Outcomes and Cost Evaluation Related to a Single-Use, Disposable Ureteric Stent Removal System: a Systematic Review of the Literature

PURPOSE OF REVIEW

To present the latest evidence related to the outcomes and cost of single-use, disposable ureteric stent removal system (Isiris).

RECENT FINDINGS

Our review suggests that compared to a reusable flexible cystoscope (re-FC), a disposable flexible cystoscope (d-FC) with built-in grasper (Isiris) significantly reduced procedural time and provided a cost benefit when the latter was used in a ward or outpatient clinic-based setting. The use of d-FC also allowed endoscopy slots to be used for other urgent diagnostic procedures. Disposable FCs are effective and safe for ureteric stent removal. They offer greater flexibility and, in most cases, have been demonstrated to be cost-effective compared to re-FCs. They are at their most useful in remote, low-volume centres, in less well-developed countries and in centres where large demand is placed on endoscopy resources.

Comparison of the diagnostic yield of routine versus indicated flowmetry, ultrasound and cystoscopy in women with recurrent urinary tract infections

Introduction and hypothesis

To quantify and compare the outcomes of routine vs. urologist-requested diagnostic testing for recurrent urinary tract infections (rUTI).

Methods

A retrospective cohort study of patients with rUTI referred to a large non-academic teaching hospital between 2016 and 2018 (Hospital A) and a university hospital between 2014 and 2016 (Hospital B). Electronic medical records were reviewed for baseline and diagnostic data. Women underwent the following assessments routinely: urinalysis, voiding diary, flowmetry in Hospital A and urinalysis, voiding diary, flowmetry, ultrasound, abdominal x-ray and cystoscopy in Hospital B. All other diagnostics were performed by indication in each hospital.

Results

We included 295 women from Hospital A and 298 from Hospital B, among whom the mean age (57.6 years) and mean UTI frequency (5.6/year) were comparable, though more were postmenopausal in Hospital A. We identified abnormalities by flowmetry or post-void residual volumes in 134 patients (Hospital A: 79; Hospital B: 55), cystoscopy in 14 patients (Hospital A: 6; Hospital B: 8) and ultrasound in 42 patients (Hospital A: 16; Hospital B: 26), but these differences were not significant. Diagnostics altered treatment in 117 patients (e.g., pelvic floor muscle training, referral to another specialist, surgical intervention), mostly due to flowmetry and post-void residual volume measurement. The retrospective design and absence of follow-up data limit these results.

Conclusions

The routine use of cystoscopy and ultrasound in female patients with rUTIs should not be recommended as they yield few abnormalities and lead to additional costs.

Cystoscopy-assisted laparoscopic partial cystectomy for muscle-invasive bladder cancer: Initial experience in Cipto Mangunkusumo Hospital, Jakarta

INTRODUCTION

We report the experience with patients of urachal adenocarcinoma of the bladder, a rare malignancy in the urinary bladder, treated with laparoscopic partial cystectomy.

AIM

Solitary transitional cell carcinoma (TCC) of the dome/anterior wall of the bladder in some cases. As compared to radical surgery, partial cystectomy has a lower morbidity rate and similar oncological outcomes. We present our experience with laparoscopic partial cystectomy (LPC) in patients with urachal adenocarcinoma.

CASE PRESENTATION

Until being admitted to the hospital, a 60-year-old woman had been suffering from painless, sporadic gross hematuria for the previous year. Her physical examination was undistinguished. Computed tomography revealed an enhancing firmly bordered mass on the anterior-superior aspect of the bladder wall. The patient then underwent cystoscopy and laparoscopic partial cystectomy simultaneously.

CONCLUSION

Based on our first experience in LPC, we suggest that cystoscopy assisted LPC is a reasonable and safe procedure with fewer complications and does not extend the operating time. The procedure's effectiveness hinges on the patient's selection. However, many cases needed to emphasize the effectiveness and safety of LPC.

[Cystoscopy in the assessment of patients with bladder pain syndrome: Results of a national multicenter observational study.]

OBJECTIVES

To study the use and results of cystoscopy and bladder hydrodistension in the objective assessment of patients with Bladder Pain Syndrome (BPS), in routine clinical practice.

MATERIAL AND METHODS

Observational, non-interventional, national, multicenter study carried out in Functional Urology and Urodynamic Units of Spain belonging to the IFU Group. 273 women with BPS who underwent cystoscopy at baseline as a diagnostic tool according to clinical criteria and following the routine clinical practice of each center, were studied. The pre and post hydrodistension findings and the scores of the symptom and Health-Related Quality of Life (HRQoL) questionnaires were described: BPIC-SS, PPBC, PGI-S and EQ-5D-5L.

RESULTS

The mean age (SD) was 59 (14) years with a high presence of bladder symptoms: increased voiding frequency (81.7%), nocturia (74%) and urgency (60.4%). 40.7% of cystoscopies were performed under anesthesia and 73.7% uses a standard rigid cystoscope. Hunner lesions were observed in 9.9% of the patients, hypervascularizations (46.2%), glomerulations (23.4%), mild bleeding (6.6%) and scars (2.2%). After hydrodistension, a greater number of grade 1 and 2 lesions were observed. In 51.6% of the patients there were no changes, but in 27.5% slight changes were observed and in 11.4% moderate or severe changes. Symptom and HRQoL questionnaire scores showed no association with cystoscopy findings before and after hydrodistension.

CONCLUSIONS

The value of the cystoscopic findings in the SDV has yet to be defined, although it plays a fundamental role in the differential diagnosis. In this observational study, we did not find a correlation of the cystoscopic findings with the symptoms of the patients, measured by validated questionnaires, nor with the HRQoL.

Current Understanding and Future Perspectives of Interstitial Cystitis/Bladder Pain Syndrome

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic disease characterized by suprapubic pain and lower urinary tract symptoms. Perhaps because of the heterogeneous nature of this disease and its multifactorial etiology, clinical trials in allinclusive populations of IC/BPS patients without phenotyping in the last decade have mainly failed to discover new therapeutic modalities of IC/BPS. Thus, phenotyping IC/BPS, aimed at identifying bladder-centric and/or bladder-beyond pathologies, including cystoscopic observation of Hunner or non-Hunner lesions of the bladder mucosa, is particularly important for the future of IC/BPS management. Based on recent discussions at international conferences, including the International Consultation on IC, Japan, it has been proposed that Hunner-lesion IC should be separated from other non-Hunner IC/BPS because of its distinct inflammatory profiles and epithelial denudation compared with non-Hunner IC/BPS. However, there are still no standard criteria for the diagnosis of Hunner lesions other than typical lesions, while conventional cystoscopic observations may miss atypical or small Hunner lesions. Furthermore, diagnosis of the bladder-centric phenotype of IC/BPS requires confirmation that identified mucosal lesions are truly a cause of bladder pain in IC/BPS patients. This review article discusses the current status of IC/BPS pathophysiology and diagnosis, as well as future directions of the proper diagnosis of bladder-centric IC/BPS, in which pathophysiological mechanisms other than those in inflammatory pathways, such as angiogenic and immunogenic abnormalities, could also be involved in both Hunner-lesion IC and non-Hunner IC/BPS. It is hoped that this new paradigm in the pathophysiological evaluation and diagnosis of IC/BPS could lead to pathology-based phenotyping and new treatments for this heterogeneous disease.

Urine staining intensity and observation of intraoperative ureteral jets among oral agents

INTRODUCTION AND HYPOTHESIS

To determine if administration of a standard 400 mg oral dose of riboflavin (vitamin B2) was comparable to phenazopyridine (pyridium) for evaluating ease of visualization of ureteral jets at the time of cystoscopy.

METHODS

A three-arm double-blinded, randomized controlled study was performed consisting of thiamine as placebo, phenazopyridine, and riboflavin. Agents were administered the morning of surgery prior to surgical procedure. The primary outcome was the ease of visualization of the ureteral jets based on a grading of urine stain intensity on a 7-point color scale, where 1-2 were minimal yellow staining, 3-4 were moderate yellow staining, and 5-7 defined as intense yellow staining. Analysis of covariance (ANCOVA) was used with pairwise comparison to characterize urine stain intensity as a continuous variable among the three groups controlling for age, BMI, creatinine, and time from ingestion of medication to first cystoscopy.

RESULTS

Eighty-four subjects were randomized with a mean ± SD age of 46.25 + 11.36 and BMI of 32.46 + 6.59. Riboflavin did have moderate or intense staining in 57% of cases; however, there was no significant difference between urine staining intensity compared to placebo (p = 0.21). There was a statistically significant increased urine staining intensity for phenazopyridine compared to placebo (p = 0.001) and for phenazopyridine compared to riboflavin (p = 0.001).

CONCLUSIONS

Phenazopyridine provided statistically significantly greater urine staining compared to both riboflavin and placebo and should be considered primarily for ease of ureteral jet visualization.

Four cases of heterotopia of an intrauterine device embedded in the bladder muscular layer causing cystolithiasis: case report and review of the literature

Family planning is a basic national policy in China. An intrauterine device (IUD) is an important method of achieving family planning owing to its high safety, low cost, and convenient use. The indwelling birth control ring has no obvious adverse effects on the sexual life of women after the operation, and the process is reversible. This ring can be removed for women who want to have children again. There are approximately 100 million women with IUDs worldwide, with approximately 80 million in China. This finding accounts for approximately 40% of women of childbearing age in China. Although an IUD is safe, the invasive operation inevitably leads to complications, such as pelvic infection, abnormal menstruation, and damage to adjacent organs. Among them, ectopic bladder stone formation is a rare complication, but several related cases have been reported. We report four cases of heterotopia of an IUD and cystolithiasis, with diagnosis based on the medical history, clinical manifestations, imaging, and cystoscopic findings. The four patients with ectopic IUDs were treated with cystoscopy combined with laparoscopy (or hysteroscopy). We describe the process of diagnosis and treatment of our patients, and the related literature on an ectopic IUD is reviewed.

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

INTRODUCTION AND HYPOTHESIS

Cystoscopic investigation to identify associated histological findings of increased mast cells in the detrusor muscle has been recommended by the European Society for the Study of Bladder Pain Syndrome (ESSIC) in the investigation of bladder pain syndrome/interstitial cystitis (BPS/IC). The aim of this study was to identify if the cystoscopy approach impacts the biopsy results when investigating women presenting with symptoms of BPS/IC.

METHODS

We performed a single-centre retrospective analysis of 300 bladder biopsy reports from 2015 to 2018 from women undergoing cystoscopy for BPS/IC. Biopsies obtained using closed cup forceps through a flexible (FC) or rigid cystoscope (RC) were compared.

RESULTS

Fifty-eight FC biopsies were compared with 242 RC biopsies. FC biopsies had a smaller mean diameter (1.6 mm vs 2.9 mm p < 0.01) and volume (4.1 mm3 vs 9.6 mm3 p < 0.001) compared with RC biopsies. There was no significant difference in the histological depth of sampling to the muscularis propria. A total of 292 samples had CD117 immunohistochemical staining for mast cell count (MCC) analysis. The MCC/mm2 was significantly lower in FC biopsies (p < 0.01). Sixteen percent of FC samples compared with 60% of RC samples had a high MCC >28/mm2 (p < 0.01). There was no significant difference in positive microbiology culture between FC (21%) and RC (28%) sampling.

CONCLUSION

Rigid and flexible cystoscopy can be used to investigate BPS/IC as recommended by international societies. However, the biopsy method impacts the mast cell count analysis, which can influence diagnosis and management. Therefore, RC would be the optimal investigation.

Urothelial-phase thin-section MDCT of the bladder in patients with hematuria: added value of multiplanar reformatted images

PURPOSE

To evaluate the diagnostic performance of MDCT with axial images and multiplanar reformatted (MPR) images from the urothelial phase of the bladder in patients with hematuria using cystoscopy as the reference standard.

MATERIALS AND METHODS

Our IRB for human investigation approved this study, and informed consent was waived. We included 192 patients (121 men, 71 women; age range 17-90 years; mean age ± SD: 60 ± 14 years) who underwent contrast-enhanced MDCT (scan delay: 70 s; section thickness: 2 mm) and conventional cystoscopy examination for painless gross hematuria or recurrent microscopic hematuria. Two radiologists in consensus interpreted the images for the presence or absence of bladder lesions. Using the kappa statistic, the patient-based agreement was determined between the CT and cystoscopic findings. We compared the diagnostic performance of axial images to those with coronal and sagittal reformations to detect bladder lesions.

RESULTS

MDCT showed excellent agreement between cystoscopy-axial scans (κ = 0.896) and axial with reformatted images (κ = 0.948). The sensitivity, specificity, and accuracy of MDCT were 94%, 96%, and 95% in the axial scans and 98%, 97%, and 97% in the axial with reformatted images, respectively. All statistical parameters of diagnostic performance were similar between the axial and the reformatted images (p > .05).

CONCLUSION

Axial MDCT imaging demonstrates high diagnostic performance in detecting bladder lesions, but additional reformatted images can improve diagnostic accuracy.

Phase II multi-center trial of optical coherence tomography as an adjunct to white light cystoscopy for intravesical real time imaging and staging of bladder cancer

BACKGROUND

Optical coherence tomography (OCT) is a novel imaging modality that provides microstructural information of different tissue layers using near-infrared light. This prospective, multicenter phase II trial aimed to assess the accuracy of OCT-assisted cystoscopy for bladder tumor staging.

METHODS

Patients with primary or recurrent bladder tumors (Ta,T1) identified by outpatient cystoscopy were included. The primary objective was to assess the accuracy and positive predictive value of for determining tumor stage ≥T1 correlated by histopathology. 72 suspicious lesions from 63 patients were eligible to analyze in the study. All suspected lesions were evaluated with conventional cystoscopy, interpreted in real-time using OCT, and then resected. All results were compared to pathology. A total of 363 OCT images of tumor and normal mucosa in 25 patients were obtained to evaluate diagnostic efficacy of the computer-aided texture analysis algorithm.

RESULTS

Sensitivity and specificity for predicting invasive tumors (≥ T1, n = 17) were 58.8% and 92.7% for cystoscopy, 64.7% and 100% for OCT-assisted cystoscopy, respectively. Accuracy of cystoscopy and OCT-assisted cystoscopy for predicting invasive tumor was 84.7% and 91.7% (P = 0.063), respectively. Cystoscopy and OCT-assisted cystoscopy correctly predicted T stage in 52/72 and 59/72 cases, respectively (P = 0.016). Cystoscopy missed 2 more invasive tumors than OCT-assisted cystoscopy. Cystoscopy (14.3%, 1/7) and OCT-assisted cystoscopy (28.6%, 2/7) showed relatively low sensitivity in detecting muscle invasion. Computer aided texture analysis demonstrated 75.1% sensitivity, 64.0% specificity, and 74.4% accuracy for differentiating tumor and normal urothelium.

CONCLUSION

OCT-assisted cystoscopy is a real time noninvasive and simple procedure that enhanced the accuracy of staging bladder tumors and prediction of any tumor invasion. Though the study did not meet the prespecified primary endpoint, OCT imaging is a promising adjunct to cystoscopy that may supplement intraoperative decision-making during transurethral resection of bladder tumors and additional prospective studies are warranted.

A sandwich technique for the removal of stone embedded intrauterine devices in the urinary bladder

A urinary bladder stone in young adults is uncommon. Dislocation of an IUD to adjection organs is a rare condition. We present a case of a 28-year female with a chief complaint of right side pelvis discomfort, off and on with the urinary system. In this case, we performed cystoscopy assisted laser lithotripsy, hysteroscopy to localize and remove IUD, transurethral resectoscope for removing IUD residual, and resection sinus tract.

This article's objective states that the multidisciplinary approach to removing dislocated IUD is safe and effective and raises awareness of forgotten contraceptive devices and their potential complications.

A new method of adjusting mesh tension using cystoscopy during laparoscopic sacrocolpopexy

We aimed to examine the usefulness of cystoscopic findings to guide mesh tension adjustment during laparoscopic sacrocolpopexy (LSC) to promote better repair of pelvic organ prolapse (POP) and prevent de novo stress urinary incontinence (SUI). In this technique, the bladder wall was observed using a cystoscope when various traction pressures were applied by pulling the mesh arm with forceps before fixation to the promontory during LSC. Adjustment was performed on 20 patients, and postoperative outcomes of POP repair and development of de novo SUI were evaluated. When excessive traction was applied on the mesh arm, a bladder neck opening and a cord-like elevation in the center of the trigone and posterior wall were observed in all cases. The tension was gradually loosened, and precisely when the above-mentioned cystoscopic finding ("Central Road") disappeared, an anatomically appropriate elevation of the vaginal apex was achieved; the mesh arm was fixed to the promontory. At 6 months after LSC, anterior wall recurrences were diagnosed in four patients (beyond the hymen in one) with few symptoms, while no occurrence of de novo SUI. Cystoscopic findings during mesh tension adjustment in LSC could be useful in achieving improved POP repair.

Urinary bladder fistula following laparoscopic inguinal hernioplasty: a case report

Background

Fistula formation due to mesh erosion into hollow viscera, such as the urinary bladder, is uncommon. To date, there have been no reports of fistula formation into the urinary bladder without evidence of mesh erosion after hernioplasty; herein, we report one such rare case, in which the clinical symptoms improved without any surgical intervention.

Case presentation

A 73-year-old man underwent a trans-abdominal preperitoneal repair for bilateral direct inguinal hernia. One month later, the patient experienced a painful induration in the right inguinal region, and computed tomography revealed fluid collection in this region. A culture of the aspirated fluid yielded no bacteria. Seven months later, he experienced another episode of painful induration in the same region. However, blood examination revealed a normal white blood cell count and C-reactive protein level. Moreover, no organisms were detected by aspirated fluid culture. Although the painful induration subsided after aspiration of the fluid collection, he developed gross hematuria and dysuria a month later. Cystoscopy revealed a fistula in the right wall of the urinary bladder that discharged a purulent fluid. Culture of the fluid revealed no bacteria, and there was no evidence of mesh erosion. Hematuria improved without therapeutic or surgical intervention. The patient’s clinical symptoms improved without mesh removal. Moreover, cystoscopy revealed that the fistula was scarred 12 months after the initial appearance of urinary symptoms. No further complications were observed during a 42-month follow-up period.

Conclusions

We report a rare case of a fistula in the urinary bladder without evidence of mesh erosion after laparoscopic hernioplasty. The patient’s condition improved without mesh removal. Fluid collection due to foreign body reaction to meshes can cause fistula formation in the urinary bladder without direct mesh contact.

Check cystoscopy in the management of anterior urethral valves in a cohort of pediatric patients

INTRODUCTION

Anterior urethral valves (AUV) are a rare cause of lower urinary tract obstruction which could progress to renal damage, Clinical presentation varies according with patient's age and severity of obstruction, but, in most cases, diagnosis is based on voiding cysto-urethrogram (VCUG). To date, the treatment of choice is endoscopic ablation even if approved guidelines about the overall management of AUVs, including the recognition and treatment of residual valves, are not available.

OBJECTIVE

We describe our protocol for AUV treatment based on primary endoscopic valve ablation followed by check cystoscopy 15 days later.

STUDY DESIGN

Medical records of 5 patients with AUVs admitted from 2008 to 2018 to our Pediatric Urology Unit were retrospectively reviewed. Blood tests, urinalysis, renal US and VCUG were performed in all children, while urodynamic evaluation was performed in the 3/5 patients who could void spontaneously. All patients underwent endoscopic valves ablation and after 15 days after a second look cystoscopy was performed. Follow up was based on clinical and radiological evaluation with US, urinalysis and blood tests. Postoperative non-invasive urodynamic studies were performed in the 3/5 patient toilet-trained patients and VCUG was performed in 1/5 patient.

RESULTS

and Discussion: At primary endoscopic ablation cystoscopy revealed AUVs in the penile urethra in three patients, in the penoscrotal urethra in one case, in the bulbar urethra in another case. In 3/5 patients check cystoscopy found residual valves and a second endoscopic ablation was performed. All patients achieved symptoms release and improved urodynamic parameters. No intra or post-operative complication were reported. The assessment of residual valves is variable in literature and it is usually described for posterior urethral valves (PUVs). Few series report the use of VCUG within the first week after valve ablation, our experience instead suggests that performing a second look cystoscopy, is very effective to evaluate the presence of residual AUVs and eventually proceed with further ablation.

CONCLUSION

Endoscopic ablation is the gold standard treatment for AUV, but residual valves management is not clearly defined. According to our experience, a check cystoscopy 15 days after primary ablation allows to identify and treat possible residual valves showing good results in terms of safety and efficacy.

Early-onset complete spontaneous migration of contraceptive intrauterine device to the bladder in a post C-section patient: A case report

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Migration of a contraceptive intrauterine device (IUD) rarely occurs.

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Computed tomography is the preferred radiological examination.

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Waiting for the complete migration of IUD is beneficial for its easy removal.

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Periodical evaluation may prevent complications in patients with contraceptive IUD.

Introduction and importance

Spontaneous migration of a contraceptive intrauterine device (IUD) to the bladder is very rare. It usually takes years for the IUD to migrate completely from the uterine cavity to the bladder. We report a case of early-onset complete spontaneous migration of contraceptive IUD to the bladder in a post C-section patient.

Case presentation

A 30-year-old woman presented with suprapubic pain and dysuria three weeks prior to hospitalization. She had C-section three months prior and underwent copper IUD insertion two months after the surgery. One week after IUD insertion, radiography showed that the IUD remained in the uterus, but the patient felt suprapubic pain and dysuria. Computed tomography (CT) three weeks after IUD insertions showed IUD migration to the bladder with its tips embedded in the uterine wall. Cystoscopy was performed one week later and the IUD was completely inside the bladder. By then, the IUD was removed completely via forceps with no complication.

Clinical discussion

The exact pathophysiology of spontaneous IUD migration is unknown, but migration always starts with uterine perforation. In our case, uterine perforation was probably caused by immediate traumatic perforation. CT is the preferred radiological examination. IUD removal was performed one month after IUD insertion showing complete migration of the IUD, though CT one week prior suggested that the tips of the IUD remained embedded.

Conclusion

In cases of early-onset complete spontaneous migration of contraceptive IUD to the bladder, CT is the preferred radiological examination, and delaying removal procedure may be beneficial.

Therapeutic intervention for fetal lower urinary tract obstruction: Current evidence and future strategies

In-utero vesica-amniotic shunting for fetal lower urinary obstruction (LUTO) is known to improve perinatal survival. More recently, studies including centres performing fetal cystoscopy, have suggested benefit on longer-term survival and renal outcome - within the limitations of small numbers and limited follow-up. These interventions carry significant risk, and therefore patient selection, and optimal timing, are key. The aim of this article is to explore ways of improving the accuracy of prenatal diagnosis, and of identifying risk factors for fetal and postnatal renal failure. The next step is that of using established staging and classification systems to select the patient group that may benefit from intervention, based on published outcomes. Several factors come into play when selecting the timing of intervention, especially if the aim is that of renal, and not only pulmonary, preservation. Lastly, current technologies and their shortfalls are discussed.

Bladder cancer risk stratification using a urinary mRNA biomarker panel - A path towards cystoscopy triaging

OBJECTIVES

The risk of bladder cancer (BCa) diagnosis and recurrence necessitates cystoscopy. Improved risk stratification may inform personalized triage and surveillance strategies. We aim to develop a urinary mRNA biomarker panel for risk stratification in patients undergoing BCa screening and surveillance.

METHODS AND MATERIALS

Urine samples were collected from patients undergoing cystoscopy for BCa screening or surveillance. In patients who underwent transurethral resection of bladder tumor, urine samples were categorized based on tumor histopathology, size, and focality. Subjects with intermediate and high-risk BCa based on American Urological Association (AUA) guideline for non-muscle invasive bladder cancer were classified as "increased-risk"; those with no cancer and AUA low-risk BCa were classified as "low-risk". Urine was evaluated for ROBO1, WNT5A, CDC42BPB, ABL1, CRH, IGF2, ANXA10, and UPK1B expression. A diagnostic model to detect "increased-risk" BCa was created using forward logistic regression analysis of cycle threshold values. Model validation was performed with ten-fold cross-validation. Sensitivity and specificity for detection of "increased-risk" BCa was determined and net benefit analysis performed.

RESULTS

Urine samples (n = 257) were collected from 177 patients (95 screening, 76 surveillance, 6 both). There were 65 diagnoses of BCa (12 low, 22 intermediate, 31 high risk). ROBO1, CRH, and IGF2 expression correlated with "increased-risk" disease yielding sensitivity of 92.5% (95% CI, 84.9%-98.1%) and specificity of 73.5% (95% CI, 67.7-79.9%). The overall calculated standardized net benefit of the model was 0.81 (95%CI, 0.71-0.90).

CONCLUSIONS

A 3-marker urinary mRNA panel allows for non-invasive identification of "increased-risk" BCa and with further validation may prove to be a tool to reduce the need for cystoscopies in low-risk patients.

Abnormal Urine Outflow from the Ureteral Orifice on Cystoscopy Following Vaginal Stump Suture in Total Laparoscopic Hysterectomy

Objectives:

Ureteral injuries may occur subsequent to abdominal or laparoscopic hysterectomy. In total laparoscopic hysterectomy (TLH), we usually check for ureteral damage by confirming urinary outflow from the bilateral ureteral orifices by cystoscopy after vaginal stump suture. In this work, we investigated the causes of urine outflow disruption after TLH.

Materials and Methods:

We conducted a retrospective review of all TLHs performed for benign diseases at our hospital from February 2012 to March 2016. There were 11 cases with no or poor urine outflow from the ureteral orifice after vaginal stump suture. For these cases, we assessed the treatment to recover urine outflow and examined the cases with intraoperative manipulation. EZR version 1.25 was used for statistical analysis. Correlation coefficients were calculated with Spearman's rank correlation coefficient test.

Results:

The abnormality was on the right and left sides in seven and four cases, respectively. In all cases, apart from one, urine outflow was recovered by removing the sutures at the affected side, where the initial suture had included a small amount of the connective tissue near the urinary bladder. It was inferred that ureteral deviation due to vaginal stump sutures that picked up the connective tissue near the ureter caused ureteral peristaltic disorder and abnormal ureteral orifice outflow.

Conclusion:

TLH without ureter isolation requires sufficient separation of the bladder from the anterior vaginal wall and careful vaginal stump suture without involving the bladder-side tissue to avoid ureteral injury.

Giant neonatal hydronephrosis of the upper pole of a complete duplicated renal system

Ureteropelvic junction obstruction (UPJO) in the upper pole of a complete duplicated renal system is extremely rare. We report a case that was diagnosed prenatally and we review 10 cases published in the literature. Diagnoses of adrenal hematoma and cystic neuroblastoma were suspected on prenatal ultrasound, based on the severity of dilatation and the difficulty of identifying the exact origin of this anomaly. Neonatal magnetic resonance imagery (MRI) was subsequently able to show a normal adrenal gland. Surgical management is similar to that of a single-system pyeloureteral junction obstruction. Since this situation is very rare, we believe cystoscopy can be useful to confirm diagnosis of UPJO associated with complete duplication, especially in the absence of preoperative MRI. Among the 11 surgical cases previously published, seven patients underwent pyeloplasty and four heminephrectomy.

Long term outcomes of one-stage augmentation anterior urethroplasty: a systematic review and meta-analysis

OBJECTIVE

The objective is to summarize and characterize the long-term success of anterior augmentation urethroplasty (AU) in published series. The current literature on AU consists largely of retrospective series reporting intermediate follow-up and incompletely characterize the long term outcomes of AU.

MATERIALS AND METHODS

A systematic literature review was performed consistent with PRISMA guidelines to characterize long-term outcomes of AU with a minimum upper limit follow-up of 100 months. Penile/preputial skin flaps and graft and oral mucosal graft urethroplasties were included. The primary outcome was stricture-free survival for one-stage AU. Secondary analysis evaluated differences in outcomes based on two failure definitions: the need for intervention versus presence of recurrent stricture on cystoscopy or urethrography. Hazard rates were induced from the reported failure rates of one-stage AU and fixed and random effect models were fitted to the data. Additional subset analysis, removing potential confounders (lichen sclerosus, hypospadias and penile skin graft), was performed.

RESULTS

Ten studies met inclusion criteria, and two studies reported separate outcomes for grafts and flaps, and thus were included separately in the analysis. The mean hazard rate across all studies was 0.0044, the corresponding survival rates at 1 year 0.948, 5 years 0.766, 10 years 0.587, and 15 years 0.45. Subset analysis of the 4 select and homogeneous studies noted 1, 5, 10, and 15 years survival rates of 0.97, 0.96, 0.74, and 0.63, respectively.

CONCLUSIONS

The long-term success rates of augmentation urethroplasty are appear to be worse than previously appreciated and patients should be counseled accordingly. Available at. https://www.intbrazjurol.com.br/pdf/aop/2019-0242RW.pdf.

Pooled analysis of Xpert Bladder Cancer based on the 5 mRNAs for rapid diagnosis of bladder carcinoma

Background

Xpert Bladder Cancer is a detection method developed in recent years, designed with the functions of integrating sample automatically, nucleic acid amplification, and target sequence detection. It is a urine assay targeting five mRNAs (CRH, IGF2, UPK1B, ANXA10, and ABL1). The purpose of this article is to review the accuracy of Xpert Bladder Cancer in the follow-up diagnosis of bladder cancer and evaluate the role of Xpert Bladder Cancer in detecting the recurrence of non-muscle-invasive bladder cancer in the round.

Methods

In the database of Embase, PubMed, Web of Science, and Cochrane Library, the articles published up to October 13, 2020, were searched and screened based on the exclusion and inclusion criteria, and data were extracted from the included studies. The sensitivity, specificity, negative likelihood ratio, positive likelihood ratio summary of receiver operating characteristic curves, and diagnostic odds ratio were combined by the Meta-DiSc 1.4 software. The Stata 12.0 software was used to obtain the assessment of publication bias.

Results

A total of 8 articles involving eight fourfold tables were finally identified. The pooled sensitivity and specificity of Xpert Bladder Cancer in the diagnosis of bladder cancer were 0.71 and 0.81, respectively. The positive likelihood ratio and negative likelihood ratio were 3.74 and 0.34, respectively. The area under the curve was 0.8407. The diagnostic odds ratio was 11.99. Deeks’ funnel plot asymmetry test manifested no publication bias.

Conclusions

In summary, Xpert Bladder Cancer presents high accuracy and specificity in monitoring bladder cancer compared with cystoscopy. More researches are still required to further confirm this conclusion.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12957-021-02154-0.

Outcomes of stratified transurethral resection of bladder tumor: A propensity score-matched analysis

BACKGROUND/PURPOSE

Several strategies have been reported for improving the integrity of transurethral resection of bladder tumor (TURBT). However, no standard has been established. Stratified TURBT (SR) is one of protocols for TURBT, wherein exophytic tumors are first resected and retrieved, and tumor bases are then resected. In this study, we aimed to evaluate the outcomes of SR in patients with nonmuscle invasive bladder cancer (NMIBC).

METHODS

From January 2012 to December 2017, patients newly diagnosed as having NMIBC with a follow-up period of more than 2 years were enrolled and categorized into SR and conventional TURBT (CR) groups. Propensity score matching at a 2:1 ratio was performed. Outcomes were the detrusor muscle sampling rate, recurrence-free survival (RFS), and progression-free survival (PFS).

RESULTS

In total, 205 patients were included in our study. The detrusor muscle sampling rate was higher in the SR group (P = 0.043). After propensity score matching, 162 patients were selected for outcome analysis, with 108 and 54 patients undergoing SR and CR, respectively. Compared with the CR group, the SR group showed a lower recurrence rate (P = 0.015) and better RFS in univariate (P = 0.010) and multivariate (P = 0.006) Cox proportional hazards regression. Progression rate and PFS were not significantly different between the two groups.

CONCLUSION

SR results in a higher detrusor muscle sampling rate and better disease outcomes. Our findings suggest that SR is a promising strategy for TURBT in patients with NMIBC.

Dorsal urethro-cutaneous fistula caused by an impacted stone at the bulbar urethra: Case report

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Penile ureteral stones constitutes less than 1% of the urinary tract stones.

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They are either primary (native) or secondary (migrated).

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Secondary urethral stones are commoner and larger in size.

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The clinical diagnosis require high index of suspicion.

Background

Penile urethral stones are very and constitutes less than 1% of the urinary tract stones and commoner in males. They are either primary or secondary. The clinical diagnosis require high index of suspicion.

Case presentation

A 30-year-old male was complaining of penile pain, weak urinary stream and dribbling at the end of micturition for 2 months, later on he developed severe dysuria and a tender nodule over the dorsal penile surface. An attempted urethral catheterization was failed. There was no history of urethral trauma or instrumentation. Examination of genitalia revealed a normal meatus with a fistula at dorsal mid penile shaft and the urine were coming out from that opening with surrounding redness and edema with palpable firm nodule in the penile shaft. A pelvic x-ray revealed a mid-urethral radiopaque shadow, cystoscopy revealed an impacted stone in mid-bulbar urethra, attempts of stone extraction was failed. An open ventral urethral incision was made and the stone was removed, dorsal fistulectomy and repair was performed. Foley's catheter was placed and removed later after 21 days. The patient had uneventful postoperative period and the follow up was done up to 6 months with no postoperative complications.

Conclusion

The clinical diagnosis of penile urethral stones require high index of suspicion. Management options are variable depending on impaction site, the size, and associated urethral pathologies. The fistula tract require excised and repair.

Supportive Care Needs of Patients on Surveillance and Treatment for Non-Muscle-Invasive Bladder Cancer

OBJECTIVE

This literature review provides an overview of non-muscle-invasive bladder cancer diagnosis (NMIBC), treatment, and surveillance. Existing evidence is reviewed to identify the NMIBC patient pathway, highlight its effect on quality of life, and identify supportive care needs of this patient group. A framework to guide nurses in the care of this underserved population is proposed.

DATA SOURCES

Electronic databases including CINAHL, Medline, PsychInfo, Cochrane, and Google Scholar were searched.

CONCLUSION

NMIBC is a chronic disease with high recurrence and progression rates with most patients requiring invasive treatment and burdensome surveillance schedules with frequent hospital visits. Treatment-related side effects may interrupt therapy and possibly result in its discontinuation. Patients' quality of life can be negatively affected at various stages of the cancer trajectory. Specialist nurses provide holistic care throughout all stages of the patient journey to optimize supportive care, information provision, and delivery of appropriate treatment and surveillance protocols. NMIBC research is historically underfunded with a paucity of evidence identifying the supportive care needs of this population. Further research is urgently required to fill the gaps identified.

IMPLICATIONS FOR NURSING PRACTICE

This timely paper raises the profile of unmet supportive care needs in an underserved research cancer population. Suggestions are proposed to improve the quality of nursing care through standardized practices and the development and integration of patient pathways. Evidence of the effect of NMIBC on family members or carers is absent from the literature. Future research implications and directions are proposed.