Detection of recurrent bladder tumours by transrectal and abdominal ultrasound compared with cystoscopy

Correlation of transabdominal sonographic and cystoscopic findings in the diagnosis of focal abnormalities of the urinary bladder wall: a prospective study

OBJECTIVE

The aim of this study was to prospectively assess the diagnostic capabilities of transabdominal sonography performed with newer sonography machines for showing focal bladder wall abnormalities (FBWAs) detected on cystoscopy.

METHODS

One hundred twelve consecutive patients (97 male and 15 female; mean age, 68 years) underwent cystoscopy. Reasons for referral were macroscopic hematuria (44 cases [39%]), surveillance after transurethral resection (56 cases [49.5%]), and incidental sonographic findings (12 cases [11.5%]). One to 2 days before cystoscopy, sonography was carried out by a single operator who was blinded to clinical and recent sonographic findings. The presence, size, number, and location of FBWAs (eg, polypoid vegetations and asymmetric bladder wall thickening) were recorded and compared with cystoscopic and histologic findings.

RESULTS

One hundred ten patients with a histologic diagnosis were available for the study. Benign conditions, nontransitional tumors, and transitional tumors were found in 26.3%, 3.7% and 70% of the patients, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of sonography of cystoscopic lesions were 91.4%, 79.3%, 91.4%, 79.3%, and 88.2%. Cancers of 15 mm or smaller and flat tumors were often missed by sonography, whereas chronic cystitis accounted for most of the false-positive sonographic findings; however, sonography had poor capability of characterizing FBWAs, with specificity of 62%. In this respect, color Doppler findings proved of little aid as well.

CONCLUSIONS

In patients selected for cystoscopy, transabdominal sonography with newer sonography machines showed good diagnostic accuracy for focal alterations of the bladder wall found on cystoscopy.

Sonography of the bladder

Ultrasonography (US) is the method of choice for the diagnosis of bladder disease. It is superior to other imaging techniques, such as urography and cystography, in depicting certain structures and abnormalities. US examination of the bladder should include a study of the ureterovesical junction and the structures round the vesical neck. The examination technique may be transabdominal, transrectal or transvaginal, or transurethral. The bladder pathology that can be studied by US includes cystitis, calculi, clots, diverticula, trauma and tumors. The sensitivity and the specificity of the method are very high and sometimes superior to cystoscopy. Sonography can be used to explore patients with stress incontinence and those with abdominal trauma. The ureterovesical junction may be clearly examined by US and the pathology of the papilla clearly defined.

[Cystoscopic impression versus histologic diagnosis in bladder tumors. Do they coincide?]

OBJECTIVE

How quality control in a university hospital and immediatly after to resents publications; we planed to evaluation of the correlation of cystoscopy impression with the histologic diagnosis after of transurethral resection (TUR).

MATERIAL AND METHODS

To give more truthfulness to the study, we requested to all department member's, that to base in your experience to describe the endoscopic characteristic of the next bladder tumors groups: superficial and low-grade GI-II Ta, superficial and high-grade GIII Ta and high grade and/or T1-< T2. In a total of 172 patients, we evaluated the initial cystoscopy impression and we to compared it with histologic diagnosis after to TUR.

RESULTS

In 172 tumors the cystoscopy classifed in 69 cases how superficial and low grade GI-II Ta-T1, 40 how superficial and high grade and 55 how high grade and/or invasive tumors GIII T1-< T2. When, we compared it with the histologic diagnosis, the cystoscopy to coincided in 46 de 69 cases (66.6%) (PNS) with the group of low-grade GI-II Ta-T1 in 13 of 40 (32.5%) (P < 0.005) with the group of superficial high grade GIII Ta and 45 of 51 (88.2%) (PNS) with the group of GIII T1 and/or invasive tumors. In 15 of 172 the endoscopic description its not conclusive. And finally in 12 cases the histologic diagnosis were normal.

CONCLUSIONS

In order of this results, we to consider that in a university hospital is essential the histologic diagnosis before any therapeutic decision, because the initial cystoscopy impression have a low correlation with the histologic diagnosis. We are disagreement with recent publication that propose the outpatient cystoscopy with fulguration to base only to the cystoscopy impression.

Urinary basic fibroblast growth factor in patients with bladder cancer and benign prostatic hypertrophy

OBJECTIVE

To investigate the role of urinary measurements of an angiogenic factor, basic fibroblast growth factor (bFGF), in the assessment of patients with bladder cancer.

PATIENTS AND METHODS

Urine from 83 patients was assayed using a commercially available ELISA for bFGF. Thirty-eight patients had a bladder tumour and 21 had a history of bladder cancer but no disease at the time of testing. Twenty-four patients acted as controls, 16 of whom were about to undergo transurethral resection of the prostate (TURP) for benign prostatic hypertrophy (BPH) and eight who had no urological disease.

RESULTS

Median urinary bFGF was higher in patients with active bladder cancer than in those with a clear cystoscopy (5.20 and 2.13 ng/g creatinine, respectively; P < 0.005). Median urinary bFGF was also elevated in patients about to undergo TURP (4.52 ng/g creatinine). Using a threshold value of 6.0 ng/g creatinine, the sensitivity of the test for detecting cancer was 42% and specificity was 88%. At a threshold value of 4.0 ng/g the sensitivity was 62% and the specificity 70%.

CONCLUSION

The relationship between urinary basic FGF and the presence of bladder cancer was significant. The test is not sufficiently sensitive or specific to use as a screening test for bladder cancer but may be very useful in monitoring the effectiveness of systemic therapies in bladder cancer. Elevated levels of bFGF in the urine of patients about to undergo TURP suggests a role for bFGF in the pathogenesis of BPH.

Flexible cystoscopy compared with ultrasound in the detection of recurrent bladder tumours

A combination of transrectal and transabdominal ultrasound was compared with flexible cystoscopy as a means of detecting recurrent bladder tumours. The study group comprised 50 patients who had previously had rigid cystoscopy. They underwent combination ultrasound in the out-patient department 1 week before flexible cystoscopy. Combination ultrasound identified 25 patients with recurrent tumours and flexible cystoscopy identified 26. Thirty-four patients (68%) preferred ultrasound, 10 (20%) preferred flexible cystoscopy, 3 (6%) preferred general anaesthesia and rigid cystoscopy and 3 (6%) had no preference. The main objection to ultrasound was the use of the transrectal probe.

Ultrasonography compared with intravenous urography in the investigation of adults with haematuria

OBJECTIVE

To compare ultrasonography with intravenous urography in the investigation of adults with haematuria.

DESIGN

Prospective study entailing the examination of all patients with both investigations concurrently. The investigations were performed independently on routine lists by different duty radiologists. Each was aware of the details of the request form but not of the findings of the other investigation.

SETTING

Radiology department of a teaching hospital.

PATIENTS

155 Consecutive adult patients (aged 18-93) referred from general practitioners and hospital outpatient clinics with a history of haematuria.

FOLLOW UP

When results of both examinations proved normal no clinical or radiological follow up was sought. All abnormal findings of either investigation were correlated with results of subsequent imaging studies or operative findings.

RESULTS

81 Patients (52%) had normal findings on urography and ultrasonography. Overall, the findings of ultrasonography concurred with those of urography in 144 cases (93%). Among the discrepant findings of the two investigations ultrasonography missed two ureteric calculi; one was in a non-dilated ureter, and in the other case ultrasonography detected the secondary ureteric dilatation. Ultrasound examination alone detected four bladder tumours not visible on urography with sizes ranging from 5 to 21 mm, representing one fifth of the 20 cystoscopically proved bladder tumours detected in the series. Ultrasonography detected all the 22 neoplastic lesions discovered in the study (20 bladder, two renal). Ultrasonography clarified the nature of renal masses evident in three urograms (simple cysts).

CONCLUSIONS

Ultrasonography is a safe and accurate method of investigating the urinary tract in adults with haematuria. When combined with a single plain abdominal radiograph it proved to be superior to urography as the primary imaging study in this series. Ultrasonography should certainly be preferred to urography if cystoscopy is not planned. No urothelial tumours of the upper urinary tract were found in the series, reflecting their rarity. For those patients in whom ultrasonography and plain radiography have shown no abnormality and in whom cystoscopic appearances are normal urography would be advisable to exclude urothelial tumours of the upper urinary tract.