Dynamic cystoscopy to optimize preoperative assessment of bladder endometriosis

PURPOSE

Bladder endometriosis (BE) accounts for 84% of cases of urinary tract involvement. The use of cystoscopy for preoperative evaluation is limited. The aim of this study was to evaluate the accuracy of preoperative dynamic cystoscopy (DC) in patients undergoing surgery for deep endometriosis and to describe the main findings and their impact on surgical planning.

MATERIALS AND METHODS

This cross-sectional observational study was conducted from January 2011 to March 2022. DC findings were divided into two groups according to the depth of involvement. To estimate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), laparoscopic findings of bladder involvement and histopathological report were used as the gold standard.

RESULTS

We included 157 patients in this study. 41 had abnormalities in DC. Of these, 39 had abnormalities that were confirmed intraoperatively. The sensitivity and specificity of the test were 58.21% and 97.78%, respectively. PPV was 95.12%, and NPV was 75.86%. The presence of any lesions in the DC had a diagnostic odds ratio (OR) of 61.28 for BE. Patients with BE type 2 had a higher rate of partial cystectomy than those with BE type 1 lesions (OR 9.72 CI 95% 1.9-49.1) Conclusion: DC appears to be a highly specific test with lower sensitivity. DC abnormalities are associated with a higher ratio of bladder surgery for the treatment of deep endometriosis, and BE type 2 seems to be associated with a greater ratio (9.72) of partial cystectomy.

Effect of temperature on fluidity of irrigation fluids

BACKGROUND

Fluid overload is a major complication during surgical hysteroscopy and transurethral resection of the prostate. We evaluated the role of temperature on absorption of the irrigation solution (IRRSOL) in endoscopic surgery when warm fluids are used to minimize hypothermia.

METHODS

We measured the density and dynamic fluidity of five IRRSOLs (0.9% saline, Ringer's lactate, 1.5% glycine, 5% dextrose, and 2.5/0.54% sorbitol/mannitol) at three different temperatures (17°C, 27°C, and 37°C). Next, a hypothetical typical endoscopic resection surgery was defined as the reference: total IRRSOL absorption (750 ml), resection time (30 min), and IRRSOL temperature (17°C). On the basis of Poiseuille's law, we calculated new values for intravasation using the predetermined dynamic fluidity values at 27°C and 37°C to assess the influence of the IRRSOL temperature on intravascular absorption (under identical conditions) and then estimated the time to reach fluid overload at each temperature with both electrolyte and non-electrolyte IRRSOLs.

RESULTS

Density and fluidity varied with temperature. In these specific conditions, when the temperature of the IRRSOL was increased from 17°C to 37°C, the mean absorption rate was predicted to increase about 54% and the theoretical 'safe' duration of surgery decreased by ∼65%, for both electrolyte and non-electrolyte IRRSOLs. The reduction in the 'safe' duration of surgery averaged 21.1 min for non-electrolyte IRRSOL (reduced from 60.0 to 38.9 min) and 35.2 min when electrolyte IRRSOLs were used (reduced from 100.0 to 64.8 min).

CONCLUSIONS

Compared with cold fluids, isothermic IRRSOL may increase the risk of fluid overload because dynamic viscosity decreases at higher temperatures.