Aggressive bladder carcinoma in an HIV-positive man with tetraplegia and neurogenic bladder

BACKGROUND/OBJECTIVE

Patients with neurogenic bladder secondary to spinal cord injury who are managed long term with an indwelling catheter are known to be at increased risk for transitional cell carcinoma of the bladder. Immunosuppression is a known risk factor for malignancies that often are more aggresSive than those seen in normal populations.

METHOD

Case report and discussion of management recommendations.

RESULTS

We summarize the case of a 44-year-old HIV-positive C5-C6 incomplete tetraplegic male (date of injury 1980), who was diagnosed with transitional cell carcinoma of the bladder and succumbed to disease within 6 months of diagnosis. The patient was a non-smoker who was never managed with an indwelling catheter. There has been no such case reported in the literature.

CONCLUSIONS

HIV infection in the presence of a neurogenic bladder may carry an increased risk of aggressive bladder malignancy. More studies are warranted to determine whether routine annual screening with cystoscopy in all patients with HIV and neurogenic bladder is indicated.

An extremely rare case of dermoid cyst of urinary bladder

We report an extremely rare case of a dermoid cyst of the urinary bladder in a 30-year-old female who presented with pain in the left flank and dysuria since 9 months. On imaging (ultrasound and computed tomography), a relatively well-defined mass lesion with areas of fat and calcification was seen arising from the bladder wall. Cystoscopy showed presence of hair on the surface of the lesion. Histopathological findings were consistent with dermoid cyst in the urinary bladder.

Appearance of a colovesical fistula at cystoscopy

Colovesical fistulae typically present with pneumaturia and/or fecaluria. Diverticulitis, inflammatory bowel disease, and malignancies of the colon are the commonest causes. The fistulous tract and adjacent organs are best demonstrated by contrast-enhanced CT scan with rectal contrast or MRI. Biopsy at cystoscopy/colonoscopy is necessary for complete evaluation and treatment planning.

How can we improve the diagnosis and management of bladder pain syndrome? Part 1: ICI-RS 2018

BACKGROUND

This paper summarizes the discussion in a think tank at the ICI-RS 2018 about the diagnosis of bladder pain syndrome (BPS).

AIMS

To review the guidelines, investigations and subtypes of BPS.

MATERIALS AND METHODS

Review of literature in the light of the think tank discussion.

RESULTS

All guidelines recommend completing history, physical examination, urine analysis, urine culture, and urine cytology to define the BPS phenotype but there are differences on further investigations. In those guidelines which recommend cystoscopy, the identification of Hunner's lesions (HLs) is recommended as this changes the treatment plan and outcome.

CONCLUSION

We propose that the differentiation of Hunner's ulcers is an important step in the assessment of these patients. Further suggestions for research are suggested.

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

OBJECTIVES

to investigate whether virtual reality (VR) experience is associated with decreased pain sensation among patients who undergo rigid cystoscopy under local anesthesia.

METHODS

we performed a prospective, randomized, controlled study of 159 patients who were aleatorily enrolled into two groups: VR and control. VR experience intervention consisted of using a headset with a smartphone adapted to a virtual reality glasses where an app-video was played during the procedure. Main outcomes analyzed were pain, discomfort, heart rate variability, difficulty and duration of the cystoscopy. Statistical analyses were performed using a Student's t test, Mann-Whitney test and Chi-square test. A P<0.05 was considered to be statistically significant.

RESULTS

among 159 patients studied (VR group=80 patients; control group=79 patients), the mean age was 63,6 years and 107 (67,3%) were male. There was no statistically significant difference in baseline characteristics between the 2 groups. VR was significantly associated to decreased heart rate variability (6,29 vs 11,09 bpm, P<0,001) and lower duration of the procedure (5,33 vs 8,65 min, P<0,001). Also, when cystoscopies due to double-J extraction were excluded, VR experience was associated with reduced pain on the visual analog score of pain (3,26 vs 4,33 cm, P=0,023).

CONCLUSIONS

the use of VR as a distraction therapy while performing outpatient cystoscopies is safe, has no side effects, is associated with less pain and discomfort, and reduces length of procedure.

Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center

BACKGROUND

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with significant manipulation of the urinary tract (UT). We aim to describe the urological events and their management in patients who underwent CRS-HIPEC.

METHODS

Clinical records of patients who underwent treatment between 2007 and 2015 were reviewed. Urological events and their multidisciplinary management were analyzed. Descriptive statistics were calculated.

RESULTS

A total of 103 patients were included. Mean age was 51 years (SD ± 11.8). Mean peritoneal cancer index (PCI) was 20.4 (SD ± 10.1). Primary tumors included appendicular (64%), gynecological (16%), colorectal (10%), and peritoneal mesotheliomas (9%). Ninety-three percent of patients had bilateral ureteral catheters inserted prior to surgery, without complications. Intraoperative UT injuries occurred in 7% of patients. In 5% of patients, tumor invasion of the bladder was evident at surgery and partial resection and primary repair of the bladder wall was performed. Urological complications included urinary tract infection (UTI) (21%) acute post-renal failure (4%), urinary fistulae (4%), and acute urinary retention (AUR) (1%).

CONCLUSIONS

In our study, intraoperative UT events and postoperative complications, although not neglectable, were infrequent. Due to the high complexity of these cases, a multidisciplinary approach is mandatory. However, randomized clinical trials are necessary to clarify current data on the need and efficacy of prophylactic ureteral catheterization in patients undergoing CRS-HIPEC.

Role of blue-light cystoscopy in detecting invasive bladder tumours: data from a multi-institutional registry

OBJECTIVES

To evaluate the role of blue-light cystoscopy (BLC) in detecting invasive tumours that were not visible on white-light cystoscopy (WLC).

PATIENTS AND METHODS

Using the multi-institutional Cysview registry database, patients who had at least one white-light negative (WL-)/blue-light positive (BL+) lesion with invasive pathology (≥T1) as highest stage tumour were identified. All WL-/BL+ lesions and all invasive tumours in the database were used as denominators. Relevant baseline and outcome data were collected.

RESULTS

Of the 3514 lesions (1257 unique patients), 818 (23.2%) lesions were WL-/BL+, of those, 55 (7%) lesions were invasive (48 T1, seven T2; 47 unique patients) including 28/55 (51%) de novo invasive lesions (26 unique patients). In all, 21/47 (45%) patients had WL-/BL+ concommitant carcinoma in situ and/or another T1 lesions. Of 22 patients with a WL-/BL+ lesion who underwent radical cystectomy (RC), high-risk pathological features leading to RC was only visible on BLC in 18 (82%) patients. At time of RC, 11/22 (50%) patients had pathological upstaging including four (18%) with node-positive disease.

CONCLUSIONS

A considerable proportion of invasive lesions are only detectable by BLC and the rate of pathological upstaging is significant. Our present findings suggest an additional benefit of BLC in the detection of invasive bladder tumours that has implications for treatment approach.

Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder

PURPOSE

Intradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB.

PATIENTS AND METHODS

This retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients' outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident.

RESULTS

Twenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2-2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0±4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and perceived tolerability.

CONCLUSION

Intradetrusor botulinum toxin injection for the treatment of refractory OAB is characterized by high efficacy and very low complications even at the very beginning of the learning curve when performed under proper mentorship.

An improved delivery system for bladder irrigation

Introduction

Occasionally, urologists may see patients requiring temporary bladder irrigation at hospitals without stocks of specialist irrigation apparatus. One option is to transfer the patient to a urology ward, but often there are outstanding medical issues that require continued specialist input. Here, we describe an improved system for delivering temporary bladder irrigation by utilizing readily available components and the novel modification of a sphygmomanometer blub. This option is good for bladder irrigation in patients with moderate or severe gross hematuria due to various causes.

Materials and methods

In this prospective study from March 2007 to April 2009, we used our new system in eligible cases. In this system, an irrigant bag with 1 L of normal saline was suspended 80 cm above the indwelled 3-way Foley catheter, and its drainage tube was inserted into the irrigant port of the catheter. To increase the flow rate of the irrigant system, we inserted a traditional sphygmomanometer bulb at the top of the irrigant bag. This closed system was used for continuous bladder irrigation (CBI) in patients who underwent open prostatectomy, transurethral resection of the prostate (TURP), or transurethral resection of the bladder (TURB). This high-pressure system is also used for irrigation during cystourethroscopy, internal urethrotomy, and transurethral lithotripsy. Our 831 eligible cases were divided into two groups: group 1 were endourologic cases and group 2 were open prostatectomy, TURP, and TURB cases. The maximum and average flow rates were evaluated. The efficacy of our new system was compared prospectively with the previous traditional system used in 545 cases.

Results

In group 1, we had clear vision at the time of endourologic procedures. The success rate of this system was 99.5%. In group 2, the incidence of clot retention decreased two fold in comparison to traditional gravity-dependent bladder flow system. These changes were statistically significant (P = 0.001). We did not observe any adverse effects such as bladder perforation due to our high-pressure, high-flow system.

Conclusion

A pressurized irrigant system has better visualization during endourologic procedures, and prevents clot formation after open prostatectomy, TURP, and TURB without any adverse effects.

Anterior urethral valves without diverticulae: a report of two cases and a review of the literature

Two unusual cases of anterior urethral valves (AUV) without diverticulae are presented. The first case is a male child born with prenatal diagnosis of bilateral hydronephrosis. On cystoscopy, iris-like diaphragm valves were encountered about 3 mm distal to the skeletal sphincter. In the second case, an 18-month-old male child was investigated for recurrent febrile urinary tract infections and obstructed urinary symptoms. Cystoscopy confirmed the presence of slit-like valves 5 mm distal to the skeletal sphincter. Fulguration of the AUVs was performed in both cases. It may be worthwhile to review all cases of anterior urethral obstruction collectively and re-categorize them appropriately to include the unusual AUVs without diverticulum in that classification.

Resident experiences with and post-training plans for cystoscopy at the time of hysterectomy

AIMS

To determine OB/GYN residents' experience with and opinions toward cystoscopy at the time of hysterectomy.

STUDY DESIGN

An internet survey of OB/GYN residents assessed utilization of cystoscopy at the time of hysterectomy, familiarity with literature regarding universal versus selective cystoscopy, and plans post residency.

RESULTS

Cystoscopy was performed universally in the minority of cases of vaginal hysterectomy (12%), laparoscopically assisted vaginal hysterectomy (14%), supracervical hysterectomy (0%), total abdominal hysterectomy (2%), laparoscopic supracervical hysterectomy (9%), total laparoscopic hysterectomy (27%), and hysterectomy with adnexa removal (5%). Residents planned universal cystoscopy post-training more frequently for all hysterectomy types.

CONCLUSION

Cystoscopy at the time of hysterectomy was performed universally in the minority for all hysterectomy categories. For all hysterectomy types, residents planned post-graduation to utilize universal cystoscopy at the time of hysterectomy more often than occurred in training.

The use of suprapubic cystoscopy in perineal urethroplasty

OBJECTIVE

Posterior urethral strictures are difficult cases to treat for urologists. Anastomotic open urethroplasty is the major surgical treatment option, and various modifications/manipulations to the procedure have been recommended in the literature. We aimed to assess the advantages of performing antegrade endoscopy through the suprapubic cystostomy tract during perineal urethroplasty.

MATERIAL AND METHODS

Thirty-six perineal urethroplasties combined with suprapubic cystoscopy were performed in 33 adult male patients between 2005 and 2011. Pre-and peri-operative records of the patients were evaluated, with a particular focus on suprapubic cystoscopy findings during urethroplasty.

RESULTS

The mean patient age was 41 years, and the mean lesion length was 2.6 cm (range 1-10 cm). Lesions were secondary to pelvic trauma in 21 patients, to a history of prostatic surgery in 8 patients, and to other miscellaneous causes in the 4 remaining patients. In 23 cases with normal bladder necks, the anastomosis was created under the guidance of antegrade cystoscopy with fluoroscopy. In 10 cases, stiff guide wires or paddles were used in addition to endoscopic light to identify the correct anastomosis site. In two procedures, fistula openings were identified during endoscopy, and fistula repair was performed along with anastomosis. In one case involving the longest lesion with involvement of the bladder neck, a combined perineal-transpubic urethroplasty was performed. The mean follow up duration was 19 (3-38) months. The overall success rate was 91%, and the re-operation rate was 9%.

CONCLUSION

Suprapubic cystoscopy is an easy-to-perform adjunctive modality in perineal urethroplasty. This method provides the benefits of supplementary endoscopic findings and feasibility of certain maneuvers that facilitate debridement and anastomosis formation concurrent with perineal urethroplasty.

Comparing 2% lidocaine gel (Dispogel and Cathejell) in cystoscopy

Objective

Cystoscopy is a common urologic procedure. Analgesics are often used to reduce any pain associated with this procedure. The aim of this study was to investigate the efficacy in reducing pain and the cost-effectiveness of two forms of lidocaine gel in patients undergoing cystoscopy.

Methods

In this double-blind, randomized clinical trial, 77 male patients who were referred for double J removal, urethral dilatation, or cystoscopy were enrolled. The patients were divided into two groups: Dispogel and Cathejell. All patients received 20 mL of intraurethral lidocaine gel 2% and cystoscopy was performed 5 minutes thereafter. The primary outcome was the pain score (visual analogue scale, VAS) during and 5 minutes after cystoscopy.

Results

There were no statistically significant differences between the VAS scores, blood pressure, and pulse rate in the groups in either observation period. No patient required additional anesthetic agents or sedatives for insufficient pain relief.

Conclusion

The results of this study show that the analgesic efficacy of Dispogel and Cathejell in the treatment of pain during and after elective cystoscopy was the same, but Dispogel was more cost-effective.

Foreign bodies in children's lower urinary tract: A case series and literature review

BACKGROUND

Children with foreign bodies (FBs) in the lower urinary tract have rarely been reported, and their management remains challenging. This study aimed to describe the characteristics and treatment of FBs in children's lower urinary tract.

METHODS

We retrospectively analyzed the clinical data on lower urinary tract FBs that were removed in our hospital from August 2017 to August 2022, including demographics, location, symptoms, imaging examinations, and treatment.

RESULTS

Four male patients were enrolled, whose ages ranged from 9 to 13 years, with a mean age of 11 years. The course of the disease ranged from 3 h to 2 weeks. Their imaging characteristics were reviewed and analyzed, and two FBs were located in the bladder and two in the urethra. Mosquito forceps were used to remove an acne needle through the urethra in one case. Cystoscopy was first attempted in three cases, in only one of which was the FB removed successfully under endoscopic minimally invasive surgery. In the remaining two cases, removal via transurethral cystoscopy failed, whereby leading to cystotomy being performed. The FBs comprise a skipping rope, hairpin, magnetic bead, and acne needle. The postoperative recovery was uneventful, and no complications occurred during the follow-up period of 3 to 6 months.

CONCLUSION

It is rare for children to have FBs in the lower urinary tract. An early diagnosis, as well as appropriate management of lower urinary tract FBs, can significantly reduce complications. Surgical removal of lower urinary tract FBs can be safe and effective, and relatively better outcomes can be achieved.

Pain and anxiety assessment during cystourethroscopy in males using voiding instruction: A prospective, randomized controlled study

Introduction

Office cystourethroscopy is one of the common and most frequent urological procedures. Pain and anxiety during the procedure might lead to noncompliance and incomplete cystoscopic examination. Negotiating cystoscope through external sphincter is the most painful and uncomfortable distressing part of cystoscopy. To overcome this, manual compression of irrigation bag during cystoscopy has been used and found to be helpful. Numerous other methods were also studied. Despite these, cystoscopy is still painful and causes anxiety in patients. External sphincter gets relaxed naturally during the act of micturition. Based on this principle, pain and anxiety were studied with voiding instruction during cystourethroscopy.

Objective

To study the effect of voiding instruction on anxiety and pain during cystourethroscopy using the Hamilton Anxiety Rating Scale (HAM-A) and visual analogue scale (VAS), in a well-matched Eastern Indian male patient population in a prospective, randomized pattern.

Methods

A total of 100 male patients were recruited from those who underwent cystourethroscopy examination in SSKM Hospital and were prospectively randomized into two groups: cystoscopy with or without voiding instruction. Pre- and postprocedure HAM-A score and postprocedure VAS score were recorded.

Results

The mean postprocedural pain (VAS) score between voiding instructed and noninstructed groups reached statistical significance: 3.06 ± 1.98 (Range, 2-5) and 5.16 ± 2.86 (Range, 4-8), respectively (P < 0.001). Preprocedure HAM-A score was similar between both groups. Postprocedure median HAM-A score was statistically significantly lower (mean 17.86 ± 2.8 vs. 19.76 ± 3.12; P < 0.001) in voiding instructed group.

Conclusion

Pain and anxiety level during cystourethroscopy examination in males can be significantly reduced when the patient is instructed to void during cystourethroscopy examination.

"Central Road" cystoscopic finding: The road to worsened incontinence following laparoscopic sacrocolpopexy

INTRODUCTION

This paper presents the "Central Road" cystoscopic finding accompanied by magnified mixed urinary incontinence following laparoscopic sacrocolopopexy.

CASE PRESENTATION

A 70-year-old female experienced severe mixed urinary incontinence upon completing laparoscopic sacrocolopopexy. The cystoscopy showed a cord-like appearance in the center of the bladder trigon and posterior wall. Videourodynamics confirmed stress urinary incontinence, and chain cystourethrography indicated that the proximal urethra was open and the posterior vesicourethral angle was atypically widened. After implanting a midurethral sling, mixed urinary incontinence was cured subjectively and objectively without medication.

CONCLUSION

The "Central Road" cystoscopic finding can be a signpost pointing to laparoscopic sacrocolopopexy mesh overtensioning, which can cause dekinking of the bladder neck, exacerbate stress urinary incontinence, and possibly lead to stress-induced instability. A midurethral sling successfully relieved mixed urinary incontinence in this case, but it might be necessary to loosen the laparoscopic sacrocolopopexy mesh in some other cases.

Potency and Sterility of 10% Sodium Fluorescein Injection, USP Stored in Sterile Polypropylene Syringes for Use During Cystoscopy

Background: A shortage of indigotindisulfonate sodium has led to a search for an alternative visualizing agent. Objective: The primary objective of this study was to evaluate the potency and sterility of 10% sodium fluorescein, USP solutions stored in sterile polypropylene syringes and refrigerated. Methods: Four samples of 10% fluorescein injection, USP were aseptically drawn up in 3 mL polypropylene syringes and stored in a refrigerator at an average temperature of 3.9°C for 7 days. After 7 days, the samples were cultured for microbial growth. Four other samples were assayed by UV/VIS spectroscopy. Concentration measurements were made at day 0 and at day 7. The pH was also measured at day 0 and day 7. Results: There was no statistical difference between the mean sodium fluorescein concentration at day 0 and at day 7 (α = 0.05, p = .622). There was no statistical difference in the pH of the samples at day 0 and at day 7 (α = 0.05, p = .0689). There was no evidence of microbial growth in any of the samples for the duration of the study period. Conclusions: The findings of this study demonstrate that a sterile solution of 10% sodium fluorescein, USP retained its potency and showed no signs of microbial growth for a period of 7 days when refrigerated and stored in sterile polypropylene syringes.

Evaluation of Spectra A and B Modes in Diagnosis of Suspicious Bladder Lesions

Background: White light imaging (WLI) cystoscopy, a "gold standard" for diagnosis of nonmuscle invasive bladder cancer (NMIBC), can miss ∼25% of bladder cancers. Spectra A (SA) and Spectra B (SB) are virtual optical chromoendoscopy modes introduced by Storz. Objective: To evaluate whether SA and SB improve over WLI in diagnosis of NMIBC. Design, Setting, and Participants: Storz Professional Image Enhancement System (SPIES) modes allow side-by-side viewing of WLI and spectra images. Cystoscopy images of some patients with suspected NMIBC and some normal cystoscopy findings were cut in two parts: one WLI and the other SA or SB. Each individual image was sent to the 3721 members of Urological Society of India separately through online survey. Histologic diagnosis was considered final diagnosis. Intervention: The observers were asked whether they considered the image to be cancer; yes, no, or cannot say were the three response options. Outcome Measures and Statistical Analysis: Primary outcome measure was improved diagnosis of NMIBC. Diagnostic efficacy was analyzed through 2 × 2 tables, McNemar test, and Fleiss Kappa. Results and Limitations: A total of 273 observers participated in the study. The sensitivities of WLI, SA, and SB were 89.81, 91.15, and 88.81, respectively. The specificities were 73.18, 66.17, and 68.68, respectively. In patients with cancer, both SA and SB improved the diagnostic efficacy of WLI. SA added significantly to the diagnostic accuracy over WLI (χ² = 12.23, p = 0.00046). SB also added significantly over WLI (χ² = 11.76, p = 0.0006). With increasing cancer grade, the sensitivity and negative predictive value of all modes increased. The major limitation of this study is the online diagnosis based on still images. Conclusions: In patients with cancer, SA and SB significantly add to the diagnostic accuracy of WLI. As compared with the negative WLI, if SA and SB are negative, NMIBC would be less likely.

Prevalence of bladder cancer in Costello syndrome: new insights to drive clinical decision-making

Costello syndrome (CS) is a rare disorder affecting development and growth characterized by cancer predisposition and caused by mutations in HRAS proto-oncogene. Somatic HRAS mutations drive bladder carcinogenesis. The aim of this study was to analyze prevalence and histological characterization of bladder cancer (BC) in a cohort of patients with CS to help clinicians plan effective management strategies. This study included 13 patients above 10 years of age with molecular diagnosis of CS. Screening cystoscopies (31 total procedures) were performed to exclude BC. Any lesion was analyzed through cold-cup biopsy or trans-urethral resection of the bladder. According to histology, patients were followed-up with urinalysis and abdominal ultrasound yearly, and cystoscopies every 12-24 months. During study enrollment, bladder lesions (often multifocal) were detected in 11/13 patients. Histological analysis documented premalignant lesions in 90% of cystoscopies performed, epithelial dysplasia in 71%, and papillary urothelial neoplasm of low malignant potential in 19%. Bladder cancers G1/low grade (Ta) were removed in 10%. Overall, 76% of patients showed a bladder lesion at first cystoscopy. The present findings document that individuals with CS aged 10 years and older have high prevalence of bladder lesions (premalignant/malignant), highlighting the importance of personalized screening protocols. This article is protected by copyright. All rights reserved.

Usefulness of a PC-Based Digitalized Recording System for Cystoscopy in Medical Education

PURPOSE

Multimedia can be used to understand the basic anatomy and pathological features of the bladder, providing more intuitive knowledge than traditional education methods. Cystoscopy is one of the most fundamental and important diagnostic procedures for detecting pathology in the bladder. Thus, we developed a PC-based digitalized recording device and electronic document to create an electronic medical record to perform cystoscopy and used them for medical education.

METHODS

To share them with an educatee, cystoscopic images from a camera unit were shown on the monitor of a personal computer, which was installed with an interface device with an S-VHS input. With these cystoscopic images, the operator could provide some information on important structures in the bladder, such as bilateral ureteral orifices, the verumontanum and the trigone to the educatee. Also, simple questionnaires were given to medical students to evaluate the effectiveness and value of this system.

RESULTS

Cystoscopic images could be transferred to the monitor with considerable ease and quality through the personal computer. This system was effective and valuable in teaching the normal anatomy and pathology of the bladder. Also, based on the results of the questionnaire, we concluded that this system provides high-quality images that are sufficient to relay medical information and is superior to traditional methods with regard to educational effectiveness and increasing one's understanding of medical diseases.

CONCLUSION

The PC-based recording system for cystoscopy substitutes for commercial recording devices for medical purposes, and provides sufficient medical information to medical students to allow them to understand the normal anatomy and pathological structure of the bladder.

Application of EUS-based techniques in the evaluation of pancreatic cystic neoplasms

Pancreatic cystic neoplasms (PCNs) are being detected increasingly frequently due to the widespread use of high-resolution abdominal imaging modalities. Some subtypes of PCNs have the potential for malignant transformation. Therefore, accurate diagnosis of PCNs is crucial to determine whether surgical resection or surveillance is the best management strategy. However, the current cross-section imaging modalities are not accurate enough to enable definite diagnoses. In the last decade, EUS-based techniques have emerged, aiming to overcome the limitations of standard cross-section imaging modalities. These novel EUS-based techniques were primarily designed to acquire distinct images to make radiological diagnoses, collect cyst fluid to undergo biochemical or molecular analyses, and obtain tissue to conclude the pathological diagnoses. In this article, we present a comprehensive and critical review of these emerging EUS techniques for the diagnosis of PCNs, with emphasis being placed on the advantages, feasibilities, diagnostic performances, and limitations of these novel techniques.

Pain modulation by audiovisual distraction during cystoscopy

Introduction:

Cystoscopy is one of the most common urological procedures used for either diagnostics, therapeutics, or for surveillance. It may be performed under local or general anesthesia. The procedure is associated with pain and discomfort.

Aims:

The aim of the study was to compare the levels of perceived pain during local cystoscopy with and without audiovisual distraction (AVD).

Methodology:

A randomized control study was performed at our academic hospital local cystoscopy theater of the urology division. Approximately half the patients already booked for the local rigid cystoscopy procedure were exposed to a distracting musical video during the procedure (study group), while the control group was not.

Statistical Analysis:

Descriptive statistics were used to determine percentage, mean, and standard deviation (SD) for categorical data. The Mann–Whitney U-test for nonparametric data was used for comparing pain levels.

Results:

A total of 91 patients participated in the study with 48 patients in the study group and 43 patients in the control group. The visual analog scale (VAS) ranged between 1 and 5/10 in the study group and 1–8/10 in the control group, while the mean VAS was 2.52 ± 1.2 SD in the study group and 4.97 ± 1.35 SD in the control group. The AVD intervention was statistically significant (P < 0.0001).

Conclusion:

AVD during local rigid cystoscopy is highly recommended, especially in patients undergoing the procedure for the first time.

Cystoscopy to remove an intrauterine contraceptive device embedded in the urinary bladder wall: a case report and literature review

Migration and embedding of an intrauterine contraceptive device (IUCD) in the urinary bladder wall is rare. We present such a case of a 30-year-old woman with complaints of persistent lower urinary tract symptoms and a history of IUCD placement 8 years earlier. The IUCD was successfully removed with cystoscopy alone. The patient recovered well and had her second baby after the surgery without complaints of new urinary symptoms.