bladder cancer?

International Journal of Surgery — Thu, 06 Oct 2011 22:52:31 +0100

Introduction: Treatment of primary non-muscle invasive bladder cancer (NMIBC) is guided by the European Association of Urology (EAU) clinical guidelines. We evaluated compliance with EAU guidelines in term of risk stratification, first check cystoscopy and further cystoscopy follow up in a University Teaching Hospital. Material and Methods: We performed a retrospective review of consecutive cases with primary NMIBC between January 2009 and January 2010. (Source: International Journal of Surgery)

Re: Intraurethral Instillation of Ketamine for Male Rigid Cystoscopy; (From: Moharai RS, Najafi A, Khajavi MR, et al. J Endourol 2010; 24:2033–2036)

Journal of Endourology — Wed, 05 Oct 2011 19:08:51 +0100

Journal of Endourology Oct 2011, Vol. 25, No. 10: 1677-1677. (Source: Journal of Endourology)

Low‐Dose Cyclophosphamide Associated with Hemorrhagic Cystitis in a Breast Cancer Patient

The Breast Journal — Wed, 05 Oct 2011 04:00:00 +0100

We present a case of a patient with stage IIB breast cancer who developed clinical, radiographic, and pathologic evidence of hemorrhagic cystitis after a single 600 mg/m2 dose of cyclophosphamide. Three subsequent cycles of cyclophosphamide with the addition of IV hydration and MESNA were given without complication, and the patient’s urologic symptoms resolved. Repeat cystoscopy demonstrated pathologic resolution of the cystitis. We review the literature regarding proposed mechanisms of hemorrhagic cystitis, and discuss the applicability of these hypotheses in our patient. (Source: The Breast Journal)

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High‐grade invasive urothelial carcinoma with focal plasmacytoid differentiation successfully treated by transurethral resection followed by chemoradiotherapy

International Journal of Urology — Sat, 01 Oct 2011 04:00:00 +0100

We report a case of high‐grade invasive urothelial carcinoma with plasmacytoid differentiation of the urinary bladder. A 75‐year‐old woman was referred to our hospital because of macroscopic hematuria. Cystoscopy detected a solid pedunculated bladder tumor, and a transurethral resection of the bladder tumor (TUR‐Bt) and the image findings showed pT1N0M0 bladder cancer. The histopathological examination revealed the coexistence of a large component of high‐grade invasive urothelial carcinoma and a small component of plasmacytoid carcinoma. Following the TUR‐Bt, external beam radiotherapy and chemotherapy with gemcitabine and nedaplatin were carried out. The bladder tumor has not recurred for 2 years after the TUR‐Bt. (Source: International Journal of Urology)

S88 narrow-band imaging (nbi) flexible cystoscopy in the diagnosis of urothelial carcinoma of the bladder

European Urology Supplements — Sat, 01 Oct 2011 04:00:00 +0100

(Source: European Urology Supplements)

C82 the long term impact of hal fluorescence cystoscopy in cis patients – a “must” for a dificult to treat pathology?

European Urology Supplements — Sat, 01 Oct 2011 04:00:00 +0100

(Source: European Urology Supplements)

C85 advanta ges of a new diagnostic and treatment aproach in cases of large non-muscle invasive bladder tumors – nbi cystoscopy and bipolar plasma vaporization

European Urology Supplements — Sat, 01 Oct 2011 04:00:00 +0100

(Source: European Urology Supplements)

C86 the role of diferentiated tisue sampling and fluorescence cystoscopy in the diagnosis and treatment of bladder cancer – 5 year experience

European Urology Supplements — Sat, 01 Oct 2011 04:00:00 +0100

(Source: European Urology Supplements)

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Cystoscopy-Assisted Percutaneous Removal of Impacted Urethral Stone: A Case Report

Journal of Laparoendoscopic — Thu, 29 Sep 2011 19:22:47 +0100

Journal of Laparoendoscopic & Advanced Surgical Techniques , Vol. 0, No. 0. (Source: Journal of Laparoendoscopic)

Nephroscopy with Carbon Dioxide in Combination with Laparoscopy in the Treatment of Urinary Stones.

Actas Urologicas Espanolas — Thu, 29 Sep 2011 04:00:00 +0100

CONCLUSIONS: Flexible nephroscopy using CO2 in combination with laparoscopy is a feasible and effective technique for the treatment of urinary stones in selected cases to avoid accumulation of fluid in the peritoneal cavity. PMID: 21963051 [PubMed - as supplied by publisher] (Source: Actas Urologicas Espanolas)

Transurethral holmium laser intravesical tape excision following TVT procedure: results from seven patients in a 12-month follow-up

International Urogynecology Journal — Wed, 28 Sep 2011 05:53:37 +0100

Conclusions Holmium laser ablation represents a simple, safe and efficacious procedure to manage intravesical mesh complications following TVT procedure. Content Type Journal ArticleCategory Original ArticlePages 1-9DOI 10.1007/s00192-011-1574-1Authors Vasileios I. Sakalis, Department of Urology, Hippokrateion General Hospital of Thesaloniki, Konstantinoupoleos 49, POB 546 42 Thessaloniki, GreeceAnastasia Chr. Gkotsi, Department of Experimental Physiology, Aristotle University of Thessaloniki, Thessaloniki, GreeceArgyrios Triantafyllidis, Department of Urology, Hippokrateion General Hospital of Thesaloniki, Konstantinoupoleos 49, POB 546 42 Thessaloniki, GreeceApostolos Giouris, Department of Urology, General Hospital of Serres, Serres, GreeceStavros Charalambous, De...

Potential factors that can be used to differentiate between interstitial cystitis/painful bladder syndrome and bladder oversensitivity in women

International Journal of Clinical Practice — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion: A diagnosis of IC/PBS can be made without cystoscopic hydrodistention in women with increased bladder sensation, having storage symptoms, a CBC ≤ 350 ml, a positive KCl test result and a VAS score ≥ 2. (Source: International Journal of Clinical Practice)

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Congenital vesicovaginal fistula with menouria: an anomaly of the urogenital sinus

European Journal of Obstetrics, Gynecology, and Reproductive Biology — Mon, 26 Sep 2011 04:00:00 +0100

Conclusions: All women with menouria need complete investigation with exhaustive exploration, analytic evaluation, ultrasound, imaging tests (principally magnetic resonance) and, very importantly, cystoscopy on the days of menouria. Surgical treatment must be careful and individualized. This case allows us to hypothesise that the blind vagina encountered reflects an anomaly of correct urogenital sinus development. (Source: European Journal of Obstetrics, Gynecology, and Reproductive Biology)

Management of the Failed Transurethral Resection of the Prostate

Current Bladder Dysfunction Reports — Fri, 23 Sep 2011 05:45:14 +0100

Abstract Transurethral resection of the prostate (TURP) is the gold standard for treatment of symptomatic benign prostatic enlargement. Failure of TURP and other similar procedures may occur when a patient has poor bladder emptying postoperatively or has persistent or de novo bothersome postoperative lower urinary tract symptoms. Reasons for failure include inadequate resection, clot retention, anesthesia-related side effects, postoperative pain, hypo- or acontractile bladder, and/or poor patient selection. Patients initially can be managed conservatively or proactively. When clinically significant storage or voiding dysfunction persists, evaluation is necessary and may include cystoscopy and/or urodynamics. Depending on the diagnosis and etiology, patients can then be man...

Combining cytology, TRAP assay, and FISH analysis for the detection of bladder cancer in symptomatic patients

Annals of Oncology — Fri, 23 Sep 2011 04:00:00 +0100

Conclusion: Compared with cytology alone, the combination of cytology, TRAP, and FISH provided the best trade-off between increase in sensitivity and loss in specificity, especially among non-bleeding patients, low-grade cancers, and early-stage cancers. (Source: Annals of Oncology)

Changing trend in the patterns of pretreatment diagnostic assessment for patients with cervical cancer in Japan.

Gynecologic Oncology — Fri, 23 Sep 2011 04:00:00 +0100

CONCLUSIONS: The use of CT/MRI that is encouraged in the latest FIGO staging guidelines already replaced intravenous urography, cystoscopy, and proctoscopy in Japan. Japanese patients received the potential benefit of CT/MRI because prognostic factors such as primary lesion size and pelvic lymph node status were evaluated by these modalities. The use of cystoscopy and proctoscopy should be continuously monitored in the future PCS survey because only CT/MRI could lead to the stage migration for patients on suspicion of bladder/rectum involvement on CT/MRI. PMID: 21945554 [PubMed - as supplied by publisher] (Source: Gynecologic Oncology)

Synchronous Renal Malignancy Presenting as Recurrent Urinary Tract Infections

Advances in Pharmacological Sciences — Sun, 18 Sep 2011 23:36:49 +0100

We report the case of a patient who underwent unilateral nephrectomy for suspected RCC and diagnosed transitional cell carcinoma of the superior pelvis. Preoperative imaging was suspicious for renal pelvic involvement, which was confirmed upon performing cystoscopy and biopsy of the suspected lesion preoperatively. This preoperative approach was especially appropriate as a nephron saving procedure was being considered prior to the discovery of the synchronous lesion. We discuss this rare simultaneous occurrence of synchronous malignancies in the same kidney. (Source: Advances in Pharmacological Sciences)

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Management of Bladder Diverticula

Current Bladder Dysfunction Reports — Fri, 16 Sep 2011 16:43:51 +0100

Abstract Bladder diverticula can be congenital or acquired. In adults, they are typically associated with bladder outlet obstruction but may also have iatrogenic causes; they are occasionally associated with bladder cancer. Although they are common in men with bladder obstruction, most diverticula are small and require no treatment other than that required for the outlet obstruction. Indications for surgery include recurrent urinary tract infections, stones, tumors, ureteral obstruction, and symptomatic incomplete bladder emptying. The type of surgery depends on a clear understanding of the degree to which the bladder diverticulum contributes to the patient’s condition based on cystoscopy, urodynamics, and upper tract imaging. Because of the increased incidence of bladde...

[Nutcracker syndrome: A rare cause of hematuria.]

Archives de Pediatrie — Tue, 13 Sep 2011 04:00:00 +0100

We report the case of a 4-year-old child who presented nutcracker syndrome confirmed by CT angiography of the abdomen after excluding the other causes of hematuria. Through this observation, we emphasize the reality of this syndrome in children and the value of imaging in the evaluation of this rare affection. PMID: 21920714 [PubMed - as supplied by publisher] (Source: Archives de Pediatrie)

Should the presence of a culture positive urinary tract infection exclude patients from rapid evaluation hematuria protocols?

Urologic Oncology — Mon, 12 Sep 2011 04:00:00 +0100

CONCLUSION: Despite selection bias inherent in this analysis, it appears that the presence of UTI does not decrease the likelihood of having a urologic malignancy diagnosed. Hence, there is no indication to delay prompt evaluation in patients with hematuria and a positive urine culture collected at the hematuria clinic. PMID: 21917488 [PubMed - as supplied by publisher] (Source: Urologic Oncology)

Molecular Pathogenesis of Non Muscle-Invasive Bladder Cancer: Implications for Novel Targeted Therapies.

Current Molecular Medicine — Fri, 09 Sep 2011 04:00:00 +0100

This article reviews the molecular pathogenesis of NMIBCs, discusses recently completed and ongoing clinical trials and anticipates the future direction of molecular targeted agents in this disease. PMID: 21902654 [PubMed - as supplied by publisher] (Source: Current Molecular Medicine)

Pure NOTES Transvesical Venous Ligation: Translational Animal Model of Varicocelectomy

Urology — Mon, 05 Sep 2011 04:00:00 +0100

Conclusion: An animal model mimicking a NOTES transvesical bilateral varicocelectomy procedure is successfully shown in the present study. Despite being encouraging, these novel findings need to be interpreted with caution. Further research is warranted and development of purpose-built instrumentation is awaited to define potential urological applications of transvesical NOTES. (Source: Urology)

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Metabolomics and bladder cancer

Urologic Oncology: Seminars and Original Investigations — Thu, 01 Sep 2011 04:00:00 +0100

Abstract: Diagnosis of bladder cancer is primarily made based on clinical presentation and then by direct visualization with cystoscopy. Despite the massive investments recently made to identify urinary-based assays that are able to diagnosis urothelial carcinoma, urine cytology and cystoscopy still remain the gold standard. Recently proof of principle studies have shown that noninvasive urine-based metabolomics, using high pressure liquid chromatography (HPLC) and nuclear magnetic resonance (NMR), may be able to accurately diagnosis bladder cancer. This review discuses the published studies investigating metabolomics and bladder cancer and the future potential of this developing field. (Source: Urologic Oncology: Seminars and Original Investigations)

Masked urinary bladder injury with a bullet expulsed spontaneously during voiding.

Turkish Journal of Trauma and Emergency Surgery : TJTES — Thu, 01 Sep 2011 04:00:00 +0100

We report a case with gunshot to the pelvis. The injury site was the soft tissue between the rectum and urinary bladder. Several days later, the bullet was expulsed spontaneously during voiding. In the literature, only a few case reports have described spontaneous expulsion of an intravesical bullet. A 19-year-old male was wounded on the left hip by gunshot. Radiographic examinations showed a bullet in the pelvis, which was localized in the soft tissue between the rectum and urinary bladder, with no accompanying visceral injury on abdominopelvic computerized tomography. Macroscopic hematuria was noticed after urethral catheterization. Rectosigmoidoscopy and retrograde cystoscopic examinations were both negative. The patient was monitored closely and treated conservatively with no surgical ...

Volume-Based Features for Detection of Bladder Wall Abnormal Regions via MR Cystography

IEEE Transactions on Biomedical Engineering — Wed, 31 Aug 2011 23:00:00 +0100

This study aims at a noninvasive procedure for bladder tumor detection and abnormal region delineation, which has the potential for further clinical analysis such as the invasion depth of the tumor and virtual cystoscopy diagnosis. Five datasets including two patients and three volunteers were used to test the presented method, all the tumors were detected by the method, and the overlap rates of the regions delineated by the computer against the experts were measured. The results demonstrated the potential of the method for detecting bladder wall abnormal regions via MR cystography. (Source: IEEE Transactions on Biomedical Engineering)

Clinical Issues—September 2011

AORN Journal — Tue, 30 Aug 2011 19:09:04 +0100

This Month: Safe medication administrationKey words: safe medication practices, rights of medication administration.Use of surgical masks during cystoscopy and dental proceduresKey words: cystoscopy attire, surgical masks.Determining whether prothrombin should be classified as tissue or medicationKey words: classification of human-derived hemostatic agents, prothrombin.Surgical patient waiting timesKey words: patient satisfaction survey, extended preoperative wait times. (Source: AORN Journal)

Mullerianosis of the Urinary Bladder

International Journal of Surgical Pathology — Mon, 29 Aug 2011 23:00:00 +0100

Müllerianosis of the urinary bladder is a rare condition that encompasses 3 histological entities (endometriosis, endocervicosis, and endosalpingiosis). The authors report 2 patients with bladder müllerianosis, one of whom had endometriosis and the other a history of past pelvic surgery, describe the histological and cystoscopic features, and review the literature on this condition. Mucosal hyperemia and submucosal nodules or cysts with associated fibrosis and distortion of the bladder wall may mimic malignancy on cystoscopy, as may the infiltrative growth pattern sometimes evident histologically. Recognition of this complex diagnostic entity is important to avoid misdiagnosis and inappropriate investigation. There is a clinical association with endometriosis and past pelvic surg...

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Acute kidney injury caused by consumption of melamine-contaminated infant formula in 47 children: a multi-institutional experience in diagnosis, treatment and follow-up.

Urological Research — Mon, 29 Aug 2011 23:00:00 +0100

Authors: Shang P, Chang H, Yue ZJ, Shi W, Zhang H, Tang X, He Q, Wang W Abstract Since the spring of 2008, an epidemic of urinary tract stones was noted among children in China. This is believed to be associated with consumption melamine-contaminated powdered formula. A few patients presented with acute kidney injury (AKI) due to bilateral renal or ureteral calculi requiring surgical intervention to relieve the obstruction. We retrospectively analyzed clinical and laboratory data, ultrasonograms and treatment methods in children with melamine-induced urolithiasis and AKI who were hospitalized at seven hospitals from September to November 2008 in Gansu Province, China. Treatment given included conservative treatment, cystoscopic or urethroscopic lithotripsy, retrograde ureteral cath...

Acute kidney injury caused by consumption of melamine-contaminated infant formula in 47 children: a multi-institutional experience in diagnosis, treatment and follow-up

Urological Research — Mon, 29 Aug 2011 15:57:51 +0100

Abstract Since the spring of 2008, an epidemic of urinary tract stones was noted among children in China. This is believed to be associated with consumption melamine-contaminated powdered formula. A few patients presented with acute kidney injury (AKI) due to bilateral renal or ureteral calculi requiring surgical intervention to relieve the obstruction. We retrospectively analyzed clinical and laboratory data, ultrasonograms and treatment methods in children with melamine-induced urolithiasis and AKI who were hospitalized at seven hospitals from September to November 2008 in Gansu Province, China. Treatment given included conservative treatment, cystoscopic or urethroscopic lithotripsy, retrograde ureteral catheterization, ureterolithotomy and nephrostomy. Patients were mo...

[Comment] Bladder cancer: neoadjuvant is new again

The Lancet Oncology — Sat, 27 Aug 2011 13:06:56 +0100

Bladder cancer is common and one of the most expensive cancers to treat. The high rate of local recurrence after transurethral resection has led to frequent cystoscopies for surveillance and various treatments to prevent tumour recurrence. Although both new tumours (second primaries) and inadequately treated disease contribute to the recurrence of bladder cancer, molecular data suggest that most recurrences relate to failures of definitive treatment. Adjuvant intravesical chemotherapy and immunotherapy—often with mitomycin and BCG, respectively—have been the mainstays of these efforts. (Source: The Lancet Oncology)

Urogynecology Training and Practice Patterns After Residency

Journal of Surgical Education — Thu, 25 Aug 2011 04:00:00 +0100

Conclusions: Recent graduates from this program are comfortable making the diagnosis of prolapse and incontinence. The most commonly performed surgical procedures in residency and in practice include anterior and posterior colporrhaphy and cystoscopy. (Source: Journal of Surgical Education)

[Surgical strategy for ectopic kidneys: analysis of 35 cases.]

Journal of Southern Medical University — Fri, 19 Aug 2011 23:00:00 +0100

CONCLUSION: Appropriate surgical approaches according to the concurrent deformities and complications can achieve good clinical results in patients with ectopic kidneys. PMID: 21868345 [PubMed - as supplied by publisher] (Source: Journal of Southern Medical University)

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Evans blue as a selective dye marker for white‐light diagnosis of non‐muscle‐invasive bladder cancer: an in vitro study

BJU International — Thu, 18 Aug 2011 23:00:00 +0100

CONCLUSION• We believe the present findings could be important for future developments in clinical diagnostics for early bladder cancer detection, staging and grading involving WLC. (Source: BJU International)

Screening for Malignancy After Augmentation Cystoplasty in Children With Spina Bifida: A Decision Analysis

The Journal of Urology — Thu, 18 Aug 2011 04:00:00 +0100

Conclusions: Annual screening for malignancy among patients with spina bifida with cystoplasty using cystoscopy and cytology is unlikely to be cost effective at commonly accepted willingness to pay thresholds. This conclusion is sensitive to a higher than expected risk of malignancy and to highly optimistic estimates of screening effectiveness. (Source: The Journal of Urology)

Decision curve analysis assessing the clinical benefit of NMP22 in the detection of bladder cancer: secondary analysis of a prospective trial

BJU International — Wed, 17 Aug 2011 23:00:00 +0100

CONCLUSIONS• NMP22 is a strong, independent predictor of bladder cancer.• Addition of NMP22 improves the accuracy of standard predictors by a statistically and clinically significant margin.• Decision curve analysis suggests that integration of NMP22 into clinical decision making helps avoid unnecessary cystoscopies, with minimal increased risk of missing a cancer. (Source: BJU International)

Long‐term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: a minimum 10‐year follow‐up

BJU International — Wed, 17 Aug 2011 23:00:00 +0100

CONCLUSIONS• We found that AIC has excellent long‐term outcomes in the definitive management of refractory NDO in patients with SCI.• The complications of AIC appear to be more than counterbalanced by a high level of patient satisfaction with the procedure and by the achievement of the primary aim of ensuring continence and upper tract safety in these patients. (Source: BJU International)

Long‐term outcomes of augmentation ileocystoplasty in patients with spinal cord injury: a minimum of 10 years of follow‐up

BJU International — Wed, 17 Aug 2011 23:00:00 +0100

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Flexible cystoscopy removal of ureteric stent: Is it painful?

British Journal of Medical and Surgical Urology — Wed, 17 Aug 2011 14:18:46 +0100

Introduction: Flexible cystoscopy removal of a ureteric stent (FCRUS) may be associated with pain. We assessed the degree of pain and patient experience during this procedure. (Source: British Journal of Medical and Surgical Urology)

[Photodynamic diagnostics of bladder carcinoma.]

Der Urologe. Ausg. A — Tue, 16 Aug 2011 23:00:00 +0100

Authors: Vom Dorp F, Tschirdewahn S, Olbricht T, Szarvas T, Rübben H Abstract The question whether conventional cystoscopy should always be performed together with fluorescent diagnostic procedures remains to be answered. The current article presents the current literature dealing with this topic. Particularly for relevant carcinoma in situ lesions of the bladder there is no obvious advantage for photodynamic diagnostics compared to conventional cystoscopy with consistent use of urine cytology. PMID: 21845422 [PubMed - as supplied by publisher] (Source: Der Urologe. Ausg. A)

Successful Endoscopic Management of a Chronic Transplant Ureterocutaneous Fistula

Urology — Tue, 16 Aug 2011 04:00:00 +0100

Conclusion: This report demonstrates that this minimally invasive technique is a safe, well-tolerated, and effective technique that may be offered as an outpatient, first-line therapy over open or laparoscopic excision. (Source: Urology)

Treatment of forgotten ureteral stents: how much does it really cost? A cost-effectiveness study in 27 patients

Urological Research — Thu, 11 Aug 2011 06:02:54 +0100

Abstract Aim of study was to present costs of forgotten ureteral stents extraction so as to distract attentions of the urologists on this issue. Medical files of 27 accessible patients who referred to our clinics between 2001 and 2010 because of forgotten ureteral stent were retrospectively analyzed. The indwelling time of double-j stents (DJS) was calculated from the time of its insertion. Costs related to radiological investigations, all invasive, and noninvasive interventions, duration of hospital stay, and medical treatments used were calculated. These estimations were based on 2010 prices determined by Turkey Ministry of Health. Mean age of the patients was 31.2 (8–86 years) years. Mean indwelling time of ureteral DJSs was 36.7 months (14–84 months)....

Ureteral injury after transvaginal ultrasound-guided oocyte retrieval: a complication of in vitro fertilization-embryo transfer that may lurk undetected in women presenting with severe ovarian hyperstimulation syndrome

Fertility and Sterility — Thu, 11 Aug 2011 04:00:00 +0100

Conclusion(s): Although ureteral injury after transvaginal ultrasound-guided oocyte retrieval is a rare complication of IVF-ET, it could have serious sequelae such as fistula formation and renal dysfunction if untreated. Clinicians must be aware that it may lurk undetected in women presenting OHSS. (Source: Fertility and Sterility)

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Treatment of forgotten ureteral stents: how much does it really cost? A cost-effectiveness study in 27 patients.

Urological Research — Wed, 10 Aug 2011 23:00:00 +0100

Authors: Sancaktutar AA, Söylemez H, Bozkurt Y, Penbegül N, Atar M Aim of study was to present costs of forgotten ureteral stents extraction so as to distract attentions of the urologists on this issue. Medical files of 27 accessible patients who referred to our clinics between 2001 and 2010 because of forgotten ureteral stent were retrospectively analyzed. The indwelling time of double-j stents (DJS) was calculated from the time of its insertion. Costs related to radiological investigations, all invasive, and noninvasive interventions, duration of hospital stay, and medical treatments used were calculated. These estimations were based on 2010 prices determined by Turkey Ministry of Health. Mean age of the patients was 31.2 (8-86 years) years. Mean indwelling time of ureteral DJSs w...

Quality of care in patients with bladder cancer

Cancer — Thu, 04 Aug 2011 23:00:00 +0100

CONCLUSION:There was a statistically significant survival advantage found among those who received at least half of the recommended care. Improving compliance with these process‐of‐care measures via systematic quality improvement initiatives serves as the primary target to meliorate bladder cancer care. Cancer 2011;. © 2011 American Cancer Society. (Source: Cancer)

Efficiency of percutaneous nephrolithotomy in pediatric patients using adult-type instruments.

Urological Research — Thu, 04 Aug 2011 23:00:00 +0100

Authors: Dogan B, Atmaca AF, Canda AE, Isgoren AE, Akbulut Z, Balbay MD To evaluate the efficiency of percutaneous nephrolithotomy using adult-type instruments in children with kidney stones. Between September 2004 and October 2009, 18 children (19 renal units) underwent percutaneous nephrolithotomy using adult-type instruments. Following percutaneous access under fluoroscopy, 20-30F tract dilatation was performed (1,92,427F), and lithotripters were used. Postoperatively, kidney-ureter-bladder X-ray and antegrade pyelography were performed to evaluate residual stones and contrast passage to the bladder. 8 boys and 10 girls with a mean age of 9.8 ± 4.56 years were evaluated. Mean stone burden was 338 ± 196.21 mm². Stones were located in the left and right kidneys in 16 (84.2%) ...

Efficiency of percutaneous nephrolithotomy in pediatric patients using adult-type instruments

Urological Research — Thu, 04 Aug 2011 15:31:38 +0100

Abstract To evaluate the efficiency of percutaneous nephrolithotomy using adult-type instruments in children with kidney stones. Between September 2004 and October 2009, 18 children (19 renal units) underwent percutaneous nephrolithotomy using adult-type instruments. Following percutaneous access under fluoroscopy, 20–30F tract dilatation was performed (1,92,427F), and lithotripters were used. Postoperatively, kidney–ureter–bladder X-ray and antegrade pyelography were performed to evaluate residual stones and contrast passage to the bladder. 8 boys and 10 girls with a mean age of 9.8 ± 4.56 years were evaluated. Mean stone burden was 338 ± 196.21 mm². Stones were located in the left and right kidneys in 16 (84.2%) and 3 (16.8%) patient...

Point-of-care clinical documentation: assessment of a bladder cancer informatics tool (eCancerCareBladder): a randomized controlled study of efficacy, efficiency and user friendliness compared with standard electronic medical records.

Journal of the American Medical Informatics Association — Wed, 03 Aug 2011 23:00:00 +0100

Conclusions Use of a specific data management tool does not appear to significantly reduce user time, but the results suggest improvement in the level of care and documentation and preference by users. Also, the use of simulated scenarios in a laboratory setting appears to be a valid method for comparing the usability of clinical software. PMID: 21816957 [PubMed - as supplied by publisher] (Source: Journal of the American Medical Informatics Association)

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Carcinosarcoma of the bladder: case report and review of the literature.

Canadian Urological Association Journal — Sun, 31 Jul 2011 23:00:00 +0100

Authors: Akoluk A, Barazani Y, Slova D, Shah S, Tareen B Primary osteosarcomas of the bladder account for about 0.04% of bladder neoplasms. Most of the patients in the literature expired within 6 months and, in almost all of the cases in the literature, radical cystectomy with postoperative chemotherapy was the treatment choice. A 79-year-old gentleman presented with gross hematuria. Cystoscopy demonstrated a 2- to 3-cm tumour along the lateral wall of the bladder. The tumour was resected incompletely via initial transurethral resection of bladder tumour (TURBT), and a second TURBT was subsequently performed to fully resect the residual mass. Surgical pathology from these 2 resections revealed osteosarcoma with invasion into the muscularis propria. A cystoprostatectomy was performed an...

Surgical management of bladder transitional cell carcinoma in a vesicular diverticulum: case report.

Canadian Urological Association Journal — Sun, 31 Jul 2011 23:00:00 +0100

This report demonstrates that conservative bladder-sparing treatment can be achieved and subsequently followed by vigilant cystoscopy. PMID: 21806896 [PubMed - in process] (Source: Canadian Urological Association Journal)

Early versus delayed repair of vesicouterine fistula.

Canadian Urological Association Journal — Sun, 31 Jul 2011 23:00:00 +0100

We report that early surgical management is technically feasible without significantly increasing the difficulty of the surgery, with an excellent outcome in selected patients. PMID: 21806894 [PubMed - in process] (Source: Canadian Urological Association Journal)

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Journal of Pediatric Surgery — Sun, 31 Jul 2011 23:00:00 +0100

The authors report on their experience with pneumovesicoscopic cross-trigonal reimplantation to correct primary vesico-ureteral reflux (VUR) in children. Fourteen children (10 girls, 4 boys, aged 4-12 years) with persistent VUR grade III and higher (5 bilateral, 19 refluxing ureters) underwent pneumovesicoscopic Cohen's cross-trigonal reimplantation. Under cystoscopic control, a midline 5-mm trocar was first introduced for a 0°/30° telescope at the dome of the bladder, and a left and right 3-mm or 5-mm trocar were inserted through the anterolateral wall. The ureter was freed by creating a sharp plane between the detrusor muscle and the ureteral wall. If necessary, the ureter was tailored outside the bladder. Submucosal tunnel(s) were prepared with the help of scissors and graspers. The ...

Delay in diagnosis of cancer as a patient safety issue - a root cause analysis based on a representative case report.

Patient Safety in Surgery — Thu, 28 Jul 2011 23:00:00 +0100

CONCLUSION: We learn from this case that doctors should be aware of the limitations of negative flexible cystoscopy and single biopsy, cytology of urine, ultrasound examination of urinary bladder, and computed tomography of pelvis for diagnosis of bladder cancer in spinal cord injury patients. Random bladder biopsies must be considered under general anaesthesia when there is high suspicion of bladder cancer. Spinal cord injury patients with lesions above T-6 may develop autonomic dysreflexia; therefore, one should be extremely well prepared to prevent or manage autonomic dysreflexia when performing cystoscopy and bladder biopsy. Spinal cord injury patients, who pass blood in urine, should be accorded top priority in scheduling of investigations and surgical procedures. PMID: 21801398 [...

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Re: Intraurethral Instillation of Ketamine for Male Rigid Cystoscopy; (From: Moharai RS, Najafi A, Khajavi MR, et al. J Endourol 2010; 24:2033–2036.)

Journal of Endourology — Thu, 28 Jul 2011 16:25:40 +0100

Journal of Endourology , Vol. 0, No. 0. (Source: Journal of Endourology)

Narrow-band imaging flexible cystoscopy in the detection of primary non-muscle invasive bladder cancer: a “second look” matters?

International Urology and Nephrology — Tue, 26 Jul 2011 15:58:10 +0100

Conclusions The “second look” did not compromise the superiority of NBI over standard WLI flexible cystoscopy for detecting primary NMIBC including CIS lesions. Content Type Journal ArticlePages 1-7DOI 10.1007/s11255-011-0036-5Authors Yi-Jun Shen, Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 ChinaYi-Ping Zhu, Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 ChinaDing-Wei Ye, Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 ChinaXu-Dong Yao, Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 ChinaShi-Lin Zhang, Department of Urology, Fudan University Shanghai Cancer...

Benign Prostatic Hyperplasia Evaluation and Management by Urologists and Primary Care Physicians: Practice Patterns From the Observational BPH Registry

The Journal of Urology — Sun, 24 Jul 2011 23:00:00 +0100

Conclusions: Significant differences in practice patterns were observed between primary care physicians and urologists in the evaluation of and management for lower urinary tract symptoms/benign prostatic hyperplasia. These data establish valuable benchmarks and identify possible interventions that may improve the standard of care. (Source: The Journal of Urology)

The sensitivity of fluorescent‐light cystoscopy for the detection of carcinoma in situ (CIS) of the bladder: a meta‐analysis with comments on gold standard

BJU International — Thu, 21 Jul 2011 21:21:18 +0100

What's known on the subject? and What does the study add?Fluorescent‐light cystoscopy has a high sensitivity, relative to that of white light cystoscopy, for carcinoma in situ of the bladder. However, this systematic review reveals that the absolute sensitivity is unknown due to the absence of proper gold standard which is microscopic examination of whole bladders.• A literature search was conducted to identify peer‐reviewed study reports on the sensitivity of fluorescent‐light cystoscopy (FLC) for the detection of carcinoma in situ (CIS) of the bladder.• Data from 16 original studies comprising 1503 patients were pooled.• The claimed sensitivity of FLC for detecting patients with CIS using the most commonly reported intravesical agents 5‐aminolevulinic acid or hexamino...

Ten-year follow-up after the tension-free vaginal tape procedure

American Journal of Obstetrics and Gynecology — Mon, 18 Jul 2011 04:00:00 +0100

Conclusion: These data indicate satisfactory objective and subjective cure rates 10 years after tension-free vaginal tape procedure placement. (Source: American Journal of Obstetrics and Gynecology)

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Minimally Invasive Methods for Bulbar Urethral Strictures: A Survey of Members of the American Urological Association

Urology — Thu, 14 Jul 2011 23:00:00 +0100

Conclusion: Our survey provides information regarding current minimally invasive management and follow-up practice strategies recommended by members of the AUA for anterior urethral strictures. Many common practices in the treatment of anterior urethral stricture disease are not supported in the literature. (Source: Urology)

Seeing Is Believing: A Randomized Controlled Study from China of Real-Time Visualization of Flexible Cystoscopy to Improve Male Patient Comfort

Journal of Endourology — Mon, 11 Jul 2011 17:08:58 +0100

Journal of Endourology , Vol. 0, No. 0. (Source: Journal of Endourology)

Nearly all patients with high-grade bladder cancer don't get recommended care

UCLA Newsroom: Health Sciences — Mon, 11 Jul 2011 04:01:00 +0100

This study suggests quite the contrary, that we don't do enough for patients with bladder cancer. If this was a report card on bladder cancer care in America, I'd say we're earning a failing grade." The study appears July 11 in the early online edition of the peer-reviewed journal Cancer, a publication of the American Cancer Society. The study also investigated the cause of such poor compliance. What researchers found was that non-compliance knew no boundaries and that patient-level factors such as age, race, ethnicity or socioeconomic status had very little impact. Instead, non-compliance with guideline-recommended care was primarily attributed to urologist...

Compliance with guidelines for patients with bladder cancer

Cancer — Sun, 10 Jul 2011 23:00:00 +0100

CONCLUSIONS:There is marked underuse of guideline‐recommended care in this potentially curable cohort. Unexplained provider‐level factors significantly contribute to this low compliance rate. Future studies that identify barriers and modulators of provider‐level adoption of guidelines are critical to improving care for patients with bladder cancer. Cancer 2011;. © 2011 American Cancer Society. (Source: Cancer)

Seeing Is Believing: A Randomized Controlled Study from China of Real-Time Visualization of Flexible Cystoscopy to Improve Male Patient Comfort.

Pain Physician — Sun, 10 Jul 2011 23:00:00 +0100

Conclusion: Real-time visualization of flexible cystoscopy with simultaneous explanation improves male patients' comfort. PMID: 21745113 [PubMed - as supplied by publisher] (Source: Pain Physician)

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Natural orifice (NOTES) transurethral sutureless radical prostatectomy with thulium laser support: first patient report

World Journal of Urology — Fri, 08 Jul 2011 06:34:35 +0100

Conclusion The presented descriptive report demonstrates that natural orifice transurethral radical thulium laser prostatectomy for prostate cancer is feasible and safe. Potential candidates include older patients with low-risk cancers and urinary obstruction. Further prospective reports are necessary to evaluate functional and oncological outcome for this innovative technique. Content Type Journal ArticlePages 1-7DOI 10.1007/s00345-011-0714-zAuthors Udo Nagele, Department of Urology and Andrology, LKH Hall i.Tirol, Landeskrankenhaus Hall i.T., Milser Str. 10, 6060 Hall i.Triol, AustriaAristotelis G. Anastasiadis, Eilenriede Clinic Hannover, Hannover, GermanyUte Walcher, Department of Urology and Andrology, LKH Hall i.Tirol, Landeskrankenhaus Hall i.T., Milser Str. ...

Suprapubic transvesical single-port technique for control of lower end of ureter during laparoscopic nephroureterectomy for upper tract transitional cell carcinoma

Indian Journal of Urology — Thu, 07 Jul 2011 23:00:00 +0100

Conclusions : The described technique for management of lower end of ureter during laparoscopic nephroureterectomy adheres to strict oncologic principles while providing the benefit of a minimally invasive approach. (Source: Indian Journal of Urology)

Emerging optical techniques in advanced cystoscopy for bladder cancer diagnosis: A review of the current literature

Indian Journal of Urology — Thu, 07 Jul 2011 23:00:00 +0100

Conclusions : Photodynamic diagnosis is the technique with most evidence of clinical effectiveness to date, but low specificity is limiting a widespread use. For the novelties, narrow-band imaging, and optical coherence tomography, more evidence is needed before these techniques can be implemented in daily urological practice. (Source: Indian Journal of Urology)

Bilateral ureteropelvic disruption following blunt abdominal trauma: Case report

BMC Urology - Latest articles — Wed, 06 Jul 2011 23:00:00 +0100

Conclusion: Diagnosis of ureteral injury was delayed, although delayed phase contrast-enhanced CT and abdominal x-rays performed after CT revealed the diagnosis early. Prompt detection and early repair prevented permanent renal damage and the necessity for nephrectomy. (Source: BMC Urology - Latest articles)

Leukoplakia of the bladder: a case report and literature review

International Urogynecology Journal — Wed, 06 Jul 2011 06:35:50 +0100

Abstract An 81-year-old woman presented with symptoms of recurrent urinary tract infections, urge incontinence and nocturia. Cystoscopy performed revealed a whitish plaque lesion on the fundus and right lateral wall of the bladder. The histology of the biopsy confirmed the diagnosis of leukoplakia vesicae of the bladder. The plan is to follow her up with repeat cystoscopy and biopsy in 6 months. The literature search revealed very little information on the pathogenesis and prognosis of this condition due to its rare occurrence. Analysis of the literature signifies the association of chronic irritation due to recurrent urinary tract infections being the commonest cause of leukoplakia vesicae. The recommended long-term follow-up and surveillance based on the literature ...

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Narrow band imaging cystoscopy

Urologic Oncology: Seminars and Original Investigations — Thu, 30 Jun 2011 23:00:00 +0100

Modern cystoscopy began with Nitze's invention of the cystoscope in 1877 , and evolved from wire filaments and incandescent bulbs to fiberoptics, rod lens systems, and digital chip cameras. Each technical innovation aimed to bring brighter white-light illumination within the bladder, permitting better recognition of a multitude of maladies, including tumors. Detection of bladder neoplasms is critical to their diagnosis, staging, and successful treatment. Conventional white-light cystoscopy fails to detect bladder tumors in 6% to 41% of cases, however, especially subtle papillary or flat lesions that blend in with the surrounding normal-appearing urothelium . This has helped to fuel the development of a new generation of optical methods designed to enhance white-light visualization . One of...

A multicolor fluorescence in situ hybridization assay: A monitoring tool in the surveillance of patients with a history of non–muscle‐invasive urothelial cell carcinoma

Cancer Cytopathology — Tue, 28 Jun 2011 23:00:00 +0100

CONCLUSIONS:Given the lack of statistically significant differences with regard to FISH and cystoscopy results, the authors propose that FISH could be a useful monitoring tool in the surveillance of patients with a previous history of NMIUCC. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society. (Source: Cancer Cytopathology)

Re: Tanriverdi et al.: Emergent Stenting After Uncomplicated Ureteroscopy: Evaluation of 23 Patients (Urology 2011;77:305-308)

Urology — Tue, 28 Jun 2011 15:54:10 +0100

Several articles have claimed that routine stenting is not necessary after “uncomplicated” ureteroscopy. This recent article demonstrates that about 8% of patients after “uncomplicated” ureteroscopy required stent insertion for severe renal colic. The decision to leave in a stent after ureteroscopy should be determined by the operating urologist and factors cited in this article. The authors state that “placement of a stent results in additional costs and possible disruption of the patient's life because secondary cystoscopy is required to removed the stent.” We are not sure if the authors have access to stents that come with a pull-string? But every stent we use comes with a pull-string which is then common practice to leave dangling outside the urethra for easy stent extracti...

Reply by the Authors

Urology — Tue, 28 Jun 2011 15:54:10 +0100

We appreciate the authors sharing their own experience with regard to intraurethral anesthesia. They mention the difficulty of anesthetizing the female urethra owing to leakage of the lidocaine jelly from the urethral meatus. Placing a cotton swab just inside the urethral meatus allows occlusion of the opening and a longer dwell time for the anesthetic jelly. This also allows a greater amount of lubricating agent for when the scope is passed into the urethra. We agree that the use of a flexible cystoscope is preferred for patient comfort, allowing adequate inspection of the bladder, with less manipulation of the urethra. We generally use a 16-gauge flexible cystoscope for office-based procedures, along with instillation of 2% lidocaine jelly with a 5-10-minute dwell time. (Source: Urology)

Treatment changes and long‐term recurrence rates after hexaminolevulinate (HAL) fluorescence cystoscopy: does it really make a difference in patients with non‐muscle‐invasive bladder cancer (NMIBC)?

BJU International — Mon, 27 Jun 2011 23:00:00 +0100

CONCLUSIONS• HAL‐BLC was better than WLC for detecting NMIBC cases and improved tumour detection rates.• HAL‐BLC significantly modified the postoperative treatment of cases.• The 3 months, 1 and 2 years recurrence rates were significantly improved in the HAL‐BLC arm. (Source: BJU International)

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Urinary tract infection

Medicine — Sun, 26 Jun 2011 15:14:32 +0100

Abstract: Urinary tract infection is one of the commonest infections to affect humans. Uncomplicated infections occur most commonly in otherwise healthy women when uropathogenic bacteria, usually Escherichia coli, ascend from the perineum into the bladder and overcome host innate immunity. Complicated infections occur in patients with an anatomical or functional abnormality of the urinary tract. The diagnosis is made on the basis of symptoms and diagnostic precision is improved by urinalysis. Urine culture is important with severe, recurrent or complicated infection and when the diagnosis is unclear, for example, in children and the elderly. Most women with symptoms that resolve quickly do not require further investigation but in children, men and patients with recurrent or severe infectio...

Quiz Page July 2011: Abdominal Pain, a Palpable Mass, and Anemia in a Woman Treated With Long-term Dialysis

American Journal of Kidney Diseases — Tue, 21 Jun 2011 15:03:27 +0100

A 62-year-old woman with a 14-year history of end-stage renal disease due to focal segmental glomerulosclerosis on maintenance hemodialysis therapy presented with acute onset of severe left-lower-quadrant abdominal pain before a dialysis session. The dull, constant, nonradiating pain was not associated with nausea, vomiting, or aggravating or relieving factors. She reported no recent trauma or consumption of herbal remedies. Medical history included ischemic heart disease and a high-grade stage pTa urothelial cell carcinoma in the bladder treated using transurethral resection 10 years earlier. Annual follow-up cystoscopy showed no recurrence. Regular medications included aspirin, isosorbide-5-mononitrate, and clonazepam. Heparin was used only during hemodialysis. (Source: American Journal ...

Optimization of Nonmuscle Invasive Bladder Cancer Recurrence Detection Using a Urine Based FGFR3 Mutation Assay

The Journal of Urology — Thu, 16 Jun 2011 23:00:00 +0100

Conclusions: The sensitivity of tumor detection increased with tumor size. FGFR3 assay sensitivity depends on the number of shed tumor cells and improves by increasing urine volume. These findings suggest that there is an upper limit to the sensitivity of the FGFR3 assay when 1 urine sample is analyzed. This may also apply to other DNA or RNA based assays. (Source: The Journal of Urology)

Dosimetric evaluation of a novel high dose rate (HDR) intraluminal / interstitial brachytherapy applicator for gastrointestinal and bladder cancers.

Journal of Applied Clinical Medical Physics — Tue, 07 Jun 2011 13:15:03 +0100

This study presents some dosimetric evaluations to introduce this applicator to the clinical use. The radiation attenuation characteristics of the applicator were evaluated by means of two dosimetric methods including well-type chamber and radiochromic film. The proposed 110 cm long applicator has a flexible structure made of stainless steel for easy passage through lumens and a needle tip to drill into big tumors. The 2mm diameter of the applicator is thick enough for source transition, while easy passage through any narrow lumen such as endoscope or cystoscope working channel is ensured. Well-chamber results showed an acceptably low attenuation of this steel springy applicator. Performing absolute dosimetry resulted in a correlation coefficient of R = 0.9916 (p-value ≈ 10-7) between st...

Modified UroVysion scoring criteria increase the urothelial carcinoma detection rate in cases of equivocal urinary cytology

Histopathology — Tue, 31 May 2011 23:00:00 +0100

Conclusions: Our data suggest that the sensitivity of the UroVysion test can be increased by the addition of a cytological pre‐screening technique prior to the UroVysion test and a modification of the UroVysion evaluation criteria. (Source: Histopathology)

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Mullerianosis involving the urinary bladder

International Urogynecology Journal — Fri, 27 May 2011 06:00:04 +0100

We report a case of mullerianosis involving the urinary bladder. A 45-year-old woman presented with complaints of chronic pelvic pain, dysmenorrhoea, irritative lower urinary tract symptoms and cyclical haematuria. Cystoscopy and transurethral biopsy suggested mullerianosis involving the posterior bladder wall; she subsequently had surgery including partial cystectomy with complete excision of the lesion. Histology reported presence of endometrial, endocervical and endosalpingeal tissues within the bladder mass confirming mullerianosis. She made satisfactory postoperative recovery. Awareness of this lesion is necessary for proper diagnosis and appropriate treatment. Content Type Journal ArticlePages 1-3DOI 10.1007/s00192-011-1455-7Authors Kenneth Ogah, Royal Victoria Infirmary,...

Clinically unconfirmed positive urinary cytology: diagnostic implications and oncological outcomes

BJU International — Wed, 25 May 2011 23:00:00 +0100

CONCLUSIONS• Unconfirmed positive urine cytology often predates the development of high‐grade urothelial carcinoma.• The bladder is most commonly involved.• The time to diagnosis is generally protracted, although the long0term outcome appears to be favourable. (Source: BJU International)

Hexaminolevulinate photodynamic diagnosis in non-muscle invasive bladder cancer: experience of the BLUE group.

Actas Urologicas Espanolas — Wed, 25 May 2011 23:00:00 +0100

CONCLUSIONS: Hexaminolevulinate fluorescence cystoscopy improves detection and resection of non-muscle invasive bladder cancer, especially of CIS. Sensitivity of PDD is higher than WL, but specificity is lower. In our study, random biopsies were able to detect some CIS not visible under PDD. PMID: 21621301 [PubMed - as supplied by publisher] (Source: Actas Urologicas Espanolas)

Urologist Compliance With AUA Best Practice Guidelines for Benign Prostatic Hyperplasia in Medicare Population

Urology — Sun, 22 May 2011 23:00:00 +0100

Conclusions: Despite the American Urological Association guidelines for BPH care, wide variations in the evaluation and treatment were seen. Improving guideline adherence and reducing variation could improve BPH care quality. (Source: Urology)

Dynamic Real-time Microscopy of the Urinary Tract Using Confocal Laser Endomicroscopy

Urology — Sun, 22 May 2011 23:00:00 +0100

Conclusions: In contrast to standard pathologic analysis of fixed tissue with hematoxylin and eosin, pCLE provides real time microscopy of the urinary tract to enable dynamic interrogation of benign and neoplastic tissues in vivo. The diagnostic criteria developed in this study will facilitate adaptation of pCLE for use in conjunction with WLC to expedite diagnosis of urinary tract pathology, particularly bladder cancer. (Source: Urology)

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Ureteric intestinal metaplasia in association with chronic recreational ketamine abuse

Journal of Clinical Pathology — Thu, 19 May 2011 23:00:00 +0100

Background Ketamine is a phencyclidine derivative which acts as a non-competitive N-methyl-D-aspartate receptor agonist. It is used in veterinary and human anaesthesia. Ketamine's hallucinogenic and dissociative properties have lead to its exploitation as a recreational drug. This trend culminated in the identification of the phenomenon of ketamine cystitis in 2007.1 In this condition, the patient with a history of ketamine use may report frequency, dysuria, haematuria and incontinence, with cystoscopy showing an erythematous contracted bladder. Histologically there is mucosal ulceration, striking urothelial reactive atypia and lamina propria inflammation, often with eosinophils. In addition squamous metaplasia, nephrogenic metaplasia and calcification have been described.2 Although previo...

Massive hematuria with hemodynamic instability—complication of oocyte retrieval

Fertility and Sterility — Wed, 18 May 2011 23:00:00 +0100

Conclusion(s): Pseudoaneurysm after oocyte retrieval has not been reported before. It resulted in massive hematuria causing hemodynamic instability. Immediate resuscitation and cystoscopy should be performed on all patients who present with persistent hematuria after oocyte retrieval. Injury to surrounding structures should always be kept in mind during oocyte retrieval. (Source: Fertility and Sterility)

Penoscrotal Extramammary Paget's Disease: The University of Texas M. D. Anderson Cancer Center Contemporary Experience

The Journal of Urology — Sun, 15 May 2011 23:00:00 +0100

Conclusions: Surgical resection to achieve tumor-free margins resulted in durable relapse-free survival of patients with intra-epidermal extramammary Paget's disease alone. Extramammary Paget's disease with invasion was associated with regional metastatic progression. The latter scenario as well as failure to treat localized extramammary Paget's disease alone was associated with a fatal outcome. Systemic chemotherapy should be further explored in patients with invasive adenocarcinoma or lymph node positive disease. (Source: The Journal of Urology)

Diagnosis and Management of Urothelial Carcinoma of the Bladder

Postgraduate Medicine Online — Sun, 15 May 2011 04:00:00 +0100

Maria F. Tanaka, MD and Guru Sonpavde, MD DOI: 10.3810/pgm.2011.05.2283 Abstract: Bladder carcinoma is the fourth most common cancer in men and the ninth most common cancer in women in the United States. In 2010, approximately 70 000 new cases of bladder carcinoma (52 000 in men and 18000 in women) and approximately 14000 deaths were expected in the United States. More than 90% of bladder carcinomas are classified as urothelial carcinoma (UC), which arise from the urothelium. This epithelium, also known as transitional cell epithelium, lines the urinary tract, which extends from the renal pelvis through the ureters, bladder, and urethra. Urothelial carcinoma of the bladder may present as a non–muscle-invasive, muscle-invasive, or metastatic malignancy. In noninvasive ...

Interstitial cystitis/painful bladder syndrome.

American Family Physician — Sat, 14 May 2011 23:00:00 +0100

Authors: French LM, Bhambore N Interstitial cystitis/painful bladder syndrome affects more than 1 million persons in the United States, but the cause remains unknown. Most patients with interstitial cystitis/painful bladder syndrome are women with symptoms of suprapubic pelvic and/or genital area pain, dyspareunia, urinary urgency and frequency, and nocturia. It is important to exclude other conditions such as infections. Tests and tools commonly used to diagnose interstitial cystitis/painful bladder syndrome include specific questionnaires developed to assess the condition, the potassium sensitivity test, the anesthetic bladder challenge, and cystoscopy with hydrodistension. Treatment options include oral medications, intravesical instillations, and dietary changes and supplements. Or...

Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy.

Urological Research — Sat, 14 May 2011 23:00:00 +0100

Authors: Song T, Liao B, Zheng S, Wei Q The aim of this study was to evaluate the necessity for stenting after ureteroscopic lithotripsy. We performed a systematic research of Medline, Embase, Cochrane central registration for RCTs concerning the comparison between stented and non-stented post-ureteroscopic procedures for stone removal and reference lists of the included study were also screened. 15 trials were included and data related was extracted and analyzed in meta way. No difference was detected in stone free rate and stricture formation between the two groups (P = 0.69; P = 0.67). Participants with stents had higher risk of being infected than those without, RR = 1.72, but with no difference. Stent related lower urinary symptoms were more frequently experienced by stented...

Meta-analysis of postoperatively stenting or not in patients underwent ureteroscopic lithotripsy

Urological Research — Sat, 14 May 2011 15:54:39 +0100

Abstract The aim of this study was to evaluate the necessity for stenting after ureteroscopic lithotripsy. We performed a systematic research of Medline, Embase, Cochrane central registration for RCTs concerning the comparison between stented and non-stented post-ureteroscopic procedures for stone removal and reference lists of the included study were also screened. 15 trials were included and data related was extracted and analyzed in meta way. No difference was detected in stone free rate and stricture formation between the two groups (P = 0.69; P = 0.67). Participants with stents had higher risk of being infected than those without, RR = 1.72, but with no difference. Stent related lower urinary symptoms were more frequently experienced by st...

The safety and efficacy of botulinum toxin‐A in the management of bladder oversensitivity: a randomised double‐blind placebo‐controlled trial

International Journal of Clinical Practice — Fri, 13 May 2011 18:43:09 +0100

Conclusions: This is the first randomised, double blind, placebo‐controlled trial examining the effects of botn‐A exclusively in patients with BO. A significant increase in MCC was observed but this did not translate to clinical benefit with no change observed in the symptoms and quality of life for the majority of patients. (Source: International Journal of Clinical Practice)

Vision-Sciences' EndoSheath Cystoscopy Technology to be Introduced by Stryker at Largest Urology Conference in North America

Medical News (via PRIMEZONE) — Fri, 13 May 2011 13:17:00 +0100

ORANGEBURG, N.Y., May 13, 2011 (GLOBE NEWSWIRE) -- Vision-Sciences, Inc. (Nasdaq:VSCI) announced today the introduction by Stryker Corporation ("Stryker") of the new line of EndoSheath Cystoscopy products at the 106th Annual American Urological Association (AUA) Meeting in Washington D.C. beginning Saturday, May14, 2011. Over 10,000 participants attend this annual meeting, the largest urological medical conference in North America. (Source: Medical News (via PRIMEZONE))

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Photocure - Hexvix(R)/Cysview™ Demonstrates Long Term Benefit: Results From 5.5 Year Follow Up Of Recurrence Of Bladder Cancer

Health News from Medical News Today — Thu, 12 May 2011 09:00:00 +0100

Photocure (OSE: PHO), a Norwegian pharmaceutical company specialising in cancer and dermatology, announces the results from a 5.5 year follow up of recurrence in patients with Non Muscle Invasive Bladder Cancer( NMIBC) showing a long term benefit of the use of Hexvix compared to patients who received white light cystoscopy alone. After a follow-up up period up to 5.5 years, the number of patients who have experienced recurrence of their bladder cancer is lower, and the time it takes before the recurrence occurs is longer when they had Hexvix-guided fluorescence cystoscopy... (Source: Health News from Medical News Today)

The AdVance® Male Sling: Patient Selection and Workup

European Urology Supplements — Tue, 10 May 2011 23:00:00 +0100

Abstract: The AdVance® male sling (American Medical Systems, Minnetonka, MN, USA) is a retrourethral transobturator sling that offers an effective surgical approach for the treatment of postprostatectomy stress urinary incontinence (SUI). Clinical studies have demonstrated success rates of 80–90% at 1-yr follow-up. The most appropriate candidate patients for the AdVance® sling may be those with mild to moderate incontinence, but success rates may not be markedly lower in patients with severe incontinence. Clinical experience with the AdVance® sling suggests that cystoscopically confirmed residual sphincter function is an important requirement for good outcome. Assessment of SUI should be modified to include a consideration of sphincter function in addition to the currently accepted de...

Phase II study of biweekly gemcitabine as first line therapy in CIS of the bladder: What does an aborted trial tell us?

Urologic Oncology — Thu, 05 May 2011 23:00:00 +0100

CONCLUSION: Biweekly gemcitabine as first line treatment for CIS led to excess toxicity and suboptimal activity. Due to the peculiar statistical design, a negative response was generated enrolling a low number of patients. The absolute 4-year CSS suggests that no window of opportunity for disease cure may have been lost by assessing a new, non standard, treatment for CIS. PMID: 21550828 [PubMed - as supplied by publisher] (Source: Urologic Oncology)

A Case of Giant Bladder Carcinosarcoma without Submucosal Invasion

Advances in Pharmacological Sciences — Thu, 05 May 2011 16:19:26 +0100

Carcinosarcoma is a rare biphasic neoplasia containing both malignant mesenchymal and epithelial elements. Bladder carcinosarcoma commonly presented as high-grade, advanced stage, and aggressive behavior with a poor prognosis. An 83-year-old male presented with painless gross hematuria to our hospital. Cystoscopy revealed massive nonpapillary bladder tumor on the right wall. The 91 g tumor could be completely removed with transurethral resection. Histology of the tumor was diagnosed as carcinosarcoma with no submucosal invasion composed of biphasic malignant epithelial and mesenchymal cells. Epithelial malignancy was urothelial cancer and mesenchymal one was chondrosarcoma and leiomyosarcoma. The specimens taken at the second-look TUR-Bt revealed that carcinoma in situ (urothelial c...

Vesicovaginal fistula following large‐loop excision of the transformation zone in a chronic systemic glucocorticoid user

Journal of Obstetrics and Gynaecology Research — Mon, 02 May 2011 23:00:00 +0100

AbstractA 42‐year‐old woman with a history of a large‐loop excision of transformation zone for cervical intraepithelial neoplasia III four years previously visited our outpatient department for cervical intraepithelial neoplasia I that newly detected by colposcopy‐directed punch biopsy. Her other medical conditions include systemic lupus erythematosus on daily prednisolone 15 mg during 19 years. After second large‐loop excision of transformation zone, delayed vesicovaginal fistula was confirmed by indigo carmine leakage test, computed tomography scan, and cystoscopy. Fistula was primarily repaired with indwelling double‐J catheters with anchoring omentum on suture site. (Source: Journal of Obstetrics and Gynaecology Research)

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A smoking cessation program as a resource for bladder cancer patients.

Canadian Urological Association Journal — Sat, 30 Apr 2011 23:00:00 +0100

CONCLUSION: Based on the data from our centre, patients with CaB who continue to smoke after their diagnosis warrant a smoking cessation program as a resource for improving prognosis and long-term health. Further research should focus on establishing an efficacious and cost-effective program that provides these patients with the resources they need to quit smoking. PMID: 21539769 [PubMed - as supplied by publisher] (Source: Canadian Urological Association Journal)

Safety and feasibility of the prostatic urethral lift: a novel, minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH)

BJU International — Sat, 30 Apr 2011 23:00:00 +0100

CONCLUSIONS• We demonstrated in this initial experience that the PUL procedure is safe and feasible.• The safety profile of the PUL procedure appears favourable; most patients reported sustained symptom relief to 12 months with minimal morbidity• PUL therefore warrants further study as a new option for the many patients who seek an alternative to current therapies. (Source: BJU International)

Anesthesia for a child with Golz syndrome

Journal of Clinical Anesthesia — Sat, 30 Apr 2011 23:00:00 +0100

We recently were requested to anesthetize a two year old girl with Golz syndrome. She presented to us for a cystoscopy and vaginoscopy secondary to a covered bladder extropy. Golz syndrome is a rare, X-linked genetic disorder that has been implicated in mutations on the PORCN gene locus Xp-11.2.3. This syndrome is also referred to as focal dermal hypoplasia, which is one of the main characteristics of the syndrome. The skin lesions are characterized as linear, reticulated, and symmetrical tender red or pink macules that follow the lines of Blaschko. These lesions may have ulcerations secondary to lack of the dermis and telangiectasias. Other features commonly seen are nail atrophy with nail spooning and grooves, asymmetry of the face, with a pointed chin, and low set asymmetry of the ears...

Prospective clinical studies at the efficacy of brucea javanica oil, mitomycin and BCG for preventing postoperative relapse of superficial bladder cancer through perfusion

The Chinese-German Journal of Clinical Oncology — Tue, 19 Apr 2011 07:02:56 +0100

Conclusion Perfusion of 10% brucea javanica oil after operation is safer and more effective in preventing superficial bladder tumour relapse and worth for popularizing. Content Type Journal ArticlePages 228-231DOI 10.1007/s10330-011-0774-yAuthors Fuli Wang, Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 ChinaWeijun Qin, Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 ChinaGeng Zhang, Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 ChinaYuntao Zhang, Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, 710032 ChinaHeliang Liu, Department of Urology, Xijing Hospital, The Fourth Military Medi...