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Rentiya ZS, Francis D, Francis SM, Inban P, Raj R, Akuma O, Akuma CM, Montecino RMB, Singh M, Makheja K, Parkash O, Kottoor SJ. The Management of a Urinary Bladder Leak in a Patient with Radiation Cystitis. Radiol Case Rep 2024; 19:2429-2433. [PMID: 38585403 PMCID: PMC10997864 DOI: 10.1016/j.radcr.2024.02.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Urinary dysfunction following treatment for rectal adenocarcinoma is a common and complex complication. We present a case of a 69-year-old male who underwent laparoscopic-assisted left hemicolectomy and loop ileostomy after receiving chemotherapy and radiation therapy for rectal adenocarcinoma. Postoperatively, it was incidentally discovered the patient had urinary frequency and urgency. Cystoscopy revealed radiation changes to the bladder walls and a bladder leak was confirmed by cystogram. The patient underwent successful repair of the urinary bladder leak, with challenges posed by prior radiation therapy. Effective prevention and management strategies for urinary dysfunction require a comprehensive preoperative risk assessment, consideration of nerve-preserving surgical techniques, and prompt identification and repair of postoperative complications.
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Affiliation(s)
- Zubir S. Rentiya
- University of Virginia, Department of Radiation Oncology & Radiology, Charlottesville, VA, USA
- MedStar Georgetown University Hospital, Department of Surgery, Washington, DC, USA
| | - Deepa Francis
- Windsor University School of Medicine, Department of Internal Medicine, Cayon, St. Kitts and Nevis
| | - Sandra Mary Francis
- Windsor University School of Medicine, Department of Internal Medicine, Cayon, St. Kitts and Nevis
| | | | - Rohan Raj
- Nalanda Medical College and Hospital, Department of Internal Medicine, Patna, India
| | - Ogbonnaya Akuma
- Ebonyi State University, Department of Internal Medicine, Abakaliki, Nigeria
| | - Chinaza Mercy Akuma
- Nnamdi Azikiwe University, Department of Internal Medicine, Awka, Anambra state, Nigeria
| | | | - Manjeet Singh
- Liaquat National Medical College, Department of Internal Medicine, Karachi, Pakistan
| | - Kainat Makheja
- Jinnah Sindh Medical University, Department of Internal Medicine, Karachi, Pakistan
| | - Om Parkash
- Chandka Medical College, Department of Internal Medicine, Larkana, Pakistan
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Hannemann A, Pessoa RR, Flaig T, Kuna EM, Warren A, Robin T, Kim SP, Ballon-Landa E. Cost of upper tract imaging obtained during hematuria evaluation: Analysis of a national claims database. Urol Oncol 2024:S1078-1439(24)00364-8. [PMID: 38679529 DOI: 10.1016/j.urolonc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/14/2023] [Accepted: 03/10/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION To investigate the actual cost of hematuria evaluation using nationally representative claims data, given that the workup for hematuria burdens the healthcare system with significant associated costs. We hypothesized that evaluation with contrast-enhanced computed tomography (CT) confers more cost to hematuria evaluation than renal ultrasound (US). METHODS Using a national, privately insured database (MarketScan), we identified all individuals with an incident diagnosis of hematuria. We included patients who underwent cystoscopy and upper tract imaging within 3 months of diagnosis. We tabulated the costs of the imaging study as well as the total healthcare cost per patient. A multivariable model was developed to evaluate patient factors associated with total healthcare costs. RESULTS We identified 318,680 patients with hematuria who underwent evaluation. Median costs associated with upper tract imaging were $362 overall, $504 for CT with contrast, $163 for US, $680 for magnetic resonance imaging (MRI), $283 for CT without contrast, and $294 for retrograde pyelogram. Median cystoscopy cost was $283. Total healthcare costs per patient were highest when utilizing MRI and CT imaging. When adjusted for comorbidities, the use of any imaging other than ultrasound was associated with higher costs. CONCLUSIONS In this nationally representative analysis, hematuria evaluation confers a significant cost burden, while the primary factor associated with higher costs of screening was imaging type. Based upon reduced cost of US-based strategies, further investigation should delineate its cost-effectiveness in the diagnosis of urological disease.
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Affiliation(s)
| | | | | | - Elizabeth Molina Kuna
- CU Anschutz School of Medicine, Aurora, CO; University of Colorado Cancer Center, Population Health Shared Resource, Aurora, CO
| | - Adam Warren
- University of Colorado Cancer Center, Population Health Shared Resource, Aurora, CO
| | | | | | - Eric Ballon-Landa
- CU Anschutz School of Medicine, Aurora, CO; Rocky Mountain Regional VA Medical Center, Aurora, CO.
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Kim JS, Lee J, Nguyen TT, Choi SY. Optimal timing for the first cystoscopic follow-up using time-to-treatment initiation analysis of oncologic outcomes in primary non-muscle invasive bladder cancer. Sci Rep 2024; 14:8440. [PMID: 38600160 PMCID: PMC11006935 DOI: 10.1038/s41598-024-58809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
Various guidelines recommend the first follow-up cystoscopy at 3 months; however, no data exist on the optimal timing for initial follow-up cystoscopy. We tried to provide evidence on the timing of the first cystoscopy after the initial transurethral resection of bladder tumor (TUR-BT) for patients with non-muscle invasive bladder cancer (NMIBC) using big data. This was a retrospective National Health Insurance Service database analysis. The following outcomes were considered: recurrence, progression, cancer-specific mortality, and all-cause mortality. Exposure was the time-to-treatment initiation (TTI), a continuous variable representing the time to the first cystoscopy from the first TUR-BT within 1 year. Additionally, we categorized TTI (TTIc) into five levels: < 2, 2-4, 4-6, 6-8, and 8-12 months. A landmark time of 1 year after the initial TUR-BT was described to address immortal-time bias. We identified the optimal time for the first cystoscopy using Cox regression models with and without restricted cubic splines (RCS) for TTI and TTIc, respectively. Among 26,660 patients, 16,880 (63.3%) underwent cystoscopy within 2-4 months. A U-shaped trend of the lowest risks at TTI was observed in the 2-4 months group for progression, cancer-specific mortality, and all-cause mortality. TTI within 0-2 months had a higher risk of progression (aHR 1.36; 95% confidence intervals [CI] 1.15-1.60; p < 0.001) and cancer-specific mortality (aHR 1.29; 95% CI 1.05-1.58; p = 0.010). Similarly, TTI within 8-12 months had a higher risk of progression (aHR 2.09; 95% CI 1.67-2.63; p < 0.001) and cancer-specific mortality (aHR 1.96; 95% CI 1.48-2.60; p < 0.001). Based on the RCS models, the risks of progression, cancer-specific mortality, and all-cause mortality were lowest at TTI of 4 months. The timing of the first cystoscopy follow-up was associated with oncologic prognosis. In our model, undergoing cystoscopy at 4 months has shown the best outcomes in clinical course. Therefore, patients who do not receive cystoscopy at approximately 4 months for any reason need more careful follow-up to predict a poor clinical course.
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Affiliation(s)
- Jeong-Soo Kim
- Department of Applied Statistics, Chung-Ang University, Seoul, South Korea
| | - Jooyoung Lee
- Department of Applied Statistics, Chung-Ang University, Seoul, South Korea
| | - Tuan Thanh Nguyen
- Department of Urology, Cho Ray Hospital, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
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Taguchi M, Yasuda K, Kinoshita H. The optimal stent pusher position to achieve successful ureteral stent insertion under fluoroscopic guidance. Asian J Urol 2024; 11:311-315. [PMID: 38680589 PMCID: PMC11053324 DOI: 10.1016/j.ajur.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/29/2022] [Indexed: 05/01/2024] Open
Abstract
Objective To examine factors to predict the optimal stent pusher position when inserting ureteral stents under fluoroscopy. Methods We retrospectively reviewed 327 patients who underwent ureteral stent insertion. We considered the pubic bone as a useful anatomical landmark to insert ureteral stents under fluoroscopic guidance. Thus, we categorized patients into three groups (proximal, middle, and distal groups) according to the position of the radiopaque tip of the push catheter when inserting the ureteral stent. Success was defined as a completely curled ureteral stent tail. We compared stent insertion success rates among the three groups. A multivariate analysis was performed to identify the factors affecting stent insertion success. Results In men, 36 (63.2%) cases were deemed successful in the proximal group compared with 40 (80.0%) cases in the middle group and 12 (20.7%) cases in the distal group (p<0.001). In women, 26 (45.6%) cases were deemed successful in the proximal group compared with 54 (98.2%) cases in the middle group and 38 (76.0%) cases in the distal group (p<0.001). With the multivariate analysis, the stent pusher position was the most significant factor influencing successful stent insertion (men: odds ratio 6.00, 95% confidence interval 2.66-13.51, p<0.001; women: odds ratio 37.80, 95% confidence interval 4.94-289.22, p<0.001). Conclusion The position of the stent pusher affects stent insertion success. The middle of the pubic symphysis is the optimal position for the radiopaque tip of the pusher when inserting ureteral stents under fluoroscopic guidance.
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Affiliation(s)
- Makoto Taguchi
- Department of Urology, Osaka Saiseikai Izuo Hospital Based on Social Welfare Organization “Saiseikai” Imperial Gift Foundation Inc., Osaka, Japan
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kaneki Yasuda
- Department of Urology, Osaka Saiseikai Izuo Hospital Based on Social Welfare Organization “Saiseikai” Imperial Gift Foundation Inc., Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
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Ceyhan E, Mammadov E, Onder SC, Dogan HS, Tekgul S. Fish: A Promising Screening Tool for Malignancy After Augmentation Cystoplasty? J Pediatr Surg 2024; 59:725-730. [PMID: 38065750 DOI: 10.1016/j.jpedsurg.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Malignancy after augmentation cystoplasty (AC) is reported up to 5.5 %. We assessed the use of urine fluorescence in situ hybridization (FISH) screening for bladder malignancy after AC. PATIENTS AND METHODS In this study, 36/98 patients under follow-up who have completed tenth year after ileal AC were included prospectively. Twenty-four (66.7 %) patients were tested with FISH initially and overall 28 (77.8 %) patients with conventional cytology (CC). Twenty-four (66.7 %) patients with FISH analysis also had cytology analysis. Blinded from the cytology results, 32 (88.9 %) patients who were consented underwent cystoscopy with random biopsy (native bladder, ileal segment, ileovesical junction). Two patients those were tested with FISH did not consented cystoscopy. This study was registred to the government registry (No: 71146310). RESULTS Mean follow-up time after AC was 15.4 ± 4.8 years. 2/32 (5.6 %) patients were diagnosed with adenocarcinoma in cyctoscopic biopsy. FISH analysis of 3/24 (12.5 %) patients demonstrated abnormal findings consistent with malignancy. Two FISH malignant patients were patients who had adenocarcinoma. The third patient's biopsy was benign and the third year control cystoscopy was normal. 2/4 patients with malignant CC had adenocarcinoma and 2/4 patients had benign biopsy. The sensitivity and specificity of FISH in our series were 100 % and 95 % respectively. Whereas the sensitivity and specificity of CC was 100 % and 91.6 % respectively. CONCLUSION Despite limited number of patients in this study, FISH showed higher specificity than CC in this series. FISH is a promising tool for malignancy screening after AC. TYPE OF STUDY Diagnostic Studies. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Erman Ceyhan
- Hacettepe University Faculty of Medicine, Department of Urology, Ankara, Turkey.
| | - Emin Mammadov
- Hacettepe University Faculty of Medicine, Department of Urology, Ankara, Turkey
| | - Sevgen Celik Onder
- Hacettepe University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Hasan Serkan Dogan
- Hacettepe University Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Ankara, Turkey
| | - Serdar Tekgul
- Hacettepe University Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Ankara, Turkey
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Roman H, Braund S, Hennetier C, Celhay O, Pasquier G, Kade S, Dennis T, Merlot B. Combined Cystoscopic-Abdominal Versus Abdominal-Only Route for Complete Excision of Large Deep Endometriosis Nodules Infiltrating the Supratrigonal Area of the Bladder: A Comparative Study. J Minim Invasive Gynecol 2024; 31:295-303. [PMID: 38244721 DOI: 10.1016/j.jmig.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
STUDY OBJECTIVE Surgical excision of large deep endometriosis nodules infiltrating the bladder may be challenging, particularly when the nodule limits are close to the trigone and ureteral orifice. Bladder nodules have classically been approached abdominally. However, combining a cystoscopic with an abdominal approach may help to better identify the mucosal borders of the lesion to ensure complete excision without unnecessary resection of healthy bladder. This study aimed to compare classical excision of large bladder nodules by abdominal route with a combined cystoscopic-abdominal approach. DESIGN Retrospective comparative study on data prospectively recorded in a database. Patients were managed from September 2009 to June 2022. SETTING Two tertiary referral endometriosis centers. PATIENTS A total of 175 patients with deep endometriosis infiltrating the bladder more than 2 cm undergoing surgical excision of bladder nodules. INTERVENTIONS Excision of bladder nodules by either abdominal or combined cystoscopic-abdominal approaches. MEASUREMENTS AND MAIN RESULTS A total of 141 women (80.6%) were managed by abdominal route and 34 women (19.4%) underwent a combined cystoscopic-abdominal approach. In 99.4% of patients, the approach was minimally invasive. Patients with nodules requiring the combined approach had a lower American Fertility Society revised score and endometriosis stage and less associated digestive tract nodules, but larger bladder nodules. They were less frequently associated with colorectal resection and preventive stoma. Operative time was comparable. The rate of early postoperative complications was comparable (8.8% vs 22%), as were the rates of ureteral fistula (2.2% vs 2.9%), bladder fistula (2.2% vs 0), and vesicovaginal fistula (0.7% vs 2.9%). CONCLUSION In our opinion, the combined cystoscopic-abdominal approach is useful in patients with large bladder nodules with limits close to the trigone and ureteral orifice. These large deep bladder nodules seemed paradoxically associated to less nodules on the digestive tract, resulting in an overall comparable total operative time and complication rate.
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Affiliation(s)
- Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute (Drs. Roman, Dennis, and Merlot), Clinique Tivoli-Ducos, Bordeaux, France; Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark (Dr. Roman); Franco-European Multidisciplinary Endometriosis Institute - Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Dr. Roman, Kade, and Dr. Merlot).
| | - Sophia Braund
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Drs. Braund and Hennetier)
| | - Clotilde Hennetier
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Drs. Braund and Hennetier)
| | - Olivier Celhay
- Department of Urology (Dr. Celhay), Clinique Tivoli-Ducos, Bordeaux, France
| | - Geoffroy Pasquier
- Department of Urology, Clinique Mathilde, Rouen, France (Dr. Pasquier)
| | - Sandesh Kade
- Franco-European Multidisciplinary Endometriosis Institute - Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Dr. Roman, Kade, and Dr. Merlot)
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute (Drs. Roman, Dennis, and Merlot), Clinique Tivoli-Ducos, Bordeaux, France
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute (Drs. Roman, Dennis, and Merlot), Clinique Tivoli-Ducos, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute - Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Dr. Roman, Kade, and Dr. Merlot)
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Haislip I, Rindorf D, Cool C, Tester B. Workflow efficiencies for flexible cystoscopy: comparing single-use vs reusable cystoscopes. BMC Urol 2024; 24:53. [PMID: 38448827 PMCID: PMC10918871 DOI: 10.1186/s12894-024-01436-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/20/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Flexible cystoscopy is a common procedure to diagnose and treat lower urinary tract conditions. Single-use cystoscopes have been introduced to eliminate time-consuming reprocessing and costly repairs. We compared the hands-on labor time differences between flexible reusable cystoscopes versus Ambu's aScope™ 4 Cysto (aS4C) at a large urology Ambulatory Surgery Center (ASC). METHODS Reusable and single-use cystoscopy procedures were shadowed for timestamp collection for setup and breakdown. A subset of reusable cystoscopes were followed through the reprocessing cycle. T-tests were calculated to measure the significance between groups. RESULTS The average hands-on time necessary for reusable cystoscope preparation, breakdown, and pre-cleaning was 4'53″. Of this, 2'53″ were required for preparation, while 2'0″ were required for breakdown and pre-cleaning. The average hands-on time for reprocessing for reusable was 7'1" per cycle. The total time for single-use scopes was 2'22″. Of this, 1'36″ was needed for single-use preparation, and 45 s for breakdown. Compared to reusable cystoscopes, single-use cystoscopes significantly reduced pre and post-procedure hands-on labor time by 2'31", or 48%. When including reprocessing, total hands-on time was 80% greater for reusable than single-use cystoscopes. CONCLUSION Single-use cystoscopes significantly reduced hands-on labor time compared to reusable cystoscopes. On average, the facility saw a reduction of 2'31″ per cystoscope for each procedure. This translates to 20 additional minutes gained per day, based on an 8 procedures per day. Utilizing single-use cystoscopes enabled the facility to reduce patient wait times, decrease turnaround times, and free up staff time.
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Affiliation(s)
- Ian Haislip
- Ambu USA, Health Economist, 6271 Columbia Gateway Drive, Suite 200, Columbia, MD, 21046, USA.
| | | | - Christina Cool
- Ambu USA, Health Economist, 6271 Columbia Gateway Drive, Suite 200, Columbia, MD, 21046, USA
- Ambu USA, Columbia, MD, USA
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Miyake M, Nishimura N, Nishioka Y, Fujii T, Oda Y, Miyamoto T, Tomizawa M, Shimizu T, Owari T, Ohnishi K, Hori S, Morizawa Y, Gotoh D, Nakai Y, Torimoto K, Tanaka N, Imamura T, Fujimoto K. Clinical impact of the intensity of follow-up cystoscopy in patients with high-risk non-muscle-invasive bladder cancer. Int Urol Nephrol 2024; 56:827-837. [PMID: 37910382 DOI: 10.1007/s11255-023-03851-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE There is significant lack on evidence regarding the effect of non-adherence to a recommended protocol in follow-up of high-risk non-muscle-invasive bladder cancer (NMIBC), or the impact of delaying detection of recurrent lesion. Here, we aimed to investigate the optimal frequency of follow-up cystoscopy of high-risk NMIBC with respect to oncological safety in the Japanese real-world clinical practice. METHODS This retrospective single-center study included 206 patients with primary high-risk NMIBC. The intensity (%) of follow-up cystoscopy was calculated based on actual visits for cystoscopy and guideline-recommended frequency in the first 24-month follow-up period. Inverse probability of treatment weighting analyses was used to reduce the risk of bias between groups. We performed a restricted cubic spline analysis with knots at intensity of follow-up cystoscopy ≤ 100% group to examine the possible association of progression risk with the intensity of follow-up as a continuous exposure. RESULTS The median intensity was 87.5% (interquartile range, 75-100). Adjusted multivariate analysis for MIBC-free and progression-free survival demonstrated no significant difference between adjusted ≤ 75% and > 75% intensity groups. A restricted cubic spline analysis suggested no significant effect of the intensity of follow-up on progression risk, and hazard ratios of patients of < 100% intensity were equivalent to those of patients of 100% intensity. CONCLUSION Our finding suggested decreased intensity of follow-up cystoscopy did not affect oncological outcomes in patients with high-risk NMIBC. Further prospective trials directly aimed at investigating optimized follow-up schedules for NMIBC are mandatory before substantial changes to existing clinical guidelines.
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Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Yuki Oda
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tatsuki Miyamoto
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Takuya Owari
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kenta Ohnishi
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
- Department of Prostate Brachytherapy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Abu Alwafa R, Aghbar A, Akkawi M, Maree M, Alami I, Abushamma F. Primary intravesical insertion of intrauterine device for 10 years: Clinical presentation and outcome. Urol Case Rep 2024; 53:102666. [PMID: 38352161 PMCID: PMC10861947 DOI: 10.1016/j.eucr.2024.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/16/2024] Open
Abstract
Intrauterine device (IUD) is considered the second most widely used method of contraception. Migration of the IUD into the urinary system has been reported. Nevertheless, a missed IUD which is mistakenly inserted into the bladder has rarely been reported. We report a female patient experienced recurrent urinary tract infection (UTI) for 10 years without appropriate evaluation. The underlying problem was an IUD that inserted into the bladder led to the formation of bladder stone. The clinical course and the endoscopic management of the stone and the IUD is reviewed in this case report.
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Affiliation(s)
- Rola Abu Alwafa
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Amir Aghbar
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Maha Akkawi
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Pathology, An-Najah National University Hospital, 44839, Nablus, Palestine
| | - Mosab Maree
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Radiology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Ibrahim Alami
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Faris Abushamma
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Urology, An-Najah National University Hospital, Nablus, 44839, Palestine
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Barba M, Cola A, Costa C, Frigerio M. Impact of Mannitol Bladder Distension in the Intraoperative Detection of Ureteral Kinking During Pelvic Floor Surgery. Int Urogynecol J 2024; 35:689-694. [PMID: 38393333 PMCID: PMC11024013 DOI: 10.1007/s00192-024-05745-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Ureteral injuries are the most feared complications of gynecological surgery and therefore intraoperative recognition is of the utmost importance. Intraoperative cystoscopy represents the diagnostics of choice to investigate ureteral patency thanks to the direct visualization of ureteral flows after administration of infusion mediums. In this study, we aimed to compare the diagnostic performance of saline versus mannitol intraoperative cystoscopy in terms of false negatives in a large cohort of patients. METHODS We retrospectively analyzed data of patients who underwent vaginal hysterectomy and high uterosacral ligament suspension for POP. Patients were divided in two groups based on the use of saline or mannitol medium for intraoperative cystoscopy. Postoperative daily control of serum creatinine was performed until discharge, as well as urinary tract imaging, in symptomatic patients. RESULTS A total of 925 patients underwent vaginal hysterectomy followed by high USL suspension for POP. Saline and mannitol medium were used in 545 patients and 380 patients respectively. Postoperative ureteral injuries were identified in 12 patients, specifically in 2% of the saline group and in 0.3% of the mannitol group. CONCLUSIONS The use of mannitol instead of saline as a bladder distension medium was able to significantly reduce the occurrence of postoperative ureteral sequelae.
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Affiliation(s)
- Marta Barba
- Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Alice Cola
- Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Clarissa Costa
- Milano-Bicocca University, Via G.B. Pergolesi 33, 20900, Monza, Italy.
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11
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Keltner C, Causbie J, Haynes R, Mandia J, Imad H, Matsee W. Surveillance cystoscopy for atypical Schistosoma haematobium infection associated with recurrent UTIs. Travel Med Infect Dis 2024:102702. [PMID: 38423232 DOI: 10.1016/j.tmaid.2024.102702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Case Keltner
- Department of Public Health, Madigan Army Medical Center, Washington, USA.
| | | | - Robert Haynes
- Department of Public Health, Madigan Army Medical Center, Washington, USA
| | - Jeremy Mandia
- Department of Public Health, Madigan Army Medical Center, Washington, USA
| | - Hisham Imad
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wasin Matsee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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12
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Stærk K, Langhorn L, Halle B, Andersen TE. Urinary bladder catheterisation of female pigs: Influence of bladder content and Escherichia coli urinary tract infection on procedural outcome. Lab Anim 2024:236772231169344. [PMID: 38334709 DOI: 10.1177/00236772231169344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Catheterisation of the urinary bladder is needed in many types of human disease models in pigs. Based on our extensive experience with the pig as an infection model, we here demonstrate an approach of catheterising domestic pigs (40 attempts) and Göttingen minipigs (10 attempts) using a blinded method, that is, without speculums or videoscopes to visualise the urethral opening. The procedure was tested on control animals and pigs with experimental Escherichia coli urinary tract infection (UTI) to assess the potential influence of this condition on procedural outcome. Lastly, we performed cystoscopy in three animals to visualise the route to the urethra and to localise potential anatomical obstacles. All domestic pigs were catheterised successfully in an average of 2 minutes and 23 seconds, and this was not influenced by UTI (p = 0.06) or bladder urine content at the time of catheterisation (p = 0.32). All Göttingen minipigs were successfully catheterised in an average of 4 minutes and 27 seconds. We conclude that blinded catheterisation is a fast and reliable approach that can be performed in pigs with or without UTI with minimal risk of trauma or contamination.
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Affiliation(s)
- Kristian Stærk
- Department of Clinical Microbiology, Odense University Hospital, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Denmark
| | - Louise Langhorn
- Biomedical laboratory, University of Southern Denmark, Denmark
| | - Bo Halle
- Department of Neurosurgery, Odense University Hospital, Denmark
| | - Thomas Emil Andersen
- Department of Clinical Microbiology, Odense University Hospital, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Denmark
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13
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Shah CP, Lord-McKenzie T, Makris A, Trail M, Gray J, Smith G, Mariappan P. The Value of Negative Urinary Dipstick Tests for Haematuria in Patients Undergoing Surveillance for Low-grade Ta Urothelial Cancer: A Two-stage Prospective Clinical Study in 524 Patients. EUR UROL SUPPL 2024; 60:24-31. [PMID: 38375346 PMCID: PMC10874875 DOI: 10.1016/j.euros.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 02/21/2024] Open
Abstract
Background and objective The risk of first recurrence beyond 5 yr for patients with low-grade (LG) Ta non-muscle-invasive bladder cancer (NMIBC) is low enough to consider discontinuing cystoscopic surveillance at that point. However, a positive urinary dipstick test for haematuria (UDH) during and beyond the period of cystoscopic surveillance can disrupt plans to cease surveillance because the association between UDH positivity and recurrence in LG Ta NMIBC is unknown. In a two-stage study, we evaluated this association and explored the role of UDH negativity in predicting the absence of recurrence. Methods Because of previously demonstrated changes in recurrence patterns over time, two prospective cohorts were assessed: an "exploratory" cohort (January 2007-March 2008) and a "validation" cohort (November 2017-August 2018). UDH was performed before flexible cystoscopy. Patient, operative, and surveillance data have been recorded prospectively using standard pro forma sheets since 1978 in our institution. Only patients with primary LG Ta pTa NMIBC were included for analysis. Key findings and limitations We assessed 231 patients in the exploratory group and 293 in the validation group. The proportion of smokers (67% vs 70%; p = 0.5) and mean follow-up (72.2 vs 79.9 mo; p = 0.2) were similar between the groups. The recurrence rate was higher in the exploratory group (19% vs 11%; p = 0.009), as was the UDH positivity rate (37% vs 11%; p < 0.001). The specificity and negative predictive value were 64% and 83% in the exploratory group, and 90% and 90%, respectively, in the validation group. These values increased further for the subgroup with solitary primary tumours the subgroup without recurrence for 3 yr. Conclusions and clinical implications UDH negativity has a high probability of being associated with the absence of recurrence in small LG Ta NMIBC and could be an inexpensive adjunct during surveillance. Ongoing validation, which started in 2019, is being performed in a now-nationalised Scottish protocol in which UDH replaces cystoscopy in years 2 and 4 for patients in the low-risk group. Patient summary We investigated the accuracy of a dipstick test for blood in the urine for patients undergoing surveillance for low-grade noninvasive bladder cancer. We found that a negative dipstick test result was highly associated with the absence of tumour recurrence, particularly for patients with the lowest risk. These findings have been introduced into a national protocol designed to reduce the frequency of telescopic inspection of the bladder during surveillance to reduce the burden for patients.
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Affiliation(s)
- Chandrarajan Premal Shah
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
- The University of Edinburgh, Edinburgh, UK
| | - Tanya Lord-McKenzie
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
| | - Antonios Makris
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Matthew Trail
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Jennifer Gray
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
| | - Gordon Smith
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
- The University of Edinburgh, Edinburgh, UK
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Latta K. [Macrohematuria in children and adolescents]. Urologie 2024; 63:149-157. [PMID: 38117295 DOI: 10.1007/s00120-023-02254-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Abstract
Hematuria is usually only noticed early in the case of macrohematuria. In around half of affected children, macrohematuria is caused by a urinary tract infection. In all other cases, a careful diagnosis is required. In addition to a detailed medical history, this builds upon a precise examination of the urine (microscopy, quantitative determination of proteinuria [mg albumin/g creatinine in spontaneously voided urine]) and measurement of blood pressure. The work-up usually includes sonography as the primary imaging modality. Invasive diagnostic tests using cystoscopy are only necessary in exceptional cases. If there is evidence of glomerulonephritis, a kidney biopsy may be indicated. Careful attention should be given to persisting microhematuria (> 6 months) and Alport syndrome should be confirmed or ruled out. Heterozygotic Alport syndrome can also be a possible cause of chronic renal failure.
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Affiliation(s)
- Kay Latta
- Clementine Kinderhospital, Theobald Christ Str. 16, 60316, Frankfurt am Main, Deutschland.
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15
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Marzuillo P, Belfiore MP, Di Sessa A, Torino G, Roberti A, Balzano M, Reginelli A, Cappabianca S, Miraglia Del Giudice E, La Manna A, Guarino S, Di Iorio G. Indirect signs of infravesical obstruction on voiding cystourethrography improve post-neonatal posterior urethral valves detection rate. Eur Radiol 2024; 34:780-787. [PMID: 37597029 PMCID: PMC10853084 DOI: 10.1007/s00330-023-10126-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/12/2023] [Accepted: 07/04/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES To identify the diagnostic performance of clinical and radiological signs (on voiding cystourethrography [VCUG]) to detect posterior urethral valves (PUV) in the post-neonatal period. MATERIALS AND METHODS One hundred eighteen males (median age = 0.8 years, range = 1 month-14 years, 48 toilet-trained) undergoing VCUG in a 2-year period were prospectively enrolled. Direct (dilated posterior urethra) and indirect (hypertrophied bladder neck, musculus interuretericus hypertrophy, and trabeculated appearance of the bladder wall) PUV signs on VCUG were assessed. Uroflowmetry was defined pathological by patterns suggesting infravesical obstruction. RESULTS Twenty-two patients with direct, 28 with indirect PUV signs on VCUG, and one with normal VCUG but persisting micturition symptoms with pathological uroflowmetry underwent urethrocystoscopy and in 43/51 a PUV diagnosis was made (n = 22, 51.2%, with direct PUV signs). In 8/28 patients with indirect signs, PUV were not confirmed. Among non-toilet-trained patients, none of the clinical signs/symptoms was associated with PUV while among toilet-trained patients only pathological uroflowmetry (odds ratio, OR = 4.0 [95% confidence interval:1.2-13.2; p = 0.02]) and pathological uroflowmetry with history of urinary tract infection (OR = infinity) were significantly associated with PUV. Significant associations with PUV of direct and indirect signs on VCUG were found both in toilet-trained and non-toilet trained patients. Direct PUV sign had 100% specificity and sensitivity while indirect PUV signs showed sensitivity = 58.1% and specificity = 89.3%. The absence of any radiological sign had a negative predictive value = 98.5%. CONCLUSION Only half of patients with endoscopy-confirmed PUV presents with direct sign of PUV on VCUG. Accounting for indirect PUV signs on VCUG and pathological uroflowmetry (in toilet-trained children) could improve the PUV detection rate. CLINICAL RELEVANCE STATEMENT Indirect radiological PUV signs should be valorized when interpreting VCUG to improve the PUV detection rate. The absence of any radiological PUV (direct and indirect) sign on VCUG excludes PUV with a very high negative predictive value. KEY POINTS • Worldwide agreement is that a non-dilated urethra on voiding cystourethrography excludes obstruction. • Half of patients with posterior urethral valves have non-dilated urethra on voiding cystourethrography. • Accounting for indirect signs of posterior urethral valves on voiding cystourethrography improves the diagnostic performance.
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Affiliation(s)
- Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
| | - Maria Paola Belfiore
- Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Giovanni Torino
- Pediatric Urology Unit, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Agnese Roberti
- Pediatric Urology Unit, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
| | - Marialuisa Balzano
- Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Angela La Manna
- Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Giovanni Di Iorio
- Pediatric Urology Unit, "Santobono-Pausilipon" Children's Hospital, Naples, Italy
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Garaz R, Stühler V, Stenzl A, Rottscholl R, Amend B. Hemangioma of the Urinary Bladder: A Brief Narrative Review of Their Diagnosis, Histology, and Treatment Options. Urol Int 2024; 108:83-88. [PMID: 38228116 DOI: 10.1159/000536057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Hemangioma of the urinary bladder is a rare benign tumor. Although benign, their presenting symptoms are alarming for both patients and doctors, and their rarity makes them challenging to correctly diagnosis and treat. This review paper summarizes current knowledge about hemangioma of the urinary bladder, treatment options, and follow-up modalities. SUMMARY After the kidney, the bladder is the second most common location of hemangiomas in the urinary tract. There is painless gross hematuria on clinical presentation once the lesion has eroded the urothelium. Magnetic resonance imaging (MRI) has been reported to be valuable in diagnosing soft-tissue hemangiomas. Cystoscopic findings of a sessile, blue, multilocular mass suggest hemangioma. Most tumors are solitary, smaller than 3 cm, and have smooth or irregular surfaces. Histologically, lesions comprise numerous proliferative capillaries with thin-walled, dilated, blood-filled vessels lined with flattened endothelium. The treatment of patients with hemangioma has been controversial. It depends on the tumor size and the degree of penetration. The prognosis of these tumors is excellent. KEY MESSAGES Despite the widespread use of MRI, CT, and endoscopy in evaluating hematuria, hemangioma remains one of the rarest bladder tumors. Moreover, only a histological examination can confirm the diagnosis. Transurethral resection, fulguration, and YAG laser ablation are standard treatments for small tumors. In terms of follow-up, cystoscopy after 6 months of treatment helps assess recurrence. In addition, MRI is a practical, noninvasive technique for follow-up of small hemangiomas.
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Affiliation(s)
- Radion Garaz
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Viktoria Stühler
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Robert Rottscholl
- Department of Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Bastian Amend
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
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17
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Ma J, Roumiguie M, Hayashi T, Kohada Y, Zlotta AR, Lévy S, Matsumoto T, Sano T, Black PC. Long-term Recurrence Rates of Low-risk Non-muscle-invasive Bladder Cancer-How Long Is Cystoscopic Surveillance Necessary? Eur Urol Focus 2024; 10:189-196. [PMID: 37442722 DOI: 10.1016/j.euf.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/02/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND While low-risk non-muscle-invasive bladder cancer (LR-NMIBC) has a low propensity to progress, the risk of recurrence remains high (50% within 4 yr). Guidelines recommend cystoscopic surveillance after resection, but the necessary duration of follow-up is debated. OBJECTIVE To determine the risk of recurrence beyond 5 yr after diagnosis in patients with LR-NMIBC, and to identify risk factors of recurrence. DESIGN, SETTING, AND PARTICIPANTS In this multicenter retrospective observational study, patients who received their first transurethral bladder tumor resection before 2016 for LR-NMIBC were included. Low risk was defined as a primary, solitary, low grade, Ta bladder tumor measuring <3 cm. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was determination of the recurrence rates at 1, 2, and 5 yr. The secondary endpoints included overall recurrence-free survival (RFS) and high-risk RFS. A univariate analysis and multivariable logistic regression were performed to assess the risk factors for recurrence over the study period. RESULTS AND LIMITATIONS The median age of the 577 patients was 70.9 yr, and 126 (21.8%) patients were female. The median follow-up was 69.6 (interquartile range: 58.4) mo, and recurrence was observed in 236 (40.9%) patients. The 1-, 2-, and 5-yr RFS rates were 81.6% (95% confidence interval 78.4-84.9), 72.4% (68.7-76.3), and 59.2% (55-63.8), respectively. Recurrence after 5 yr was observed in 13.1% (28/213). High-risk recurrence, defined as the first recurrence of a high-grade and/or ≥T1 tumor, occurred in 6.2% (36/579) overall and 2.8% (6/213) after 5 yr. The lack of a single postoperative dose of chemotherapy and tumor size >2 cm were prognostic factors of recurrence. CONCLUSIONS The risk of recurrence in patients with LR-NMIBC decreases progressively after the 1st year and remains low beyond 5 yr. Discontinuation of endoscopic surveillance after 5 yr in patients with LR-NMIBC can be discussed. Treatment with postoperative chemotherapy and tumor size <2 cm may be relevant variables to identify patients who will benefit from cystoscopic follow-up as short as 12 mo. PATIENT SUMMARY In this study, we observed that 13% of patients who did not have a recurrence during the first 5 yr following the diagnosis of low-risk non-muscle-invasive bladder cancer will recur after this time point. Discontinuation of cystoscopic surveillance can be discussed after 5 yr in these patients.
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Affiliation(s)
- Joshua Ma
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mathieu Roumiguie
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Department of Urology, CHU-Institut Universitaire du Cancer de Toulouse, Toulouse, France.
| | - Tetsutaro Hayashi
- Department of Urology, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yuki Kohada
- Department of Urology, Hiroshima University, Graduate School of Biomedical Sciences, Hiroshima, Japan; Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Sinai Health System, Toronto, ON, Canada; Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Stephan Lévy
- Department of Urology, CHU-Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Takashi Matsumoto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Sano
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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18
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Devlies W, de Jong JJ, Hofmann F, Bruins HM, Zuiverloon TCM, Smith EJ, Yuan Y, van Rhijn BWG, Mostafid H, Santesso N, Violette P, Omar MI. The Diagnostic Accuracy of Cystoscopy for Detecting Bladder Cancer in Adults Presenting with Haematuria: A Systematic Review from the European Association of Urology Guidelines Office. Eur Urol Focus 2024; 10:115-122. [PMID: 37633791 DOI: 10.1016/j.euf.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
CONTEXT Haematuria can be macroscopic (visible haematuria [VH]) or microscopic (nonvisible haematuria [NVH]), and may be caused by a number of underlying aetiologies. Currently, in case of haematuria, cystoscopy is the standard diagnostic tool to screen the entire bladder for malignancy. OBJECTIVE The objective of this systematic review is to determine the diagnostic test accuracy of cystoscopy (compared with other tests, eg, computed tomography, urine biomarkers, and urine cytology) for detecting bladder cancer in adults. EVIDENCE ACQUISITION A systematic review of the literature was performed according to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for diagnostic test accuracy studies' checklist. The MEDLINE, Embase, Cochrane CENTRAL, and Cochrane CDSR databases (via Ovid) were searched up to July 13, 2022. The population comprises patients presenting with either VH or NVH, without previous urological cancers. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). EVIDENCE SYNTHESIS Overall, nine studies were included in the qualitative analysis. Seven out of nine included trials covered the use of cystoscopy in comparison with radiological imaging. Overall, sensitivity of cystoscopy ranged from 87% to 100%, specificity from 64% to 100%, positive predictive value from 79% to 98%, and negative predictive values between 98% and 100%. Two trials compared enhanced or air cystoscopy versus conventional cystoscopy. Overall sensitivity of conventional white light cystoscopy ranged from 47% to 100% and specificity from 93.4% to 100%. CONCLUSIONS The true accuracy of cystoscopy for the detection of bladder cancer within the context of haematuria has not been studied extensively, resulting in inconsistent data regarding its performance for patients with haematuria. In comparison with imaging modalities, a few trials have prospectively assessed the diagnostic performance of cystoscopy, confirming very high accuracy for cystoscopy, exceeding the diagnostic value of any other imaging test. PATIENT SUMMARY Evidence of tests for detecting bladder cancer in adults presenting with haematuria (blood in urine) was reviewed. The most common test used was cystoscopy, which remains the current standard for diagnosing bladder cancer.
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Affiliation(s)
- Wout Devlies
- Department of Urology, UZ Leuven, Leuven, Belgium
| | - Joep J de Jong
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Harman Max Bruins
- Department of Urology, Zuyderland Medical Center, Sittard-Geleen/Heerlen, The Netherlands
| | | | | | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hugh Mostafid
- Department of Urology, Royal Surrey Hospital, Guildford, UK
| | - Nancy Santesso
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Phil Violette
- Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Yu WR, Jiang YH, Jhang JF, Kuo HC. Cystoscopic characteristic findings of interstitial cystitis and clinical implications. Tzu Chi Med J 2024; 36:30-37. [PMID: 38406570 PMCID: PMC10887339 DOI: 10.4103/tcmj.tcmj_172_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 02/27/2024] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic inflammatory bladder disease of unknown etiology, characterized by bladder pain and frequency urgency symptoms. Based on the cystoscopic findings after hydrodistention under anesthesia, the phenotype of IC/BPS includes no glamerulation, characteristic glomerulation, and with Hunner's lesion. IC is specifically defined if there are characteristic Hunner's lesion appeared in cystoscopy or after hydrodistention. If there are glomerulations without Hunner's lesion, BPS should be considered. The definition of Hunner's lesion and glomerulations differs based on different definition and observations. Currently, there has been no clear description and grading of the glomerulations and Hunner's lesion. Because the classification of IC/BPS has an impact on the treatment strategy and associated with therapeutic outcome, it is unmet to have a clear definition and consensus on the characteristic cystoscopic findings of IC/BPS. This article reviews the literature and presents the figures of Hunner's lesions and description of different mucosal lesions after cystoscopic hydrodistention.
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Affiliation(s)
- Wan-Ru Yu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Guo Y, Li C, Zhang S, Zhu G, Sun L, Jin T, Wang Z, Li S, Zhou F. U-Net-Based Assistive Identification of Bladder Cancer: A Promising Approach for Improved Diagnosis. Urol Int 2023; 108:100-107. [PMID: 38081150 DOI: 10.1159/000535652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/29/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Bladder cancer (BC) is a major health concern that poses a significant threat to the population, with an increasing incidence rate and a high risk of recurrence and progression. The primary clinical method for diagnosing BC is cystoscopy, but due to the limitations of traditional white light cystoscopy and inadequate clinical experience among junior physicians, its detection rate for bladder tumor, especially small and flat lesions, is relatively low. However, recent years have seen remarkable advancements in the application of artificial intelligence (AI) technology in the field of medicine. This has led to the development of numerous AI algorithms that have been successfully integrated into medical practices, providing valuable assistance to clinicians. The purpose of this study is to develop a cystoscopy algorithm that is real time, cost effective, high performing, and accurate, with the aim of enhancing the detection rate of bladder tumors during cystoscopy. MATERIALS AND METHODS For this study, a dataset of 3,500 cystoscopic images obtained from 100 patients diagnosed with BC was collected, and a deep learning model was developed utilizing the U-Net algorithm within a convolutional neural network for training purposes. RESULTS This study randomly divided 3,500 images from 100 BC patients into training and validation groups, and each patient's pathology result was confirmed. In the validation group, the accuracy of tumor recognition by the U-Net algorithm reached 98% compared to primary urologists, with greater accuracy and faster detection speed. CONCLUSION This study highlights the potential of U-Net-based deep learning techniques in the detection of bladder tumors. The establishment and optimization of the U-Net model is a significant breakthrough and it provides a valuable reference for future research in the field of medical image processing.
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Affiliation(s)
- Yinsheng Guo
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China,
| | - Chengbai Li
- Department of Urology, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Shuhan Zhang
- Department of Clinical Medicine, Suzhou Medical College, Soochow University, Suzhou, China
| | - Guanhua Zhu
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lu Sun
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tao Jin
- Mingxu Technology Co., Ltd., Shanghai, China
| | - Ziyue Wang
- Mingxu Technology Co., Ltd., Shanghai, China
| | - Shiqing Li
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Zhou
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
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Jindal T, Sarwal A, Jain P, Koju R, Mukherjee S. A retrospective analysis of the factors associated with increased risk of readmission within 30 days after primary transurethral resection of bladder tumor. Curr Urol 2023; 17:257-261. [PMID: 37994339 PMCID: PMC10662801 DOI: 10.1097/cu9.0000000000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background Transurethral resection of bladder tumor (TURBT) is associated with perioperative morbidity of 5% to 10%, which can lead to unplanned readmissions. In this study, we aimed to identify the factors that lead to an increased risk of unplanned readmissions within 30 days of primary TURBT. Materials and methods A retrospective study was conducted to identify patients who underwent primary TURBT at our institute from 2011 to 2019. Clinical and demographic factors, history of smoking, antiplatelet drugs intake, comorbidities, tumor size (<3 or >3 cm), multifocality, and histopathological type were abstracted. Patients who were readmitted were identified, and reasons for admission were recorded. Results A total of 435 patients were identified. The median age of the patients was 66 years. From 378 male patients (86.9%), 110 (25.3%) and 37 (8.5%) had a history of smoking and antiplatelet agents intake, respectively. In the cohort, 166 patients (38.2%) were diabetic, 239 (54.9%) were hypertensive, 72 (16.6%) had chronic obstructive pulmonary disease, and 78 (7.9%) had hypothyroidism. A total of 206 patients (47.4%) had a tumor >3 cm; multifocality was seen in 140 (32.2%) patients, whereas muscle invasive tumors were present in 161 patients (37%). A total of 22 patients (5.06%) had readmissions within 30 days, with hematuria being the most common etiology. On univariate and multivariate analyses, a history of smoking (p = 0.006 and p = 0.008, respectively) or antiplatelet agents intake (p < 0.001 and p < 0.001, respectively) was significantly associated with increased unplanned readmission. Conclusions Our study revealed smoking and antiplatelet agents intake as factors leading to an increased risk of unplanned readmissions.
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Affiliation(s)
- Tarun Jindal
- Department of Uro-oncologyy, Tata Medical Centre, Kolkata, India
- Department of Uro-Oncology, NH Narayana Superspeciality Hospital, Howrah, India
| | - Ankush Sarwal
- Department of Uro-oncologyy, Tata Medical Centre, Kolkata, India
| | - Prateek Jain
- Department of Head and Neck Surgery, Tata Medical Centre, Kolkata, India
| | - Rajan Koju
- Department of Uro-oncologyy, Tata Medical Centre, Kolkata, India
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Liang H, Yang Q, Sun H, Xu Y, Wang J, Huang W, Ge N, Fu Q, Diao T, Jiang X, Chen S, Li Y, Zhang N, Shi B, Chen J. The vascular and morphological characteristics of tumors under narrow-band imaging as predictors for the grade and stage of bladder cancer: a prospective and multi-center study. Ann Med 2023; 55:2281656. [PMID: 37949085 PMCID: PMC10653648 DOI: 10.1080/07853890.2023.2281656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
The vascular and morphological features of tumors are important predictors of the nature, grade, and stage of various cancers. However, this association has not been tested in bladder cancer. The aim of our study was to investigate the correlation between the morphological characteristics of tumor vessels and the nature, stage and grade of bladder cancer. Between November 2021 and March 2023, we prospectively collated clinical information and cystoscopy information from a series of patients with bladder cancer. Univariate and multivariate logistic regression analysis were used to identify independent risk factors for the nature, grade and stage of bladder cancer. Our analysis showed that cauliflower-like tumors, dotted vessels, and circumferential vessels were independent risk factors for bladder cancer. Reticular vessels were an independent risk factor for high-grade bladder cancer. Thick branching vessels in bladder tumors, along with a wide base, were independent risk factors for the invasion of bladder cancer into the lamina propria. Primary diagnosis, lesion location (beside the left ureteral orifice) and obscure lesion boundaries were all identified as independent risk factors for muscle invasive bladder cancer.
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Affiliation(s)
- Hao Liang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Qingya Yang
- Department of Urology, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Hui Sun
- Department of Urology, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Yang Xu
- Department of Urology, The Second Hospital of Shandong University, Jinan, China
| | - Jin Wang
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wei Huang
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Nan Ge
- Department of Urology, The Second Hospital of Shandong University, Jinan, China
| | - Qiang Fu
- Department of Urology, Shandong Provincial Hospital, Jinan, China
| | - Tongxiang Diao
- Department of Urology, Shandong Provincial Hospital, Jinan, China
| | - Xuewen Jiang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Shouzhen Chen
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yan Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Nianzhao Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Jun Chen
- CONTACT Jun Chen Department of Urology, Qilu Hospital of Shandong University, 107 Wenhua West Road, Lixia District, Jinan, China
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23
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Liang H, Yang Q, Zhang Y, Sun H, Fu Q, Diao T, Wang J, Huang W, Xu Y, Ge N, Jiang X, Chen S, Li Y, Zhou B, Li P, Zhang X, Zhang N, Shi B, Chen J. Development and validation of a predictive model for the diagnosis of bladder tumors using narrow band imaging. J Cancer Res Clin Oncol 2023; 149:15867-15877. [PMID: 37672077 DOI: 10.1007/s00432-023-05355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE At present, the prediction of bladder tumor nature during cystoscopy is partially dependent on the clinician's own experience. Subjective factors may lead to excessive biopsy or delayed treatment. The purpose of our study is to establish a reliable model for predicting the nature of bladder tumors using narrow band imaging. METHODS From November 2021 to November 2022, the clinical data of 231 patients who required a cystoscopy were prospectively collected at our center. Cystoscopy was performed in 219 eligible patients, in which both tumor and vascular morphology characteristics were recorded. Pathological results were used as the diagnostic standard. A logistic regression analysis was used to screen out factors related to tumor pathology. Bootstrap resampling was used for internal validation. A total of 71 patients from four other centers served as an external validation cohort. RESULTS The following diagnostic factors were identified: tumor morphology (cauliflower-like or algae-like lesions), vascular morphology (dotted or circumferential vessels), tumor boundary (clear or unclear), and patients' symptoms (gross hematuria) and were included in the prediction model. The internal validation results showed that the area under the curve was 0.94 (95% CI 0.92-0.97), and the P value from the goodness-of-fit test was 0.97. After external validation, the results showed the area under the curve was 0.89 (95% CI 0.82-0.97) and the P value of the goodness-of-fit test was 0.24. CONCLUSION A diagnostic prediction nomogram was established for bladder cancer. The verification results showed that the prediction model has good prediction performance.
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Affiliation(s)
- Hao Liang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Qingya Yang
- Department of Urology, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Yaozhong Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Hui Sun
- Department of Urology, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong, China
| | - Qiang Fu
- Department of Urology, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Tongxiang Diao
- Department of Urology, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Jin Wang
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Wei Huang
- Department of Urology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Yang Xu
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Nan Ge
- Department of Urology, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Xuewen Jiang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shouzhen Chen
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yan Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Bin Zhou
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Peixin Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiaoyi Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Nianzhao Zhang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jun Chen
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Hagmann S, Born D, Schmid HP, Rührup J. [Melanosis of the bladder-a rare diagnosis]. Urologie 2023; 62:1200-1203. [PMID: 37367951 PMCID: PMC10630223 DOI: 10.1007/s00120-023-02127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/28/2023]
Abstract
Melanosis of the urinary bladder is an extremely rare benign condition in which melanin deposits occur in the urothelial and stromal cells. We report such a case in which melanosis of the urinary bladder was detected in a 55-year-old woman with known multiple sclerosis during an extended workup due to urinary urgency complaints. The findings were confirmed by biopsy.
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Affiliation(s)
- S Hagmann
- Klinik für Urologie, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Schweiz.
| | - D Born
- Institut für Pathologie, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - H P Schmid
- Klinik für Urologie, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Schweiz
| | - J Rührup
- Klinik für Urologie, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Schweiz
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de Beaufort CMC, Boom DT, Mackay TM, Dekker JJML, Arguedas Flores OE, de Jong JR, Kuijper CF, Gorter RR. Potential benefits of routine cystoscopy and vaginoscopy prior to reconstructive surgery in patients with an anorectal malformation. Pediatr Surg Int 2023; 39:284. [PMID: 37889354 PMCID: PMC10611826 DOI: 10.1007/s00383-023-05565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE First, to assess the number of patients with anorectal malformations (ARM) in whom additional urological and/or gynecological anomalies were identified through routine screening with cysto- or vaginoscopy prior to reconstructive surgery. Second, to assess potential procedure-related complications. METHODS Retrospective mono-center cohort study, including all ARM patients born between January 2019 and December 2022. Routine screening consisted of cystoscopy for male patients, with the addition of vaginoscopy for female patients. Chi-square was used to compare the screening percentages over time. RESULTS In total, 38 patients were included, of whom 27 (71.1%) underwent cystoscopy ± vaginoscopy, without the occurrence of complications. Nine of 13 females (69.2%) underwent cysto- and vaginoscopy and 18 of 25 males (72.0%) underwent a cystoscopy. The percentage of patients that underwent these procedures improved over the 2 time periods (50.0% in 2019-2020 vs 90.0% in 2021-2022, p = 0.011). In 15 of 27 patients (55.6%) that underwent cystoscopy ± vaginoscopy, additional anomalies were found that were not identified through physical examination or US-kidney. CONCLUSIONS In 56% of the patients that underwent cysto- ± vaginoscopy, additional anomalies were identified that were not with imaging studies or physical examination. This study emphasizes the potential benefit of routine cysto- and vaginoscopy in the diagnostic work-up of children with ARM. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cunera M C de Beaufort
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Daphne T Boom
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tara M Mackay
- Amsterdam UMC, Department of Surgery, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Judith J M L Dekker
- Amsterdam UMC, Department of Gynecology, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Olga E Arguedas Flores
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Justin R de Jong
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Caroline F Kuijper
- Department of Pediatric Urology, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Ramon R Gorter
- Department of Pediatric Surgery, Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
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Hernigou P, Karam S, Khaled I. Scoping out the past: meniscus examination with arthroscopy; the light arrived in the knee before the end of World War I with the cystoscope, Fresnel's lens, and Edison's lamp. Int Orthop 2023; 47:2601-2614. [PMID: 37606766 DOI: 10.1007/s00264-023-05940-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Before radiology and arthroscopy, an arthrotomy had to be made for a definitive diagnosis and treat intraarticular pathology. Before arthroscopy, endoscopy was performed on other organs, and particularly the bladder. This paper aimed to investigate the transition of the cystoscope to the arthroscope, and all the bright innovations about light and optics that finally allow arthroscopy. METHODS Physicians have always wanted to examine their patients' body cavities. Some cavities are quite accessible for diagnostic purposes, using specula and light, while others are difficult to inspect. The female bladder was the first organ to be examined using an endoscope with some light by Philipp Bozzini in 1806. We report the important innovations and inventions done by surgeons but also by scientists in optic and electricity during two centuries before arriving to arthroscopy. RESULTS Whereas the urologists immediately embraced the idea of endoscopy, and adapted the rules of optic and the progress in electricity to allow bladder illumination and examination with cystoscopes, the orthopedic surgeons were reluctant. We focus on the early history of endoscopy and arthroscopy specifically. Our story ends in 1918 with Dr. Severin Nordentoft in Germany and Professor Kenji Takagi in Japan began with cystoscopes before designing the first arthroscopes for performing the first knee arthroscopies. CONCLUSION We document some crucial figures on the thorny path, from cystoscopy to adopting the arthroscope as a useful orthopaedic tool.
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Affiliation(s)
| | - Sami Karam
- Hopital Henri Mondor, 94000, Creteil, France
| | - Issam Khaled
- Hopital Saint Denis la Reunion, 97400, Saint-Denis, France
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Huang H, Liu A, Liang Y, Xin Y, Liu J, Hao Y, Huang D, Chen L, Li W, Jiang G, Huang Y, Xu Y, Zhang J, Ma T, Xu D, Gao Y. A urinary assay for mutation and methylation biomarkers in the diagnosis and recurrence prediction of non-muscle invasive bladder cancer patients. BMC Med 2023; 21:357. [PMID: 37726806 PMCID: PMC10510256 DOI: 10.1186/s12916-023-03065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Currently, the clinical strategy for diagnosis of non-muscle invasive bladder cancer (NMIBC) such as cystoscopy and cytology are invasive and/or with limited accuracy. OncoUrine, a urinary assay for mutation and methylation biomarkers, have showed a high accuracy in the detection of upper tract urinary carcinoma (UTUC) patients with hematuria. The aim of this study is to evaluate the performance of OncoUrine in diagnosis of NMIBC patients. METHODS In this multicenter prospective study, a total of 203 patients were enrolled, including 60 patients present with hematuria and 143 NMIBC patients under recurrence surveillance. Urine samples were collected before cystoscopy to undergo OncoUrine test. OncoUrine performance was calculated compared to clinical standard methods in hematuria cohort and recurrence surveillance cohort, respectively. Furthermore, NMIBC patients were followed up with a median time of 20.5 months (range 0.03 to 24.03 months) to assess the predictive value of OncoUrine during recurrence monitoring. RESULTS For bladder cancer diagnosis, OncoUrine tested 47 samples and achieved a sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) of 80% (95% CI 44.2-96.5)/91.9% (95% CI 77.0-97.9)/72.7% (95% CI 39.3-92.7)/94.4% (95% CI 80.0-99.0) (kappa value 69.4%, 95% CI 44.4-94.3), indicating 72.3% of unnecessary cystoscopy. For recurrence diagnosis, OncoUrine tested 93 samples, and the sensitivity/specificity/PPV/NPV was 100% (95% CI 59.8-100.0)/68.2% (95% CI 57.1-77.7)/22.9% (95% CI 11.0-40.6)/100% (95% CI 92.3-100.0) (kappa value 27.0%, 95% CI 11.1-42.8), indicating 62.4% of spared cystoscopy. What is more, OncoUrine correctly predicted 80% (20/25) of final recurrence with 12/25 (48%) patients who were OncoUrine positive, but cystoscopy negative was followed with recurrence during follow-up. The test result of OncoUrine was also found significantly correlated with recurrence free survival (RFS) of NMIBC patients (median 34.4-month vs unreached; HR 6.0, 95% CI 2.7-13.5, P < 0.0001). CONCLUSIONS OncoUrine showed potential value to reduce the frequency of unnecessary cystoscopy and the healthcare cost of bladder cancer patients. Patients with positive test results represented a population who were at high risk of recurrence and thus should be subject to frequent surveillance to ensure timely detection of any potential recurrence. This study has been registered in ClinicalTrials.gov with the number NCT04994197 posted on August 2021.
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Affiliation(s)
- Hai Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Ao Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Yiming Liang
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China
| | - Yaqun Xin
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China
| | - Jiacheng Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Yining Hao
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Lu Chen
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Wei Li
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China
| | - Guangliang Jiang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Yuhua Huang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yaoting Xu
- Department of Urologic Surgery, Shanghai Fourth People`S Hospital Affiliated to Tongji University, No.1279, Sanmen Road, Shanghai, 200081, China
| | - Jie Zhang
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China
| | - Tonghui Ma
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China.
- Department of Translational Medicine, Genecn-Biotech. Co., Ltd., Hangzhou, 310000, China.
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China.
| | - Yi Gao
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China.
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Hmaidy O, Roumi Jamal B, Mayo M, Haidar M, Horan M, Alsayed-Ahmad ZA. Non-muscle invasive urothelial bladder cancer in a 17-year-old male: A rare case report. Int J Surg Case Rep 2023; 110:108728. [PMID: 37683512 PMCID: PMC10509874 DOI: 10.1016/j.ijscr.2023.108728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Urothelial carcinoma of the bladder predominantly affects adults with rare cases in young patients. This manuscript presents a rare case of urothelial carcinoma highlighting clinical characteristics, diagnosis, treatment, and prognosis in this age group. Our aim is to raise awareness among healthcare professionals for improved outcomes in children and adolescents with bladder urothelial carcinoma. CASE PRESENTATION A 17-year-old male presented with hematuria and urinary symptoms. No history of smoking, alcohol, surgeries, family conditions, or medications. The patient had environmental chemical exposure near an oil refinery. An initial ultrasound and Cystoscopy showed a sizable bladder tumor. A complete TURBT was done, followed by cauterization and catheter placement. The tumor was diagnosed as low-grade urothelial carcinoma (pT1). Follow-up cystoscopies after 3 and 9 months showed no recurrence. CLINICAL DISCUSSION Urothelial bladder carcinoma (UBC) is linked to occupational exposure and smoking. Limited research exists on UBC in young patients, but genetic factors and environmental exposure may play a role. In young individuals, UBC typically presents as low-grade, non-muscle invasive tumors (NMIBC). Transurethral resection may be sufficient for low-grade tumors, and postoperative follow-up with ultrasound is important. Larger tumors have a higher risk of recurrence and progression. CONCLUSION The present case emphasizes the need to consider urothelial bladder carcinoma as a potential cause of hematuria in young patients and conduct a thorough evaluation of all risk factors. Future research is needed to establish evidence-based guidelines for managing this condition in pediatric and adolescent patients.
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Affiliation(s)
- Osama Hmaidy
- Department of Urologic Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Mohammed Mayo
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Mariam Haidar
- Department of Pathology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohammad Horan
- Department of urology, NMC ROYAL HOSPITAL SHARJAH, NMC healthcare, Sharjah, United Arab Emirates.
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Zhu L, Ke H, Wang Q, Xu K. Cystoscopy, an indispensable tool for the diagnosis and prognosis of bladder pain syndrome, takes nomograms for predicting recurrence. World J Urol 2023; 41:2451-2458. [PMID: 37453960 DOI: 10.1007/s00345-023-04517-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE We aimed to illustrate the importance of cystoscopy for the diagnosis and prognosis of bladder pain syndrome (BPS) or interstitial cystitis (IC). METHODS AND MATERIALS We designed a 4-year prospective follow-up study. Patients who underwent cystoscopy between May 2011 and July 2021 with a diagnosis of BPS/IC before surgery or positive cystoscopic findings during initial surgery at Peking University People's Hospital were enrolled. Data related to symptom recurrence were obtained through clinic visits and telephone follow-up. We compared the differences in clinical features of BPS/IC subtypes differentiated by cystoscopy and first created clinical predictive nomograms for BPS/IC. RESULTS A total of 141 patients were included. There was an 8.51% chance of BPS/IC being misdiagnosed as other diseases or other diseases being misdiagnosed as BPS/IC without cystoscopy. Patients with HIC had higher pain scores and ICPI, higher residual urine volume, lower first-sense-to-void, and maximum cystometric bladder capacities than NHIC. Nomogram Models showed that patients who with higher ICPI, ICSI and lower AMBC have a greater recurrence probability, and lesions in the trigone may indicate a greater likelihood of recurrence than lesions in other bladder walls. CONCLUSIONS Timely detection of bladder cancer and other diseases using cystoscopy can avoid poor treatment effects. BPS/IC subtypes can be classified according to mucosal changes under cystoscopy. Lesions in the bladder triangle can indicate a higher recurrence risk, which is important in follow-up treatment. We strongly recommend that cystoscopy should be included in the international BPS/IC diagnostic criteria.
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Affiliation(s)
- Lin Zhu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
- Peking University Applied Lithotripsy Institute, Peking University People's Hospital, Beijing, 10034, China
| | - Hanwei Ke
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
- Peking University Applied Lithotripsy Institute, Peking University People's Hospital, Beijing, 10034, China
| | - Qi Wang
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
- Peking University Applied Lithotripsy Institute, Peking University People's Hospital, Beijing, 10034, China
| | - Kexin Xu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
- Peking University Applied Lithotripsy Institute, Peking University People's Hospital, Beijing, 10034, China.
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Vanneste M, van der Heij B, Christiaansen CE, Berendsen CL, Driessen EJM, Bruins HM. Implications of the COVID19 pandemic on the need and timing of second transurethral bladder tumour resection in high-grade non-muscle invasive bladder cancer. World J Urol 2023; 41:2173-2178. [PMID: 37328699 DOI: 10.1007/s00345-023-04469-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023] Open
Abstract
PURPOSE Due to the COVID19 pandemic, the EAU has recommended to, if needed, postpone second transurethral resection of bladder tumour (TURBT) after BCG induction in selected patients. We aimed to evaluate the oncological outcomes of postponed TURBT and the potential to replace second TURBT by routine cystoscopy and cytology. METHODS A single-center, retrospective analysis of patients with TaG3/high grade (HG) or T1HG urothelial bladder cancer was performed. All patients underwent a complete TURBT between 2000 and 2013 with presence of detrusor muscle, full BCG induction and routine cystoscopy and cytology, followed by a second TURBT. Results of the cystoscopy, cytology and pathology reports of the TURBT were analyzed by descriptive characteristics, sensitivity, specificity, negative and positive predictive values, as well as survival analyses. RESULTS 112 patients were included. Residual tumour was present at second TURBT in 21.4%. Upstaging rate from pTaHG to pT1HG and pT1HG to pT2 was 0% and 2.7%, respectively. pT0 was confirmed in 79% of patients, but in 98% of patients with combined negative cytology and cystoscopy after BCG. With a median follow-up of 109 months, the 3-year OS was 85%, RFS 74% and PFS 89%. Sensitivity, specificity, negative predictive value and positive predictive value of cystoscopy and urinary cytology for the presence of residual tumour were 92%, 97%, 98% and 85%, respectively. CONCLUSION This study underpins the recommendation of the EAU NMIBC guideline panel that, if needed and in selected patients, second TURBT may be postponed until after BCG induction treatment in pT1HG disease. Also, routine second TURBT can be omitted in pTaHG disease. Data on replacing second TURBT after BCG treatment by routine cystoscopy and cytology appear promising but require further confirmation in prospective studies.
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Affiliation(s)
- Matthias Vanneste
- Department of Urology, Zuyderland Medical Center, Dunantlaan 5, 6419 PC, Heerlen, The Netherlands.
| | - Bart van der Heij
- Department of Urology, Zuyderland Medical Center, Dunantlaan 5, 6419 PC, Heerlen, The Netherlands
| | | | - Chris L Berendsen
- Department of Urology, Zuyderland Medical Center, Dunantlaan 5, 6419 PC, Heerlen, The Netherlands
| | | | - Harman Maxim Bruins
- Department of Urology, Zuyderland Medical Center, Dunantlaan 5, 6419 PC, Heerlen, The Netherlands
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van Straten CGJI, Bruins MH, Dijkstra S, Cornel EB, Kortleve MDH, de Vocht TF, Kiemeney LALM, van der Heijden AG. The accuracy of cystoscopy in predicting muscle invasion in newly diagnosed bladder cancer patients. World J Urol 2023; 41:1829-1835. [PMID: 37195314 PMCID: PMC10352162 DOI: 10.1007/s00345-023-04428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE The prognosis of muscle-invasive bladder cancer (MIBC) has not improved for three decades. Transurethral resection of the bladder tumor (TURBT) is the standard procedure for local tumor staging. TURBT has several limitations, including the spread of tumor cells. Therefore, an alternative is needed in patients with suspected MIBC. Recent studies have shown that mpMRI is very accurate in staging bladder tumors. Because the diagnostic efficacy of urethrocystoscopy (UCS) has been reported as good as the efficacy of mpMRI to predict muscle invasion we performed this prospective multicenter study in which we compare UCS with pathology. METHODS From July 2020 until March 2022, 321 patients with suspected primary BC in seven participating Dutch hospitals were included in this study. A flexible UCS was performed by urologists, physician assistants, or residents. Predictions of muscle invasion using a 5-point Likert scale alongside the histopathology data were recorded. The sensitivity, specificity, predictive values, and 95% confidence intervals were determined using a standard contingency table. RESULTS Of the 321 included patients, 232 (72.3%) received a histopathological diagnosis of non-muscle-invasive bladder cancer (NMIBC) and 71 (22.1%) were histopathologically diagnosed as MIBC. In 2 patients (0.6%), classification was not possible (Tx). Cystoscopy predicted muscle invasion with a sensitivity of 71.8% (95% CI 59.9-81.9), and a specificity of 89.9% (95% CI 85.4-93.3). This corresponds to a positive predictive value (PPV) of 67.1% and a negative predictive value (NPV) of 91.7%. CONCLUSION Our study shows a moderate accuracy of cystoscopy to predict muscle invasion. This result does not support the use of cystoscopy only instead of TURBT for local staging.
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Affiliation(s)
| | - Max H. Bruins
- Department of Urology, Zuyderland Medisch Centrum, Heerlen and Sittard, The Netherlands
| | - Siebren Dijkstra
- Department of Urology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Erik B. Cornel
- Department of Urology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | | | | | - Lambertus A. L. M. Kiemeney
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Antoine G. van der Heijden
- Department of Urology, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Ma C, Zeng S, Dai L, Han H, Song R, Xu J, Ai X, Xu C. The natural course of bacillus Calmette-Guérin induced bladder lesions: A long-term follow-up study and systematic review. Asian J Urol 2023; 10:356-363. [PMID: 37538149 PMCID: PMC10394293 DOI: 10.1016/j.ajur.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/18/2022] [Accepted: 12/20/2022] [Indexed: 08/05/2023] Open
Abstract
Objective Bacillus Calmette-Guérin (BCG) instillation is the standard adjuvant treatment for intermediate- and high-risk non-muscle-invasive bladder cancer after transurethral resection. Nevertheless, its toxicity often causes bladder complications. On follow-up cystoscopy, post-BCG bladder lesions can be pathologically benign, urothelial carcinoma recurrence, or other types of bladder malignancy. Only a small number of case reports have been published on post-BCG bladder lesions. Their clinical features, natural course, and management remain unknown. Methods We retrospectively studied cystoscopic videos and medical records of BCG-treated bladder cancer patients at our center. During a long-term follow-up, we took biopsies on tumor-like lesions and described their changes. In addition, we summarized previous studies on post-BCG bladder lesions by systematic literature searching and review. Results We described a series of three cases with post-BCG bladder lesions mimicking tumor recurrence from a total of 38 cases with follow-up data for more than 5 years. Those lesions could last, grow, or disappear spontaneously, and remain pathological benign for years. In systematic review, we identified and analyzed a total of 15 cases with post-BCG bladder lesions with detailed clinical information. Eleven of the 15 were benign and have a good prognosis with nephrogenic adenoma being the most common pathological type. Conclusion Based on previous studies and our experience, benign lesions after BCG instillation cannot distinguish with cancer recurrence by cystoscopy alone, even under narrow band imaging mode. Nonetheless, given most of them have a good prognosis, random biopsy or transurethral resection might be spared in the patients with long-term negative biopsy and urine cytology.
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Affiliation(s)
- Chong Ma
- Department of Urology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Shuxiong Zeng
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lihe Dai
- Department of Urology, The 943 Hospital of Joint Logistics Support Force of Chinese PLA, Gansu, China
| | - Huan Han
- Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ruixiang Song
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jinshan Xu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xing Ai
- Department of Urology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
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Eminaga O, Lee TJ, Ge J, Shkolyar E, Laurie M, Long J, Hockman LG, Liao JC. Conceptual framework and documentation standards of cystoscopic media content for artificial intelligence. J Biomed Inform 2023; 142:104369. [PMID: 37088456 PMCID: PMC10643098 DOI: 10.1016/j.jbi.2023.104369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The clinical documentation of cystoscopy includes visual and textual materials. However, the secondary use of visual cystoscopic data for educational and research purposes remains limited due to inefficient data management in routine clinical practice. METHODS A conceptual framework was designed to document cystoscopy in a standardized manner with three major sections: data management, annotation management, and utilization management. A Swiss-cheese model was proposed for quality control and root cause analyses. We defined the infrastructure required to implement the framework with respect to FAIR (findable, accessible, interoperable, reusable) principles. We applied two scenarios exemplifying data sharing for research and educational projects to ensure compliance with FAIR principles. RESULTS The framework was successfully implemented while following FAIR principles. The cystoscopy atlas produced from the framework could be presented in an educational web portal; a total of 68 full-length qualitative videos and corresponding annotation data were sharable for artificial intelligence projects covering frame classification and segmentation problems at case, lesion, and frame levels. CONCLUSION Our study shows that the proposed framework facilitates the storage of visual documentation in a standardized manner and enables FAIR data for education and artificial intelligence research.
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Affiliation(s)
- Okyaz Eminaga
- Department of Urology, Stanford University School of Medicine, Stanford, USA; Center for Artificial Intelligence and Medical Imaging, Stanford University School of Medicine, Stanford, CA, USA.
| | - Timothy Jiyong Lee
- Department of Urology, Stanford University School of Medicine, Stanford, USA
| | - Jessie Ge
- Department of Urology, Stanford University School of Medicine, Stanford, USA
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, USA
| | - Mark Laurie
- Department of Urology, Stanford University School of Medicine, Stanford, USA
| | - Jin Long
- Center for Artificial Intelligence and Medical Imaging, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, USA; Center for Artificial Intelligence and Medical Imaging, Stanford University School of Medicine, Stanford, CA, USA.
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Soorojebally Y, Neuzillet Y, Lebret T, Allory Y, Descotes F, Ferlicot S, Kassab-Chahmi D, Lamy PJ, Oudard S, Rébillard X, Roy C, Roumiguié M, Rouprêt M, Audenet F. Photodynamic cystoscopy for bladder cancer diagnosis and for NMIBC follow-up: An overview of systematic reviews and meta-analyses. Prog Urol 2023; 33:307-318. [PMID: 37088584 DOI: 10.1016/j.purol.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/07/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Currently, bladder cancer detection is based on cytology and cystoscopy. White light cystoscopy (WLC) is an invasive procedure and may under-detect flat lesions. Blue light cystoscopy (BLC) and narrow band imaging (NBI) cystoscopy are new modalities that could improve the detection of non-muscle invasive bladder cancer (NMIBC) and its recurrence or progression to muscle invasive bladder cancer. We present a systematic review on BLC and NBI cystoscopy for bladder cancer diagnosis and NMIBC follow-up. MATERIAL AND METHODS All available systematic reviews and meta-analyses on cystoscopy published in PubMed® between May 2010 and March 2021 were identified and reviewed. The main endpoints were clinical performance for bladder cancer diagnosis and for recurrence or progression detection during NMIBC follow-up, and additional value compared with cytology and/or WLC. RESULTS Most of the meta-analyses and systematic reviews published suggest a better sensitivity of BLC and NBI cystoscopy compared to WLC, particularly for the detection of flat lesions (CIS). NBI- and BLC-guided TURBT could decrease the recurrence rates. However, their clinical utility to reduce progression rate and increase survival is still unclear. CONCLUSIONS BLC and NBI cystoscopy are efficient techniques for bladder cancer diagnosis and NMIBC follow-up. However, their clinical benefit remains to be confirmed.
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Affiliation(s)
- Y Soorojebally
- Department of urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Y Neuzillet
- Department of urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - T Lebret
- Department of urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Y Allory
- Department of pathology, Institut Curie, Saint-Cloud, France
| | - F Descotes
- Biochemistry, biology and pathology centre South, Hospices civils de Lyon (HCL), Université Claude-Bernard Lyon I, Pierre-Bénite, France
| | - S Ferlicot
- Service d'anatomie pathologique, Hôpital de Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | | | - P-J Lamy
- Biopathologie et génétique des cancers, Institut médical d'analyse génomique, Imagenome, Inovie, Montpellier, France
| | - S Oudard
- Department of medical oncology, Hôpital européen Georges-Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - X Rébillard
- Urology Department, Beausoleil Private Hospital, Montpellier, France
| | - C Roy
- Department of radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, France
| | - M Roumiguié
- Department of urology, andrology and renal transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse cedex, France
| | - M Rouprêt
- Sorbonne University, GRC 5 predictive Onco-Uro, Urology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - F Audenet
- Department of urology, Hôpital européen Georges-Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France.
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Lütfrenk T, Neisius A, Rausch S, Salem J, Kuru TH. Prospective Analysis of Versatility and User Satisfaction with a Novel Single-Use Cystoscope with Working Channel. Urol Int 2023; 107:570-577. [PMID: 37071983 PMCID: PMC10871682 DOI: 10.1159/000529488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/30/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION In the present study, a prospective systematic assessment of the clinical utility of the Ambu® aScopeTM 4 Cysto Reverse Deflection with regard to image quality, maneuverability, and navigation in an outpatient and inpatient setting was performed. MATERIALS AND METHODS A prospective multicenter study was performed for evaluation of the instrument during routine cystoscopy. We evaluated the clinical performance of the instruments using a standardized user questionnaire in different categories including image quality, treatment success, imaging of all areas of the urinary bladder, quality of navigation, flexibility of the endoscope, and satisfaction with the device. Statistical analyses were performed by SPSS using the Kruskal-Wallis and Wilcoxon-Mann-Whitney tests. A p value of p ≤ 0.05 was defined as statistically significant. RESULTS A total of 200 cystoscopies were performed, and the questionnaire response rate was 100%. The image quality was rated as very good in 65.5% (n = 131), good in 30.5% (n = 61), and neutral in 4% (n = 8) of cases. The criteria for poor or very poor were not mentioned. The characteristic "treatment success based on image quality" was also evaluated as very good in 49% (n = 98) and good in 50.5% (n = 101). The analysis revealed a very good or good overall impression of the examiners in all cases. Replacement of the cystoscope was not necessary during any of the examinations. However, in 3 cases, technical difficulties were documented. Further analysis of the data showed that physicians with less professional experience rated the visualization of the urinary bladder (p = 0.007) and the treatment success with regard to image quality significantly worse (p = 0.007). CONCLUSION The Ambu® aScope™ 4 Cysto Reverse Deflection shows high satisfaction values among users in clinical routine. In analogy to other studies with flexible endoscopes, urologists with more professional experience show higher satisfaction values than examiners with less training in flexible endoscopy.
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Affiliation(s)
- Thomas Lütfrenk
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Andreas Neisius
- Department of Urology, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Germany
| | - Steffen Rausch
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Johannes Salem
- CUROS urologisches Zentrum, Cologne, Germany
- Department of Urology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Timur H. Kuru
- CUROS urologisches Zentrum, Cologne, Germany
- Department of Urology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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da Silva FS, Favorito LA, Crispi CP, Fonseca MDF, de Resende JA. Dynamic cystoscopy to optimize preoperative assessment of bladder endometriosis. Int Braz J Urol 2023; 49:202-210. [PMID: 36638147 DOI: 10.1590/s1677-5538.ibju.2022.0594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 01/14/2023] Open
Abstract
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.
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Affiliation(s)
| | - Luciano Alves Favorito
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
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Lisanti CJ, Graeber A, Syed H, Moeck A, Rittel AG, Aden JK, Schwope R, Jellison F. What is the relative risk of urologic malignancy in microscopic hematuria patients after negative evaluation? A long-term population-based retrospective analysis of 8465 patients. Abdom Radiol (NY) 2023; 48:1011-1019. [PMID: 36592198 DOI: 10.1007/s00261-022-03793-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate whether microscopic hematuria (MH) patients with a negative initial evaluation have an elevated risk for urinary carcinoma. METHODS This is a population-based retrospective study with a matched control identified 8465 adults with an MH ICD code, an initial negative urinary malignancy work-up of cystoscopy and CT urography, and at least 35 months of clinical care. 8465 hematuria naïve controls were age, gender, and smoking status matched. Subsequent coding of non-prostatic urinary cancer, or any following hematuria codes: additional microscopic unspecified or unspecified hematuria, and gross hematuria was obtained. Χ2 tests were performed. RESULTS There was no statistically significant difference in urinary malignancy rates (p > 0.05). Any urinary cancer: cases 0.74% (63/8465; 95% CI 0.58-0.95%)/controls 0.83% (71/8465; 95% CI 0.66-1.04%%) (p = 0.54); bladder: 0.45%/0.47% (p = 0.82); renal: 0.31%/0.38% (p = 0.43); ureteral: 0.01%/0.02% (p = 0.56). Subsequent gross hematuria in both males and females increased the odds of cancer: males 2.35 (p = 0.001; CI 1.42-3.91); females 4.25 (p < 0.001; CI 1.94-9.34). Males without additional hematuria had decreased odds ratio: 0.32 (p = 0.001; CI 0.16-0.64). Females without additional hematuria 0.58 (p = 0.19; CI 0.26-1.30) and both genders with additional unspecified hematuria/microscopic hematuria males 1.02 (p = 0.97; CI 0.50-2.08) and females 1.00 (p = 0.99; CI 0.38-2.66) did not have increased odds ratios (p > 0.05). CONCLUSION MH patients with initial negative evaluation have a subsequent urologic malignancy rate of less than 1% and likely do not need further urinary evaluation unless they develop gross hematuria.
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Affiliation(s)
- Christopher J Lisanti
- Brooke Army Medical Center, 3551 Roger Brooke Dr., Ft., Sam Houston, TX, USA.
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Adam Graeber
- Brooke Army Medical Center, 3551 Roger Brooke Dr., Ft., Sam Houston, TX, USA
| | - Helal Syed
- Brooke Army Medical Center, 3551 Roger Brooke Dr., Ft., Sam Houston, TX, USA
| | - Adam Moeck
- Brooke Army Medical Center, 3551 Roger Brooke Dr., Ft., Sam Houston, TX, USA
| | | | - James K Aden
- Brooke Army Medical Center, 3551 Roger Brooke Dr., Ft., Sam Houston, TX, USA
| | - Ryan Schwope
- Brooke Army Medical Center, 3551 Roger Brooke Dr., Ft., Sam Houston, TX, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Soorojebally Y, Neuzillet Y, Roumiguié M, Lamy PJ, Allory Y, Descotes F, Ferlicot S, Kassab-Chahmi D, Oudard S, Rébillard X, Roy C, Lebret T, Rouprêt M, Audenet F. Urinary biomarkers for bladder cancer diagnosis and NMIBC follow-up: a systematic review. World J Urol 2023; 41:345-359. [PMID: 36592175 DOI: 10.1007/s00345-022-04253-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/08/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Bladder cancer detection and follow-up is based on cystoscopy and/or cytology, but it remains imperfect and invasive. Current research focuses on diagnostic biomarkers that could improve bladder cancer detection and follow-up by discriminating patients at risk of aggressive cancer who need confirmatory TURBT (Transurethral Resection of Bladder Tumour) from patients at no risk of aggressive cancer who could be spared from useless explorations. OBJECTIVE To perform a systematic review of data on the clinical validity and clinical utility of eleven urinary biomarkers (VisioCyt®, Xpert®Bladder, BTA stat®, BTA TRAK™, NMP22 BC®, NMP22® BladderChek® Test, ImmunoCyt™/uCyt1+™, UroVysion Bladder Cancer Kit®, Cxbladder, ADXBLADDER, Urodiag®) for bladder cancer diagnosis and for non-muscle invasive bladder cancer (NMIBC) follow-up. METHODS All available studies on the 11 biomarkers published between May 2010 and March 2021 and present in MEDLINE® were reviewed. The main endpoints were clinical performance for bladder cancer detection, recurrence or progression during NMIBC monitoring, and additional value compared to cytology and/or cystoscopy. RESULTS Most studies on urinary biomarkers had a prospective design and high level of evidence. However, their results should be interpreted with caution given the heterogeneity among studies. Most of the biomarkers under study displayed higher detection sensitivity compared with cytology, but lower specificity. Some biomarkers may have clinical utility for NMIBC surveillance in patients with negative or equivocal cystoscopy or negative or atypical urinary cytology findings, and also for recurrence prediction. CONCLUSION Urinary biomarkers might have a complementary place in bladder cancer diagnosis and NMIBC surveillance. However, their clinical benefit remains to be confirmed.
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Affiliation(s)
- Yanish Soorojebally
- Department of Urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Mathieu Roumiguié
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse Cedex, France
| | - Pierre-Jean Lamy
- Biopathologie et Génétique des Cancers, Institut Médical d'Analyse Génomique, Imagenome, Inovie, Montpellier, France
| | - Yves Allory
- Department of Pathology, Institut Curie, Saint-Cloud, France
| | - Françoise Descotes
- Biochemistry, Biology and Pathology Center South, Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon I, Pierre-Bénite, France
| | - Sophie Ferlicot
- Service d'Anatomie Pathologique, AP-HP,, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | | | - Stéphane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - Xavier Rébillard
- Urology Department, Beausoleil Private Hospital, Montpellier, France
| | - Catherine Roy
- Department of Radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, France
| | - Thierry Lebret
- Department of Urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitié-Salpêtrière Hospital, Sorbonne University, F-75013, Paris, France
| | - François Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France.
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Llorente-Ortega M, Polo R, Chiva S, Martín-Calvo N, Sáenz-Santa-María E, Diez-Caballero F, Fernandez S. The development and validation of a new simulator for endourology. Actas Urol Esp 2023; 47:236-243. [PMID: 36731822 DOI: 10.1016/j.acuroe.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Simulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators. MATERIALS AND METHODS A low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale. RESULTS New simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (p<0.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation ±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure. CONCLUSION The simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills.
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Affiliation(s)
- M Llorente-Ortega
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - R Polo
- Faculty of Medicine, Universidad de Navarra, Pamplona, Spain
| | - S Chiva
- Department of Urology, Clínica Universidad de Navarra, Pamplona, Spain
| | - N Martín-Calvo
- Faculty of Medicine, Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain, CIBER-obn, Instituto Salud Carlos III, IdiSNA, Institute of Health Research of Navarra, Madrid, Spain
| | - E Sáenz-Santa-María
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain
| | - F Diez-Caballero
- Department of Urology, Clínica Universidad de Navarra, Pamplona, Spain
| | - S Fernandez
- Medical Engineering Laboratory, School of Medicine, Universidad de Navarra, Pamplona, Spain.
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Taneja R, Pandey S, Priyadarshi S, Goel A, Jain A, Sharma R, Purohit N, Bandukwalla V, Tanvir, Ragavan M, Agrawal A, Shah A, Girn Z, Ajwani V, Mete U. Diagnostic and therapeutic cystoscopy in bladder pain syndrome/interstitial cystitis: systematic review of literature and consensus on methodology. Int Urogynecol J 2023:10.1007/s00192-023-05449-w. [PMID: 36708406 DOI: 10.1007/s00192-023-05449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/31/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Cystoscopy has been routinely performed in patients suspected to be suffering from bladder pain syndrome/interstitial cystitis (BPS/IC) across the globe. The methodology reported by various guidelines appears to have differences in the techniques and hence there is a need for a review of all those techniques in order to arrive at a consensus. The aim was to review the literature describing the prevalent techniques of cystoscopy for patients of BPS/IC and try to evolve a consensus. METHODS The group the Global Interstitial Cystitis, Bladder Pain Society (GIBS) has worked collectively to systematically review the literature using the key words, "Cystoscopy in Hunner's lesions, bladder pain syndrome, painful bladder syndrome and interstitial cystitis" in the PubMed, COCHRANE, and SCOPUS databases. A total of 3,857 abstracts were studied and 96 articles referring to some part of technique of cystoscopy were short-listed for review as full-length articles. Finally, six articles with a description of a technique of cystoscopy were included for final tabulation and comparison. The group went on to arrive at a consensus for a stepwise technique of diagnostic and therapeutic cystoscopy in cases of BPS/IC. This technique has been compared with the previously described techniques and may serve to be a useful practical guide for treating physicians. CONCLUSION It is important to have a uniform standardized technique for performing a diagnostic and therapeutic cystoscopy in patients with BPS/IC. Consensus on one such a technique has been arrived at and described in the present article.
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Affiliation(s)
- Rajesh Taneja
- Urology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, 110070, India.
| | - Sanjay Pandey
- Urology and Renal Transplant, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India
| | | | - Apul Goel
- Department of Urology, King George Medical University, Lucknow, India
| | - Amita Jain
- Institute of Urology and Robotics, Medanta The Medicity, Gurugram, India
| | - Ranjana Sharma
- Gynecology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Navita Purohit
- Department of Physiatry, Kokilaben Dhitubhai Ambani hospital, Mumbai, India
| | | | - Tanvir
- Tanvir Hospital, Hyderabad, India
| | | | | | - Amit Shah
- Surgery and Urology, Naval Hospital, Mumbai, India
| | | | - Vikky Ajwani
- The Cure Urology Hospital, Vadodara, Gujarat, India
| | - Uttam Mete
- Urology and Robotic Surgery, PGIMER, Chandigarh, India
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Öztürk E, Yikilmaz TN, Hamidi N, Selvi İ, Başar H. Scheduled or immediate cystoscopy: Which option reduces pain and anxiety? Int Urol Nephrol 2023; 55:37-41. [PMID: 36125620 DOI: 10.1007/s11255-022-03364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/10/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Office-based flexible cystoscopy is a common outpatient procedure in daily urology practice. Sometimes, cystoscopy procedures are performed on the initial day or scheduled on the following days. We designed this study to compare immediate versus scheduled cystoscopy in terms of anxiety and pain. METHODS In this study, 160 patients were prospectively randomized to undergo office-based flexible cystoscopy by the same urologist between November 2017 and January 2018. Participants were grouped as scheduled for a cystoscopy on the third day of their application (group 1) and immediate cystoscopy on the same day of the application (group 2). A visual analog scale (VAS), State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI) were completed by the patients. RESULTS Among men, immediate cystoscopy group experienced an increased state anxiety score compared to scheduled group (51.21 ± 8.108 vs 35.29 ± 10.553; p < 0.001). BAI scores were 16.51 ± 8.078 for group1 vs 31.92 ± 8.403 for group2 (p < 0.001). The mean VAS score was 3 ± 1.183 and 4.55 ± 1.155 in group1 and group2, respectively (p < 0.001). Among women, both the trait anxiety score and state anxiety score were found significantly low in scheduled group (mean trait anxiety scores 44.71 ± 6.051 and 49.3 ± 6.670, mean state anxiety scores were 33.71 ± 8.776 and 44.15 ± 7 in group1 and 2, respectively; p < 0.0001). BAI scores were also low in scheduled group (19.02 ± 7.786 vs 34.13 ± 8.367). Additionally, the mean VAS score was significantly high in immediate cystoscopy group compared to scheduled cystoscopy group (3.50 ± 0.784 vs 2.61 ± 0.919; p < 0.001). CONCLUSION To reduce anxiety and pain, informing patients properly about the cystoscopy and scheduling the procedure would be helpful for a better cooperation of the patient.
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Affiliation(s)
- Erdem Öztürk
- Urology Department, Department of Urology, Ankara Dr. Abdurrahman Yurtaslan Training and Research Hospital, Vatan Street No:91, Yenimahalle, 06200, Ankara, Turkey.
| | - Taha Numan Yikilmaz
- Urology Department, Department of Urology, Denizli Egekent Hospital, Denizli, Turkey
| | - Nurullah Hamidi
- Urology Department, Department of Urology, Ankara Dr. Abdurrahman Yurtaslan Training and Research Hospital, Vatan Street No:91, Yenimahalle, 06200, Ankara, Turkey
| | - İsmail Selvi
- Urology Department, Department of Urology, Başakşehir Çam and Sakura Hospital, Istanbul, Turkey
| | - Halil Başar
- Urology Department, Department of Urology, Ankara Dr. Abdurrahman Yurtaslan Training and Research Hospital, Vatan Street No:91, Yenimahalle, 06200, Ankara, Turkey
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Ericson CA, Baird BA, Mauler DJ, Lyon TD, Ball CT, Dora CD. Early apical release versus En-bloc no touch technique for holmium laser enucleation of the prostate: a high-volume single-surgeon cohort study. World J Urol 2023; 41:167-172. [PMID: 36357603 DOI: 10.1007/s00345-022-04206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/06/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine whether the early apical release (EAR) technique for holmium laser enucleation of the prostate (HOLEP) is associated with improved perioperative outcomes compared to the En-bloc no touch (EBNT) technique. METHODS Consecutive men treated with HOLEP by a single surgeon from August 2018 to March 2021 were identified. Beginning in June 2021 all procedures were performed using the EAR technique, and these were compared to the preceding cases done with the EBNT technique. Intraoperative outcomes included operative time, need for open conversion, enucleation efficiency (tissue removed per minute of OR time), and enucleation ratio (tissue removed relative to preoperative gland size on imaging). Postoperative outcomes included catheter reinsertion, blood transfusion, and complications classified by the Clavien-Dindo scale. RESULTS We identified 801 men, including 571 (71%) treated with EBNT and 230 (29%) with EAR. Median preoperative characteristics were similar between groups. The EAR approach was associated with significantly longer mean operating room time, 100.5 min versus 91.9 min, p = 0.003. However, EAR patients had a much lower rate of conversion to open cystotomy (0.43% versus 3.0%). There were no significant differences in rate of catheter reinsertion or perioperative complications between groups (p > 0.05). CONCLUSION EAR technique by an experienced HoLEP surgeon resulted in longer operative times, potentially reflecting an initial learning curve, but essentially eliminated the need for open cystotomy. Perioperative results including catheter reinsertion rate and bleeding complications were similar between the two cohorts. These data support continued use of the EAR technique for HOLEP to minimize risk of open conversion.
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Affiliation(s)
- Christian A Ericson
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bryce A Baird
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Timothy D Lyon
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Colleen T Ball
- Department of Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Chandler D Dora
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Alzubaidi AN, Sekoulopoulos S, Birk A, Pham JT, Washburn E, Knoedler JJ. Synchronous melanosis of upper and lower urinary tract. Urol Case Rep 2022; 46:102309. [PMID: 36619659 PMCID: PMC9817159 DOI: 10.1016/j.eucr.2022.102309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/14/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022] Open
Abstract
Urothelial melanosis is an exceptionally rare diagnosis, with less than 25 cases being reported in the literature. Melanosis of the urothelium is characterized by abnormal melanin deposition within tissues, producing a black, velvety appearance to the urothelial mucosa. We present a 67-year-old male undergoing cystoscopy during a routine percutaneous nephrolithotomy (PCNL), who was found to have diffuse bladder melanosis extending up the ureter and into the renal pelvis. To our knowledge, this is the first reported case of synchronous melanosis of upper and lower urinary tract.
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Affiliation(s)
- Ahmad N. Alzubaidi
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Stephen Sekoulopoulos
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alexander Birk
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jonathan T. Pham
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Erik Washburn
- Department of Pathology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - John J. Knoedler
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA,Corresponding author. Department of Urology, Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
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Zhao H, Peng P, Luo Z, Liu H, Sun J, Wang X, Jia Q, Yang Z. Comparison of hexaminolevulinate (HAL) -guided versus white light transurethral resection for NMIBC: A systematic review and meta-analysis of randomized controlled trials. Photodiagnosis Photodyn Ther 2022; 41:103220. [PMID: 36462704 DOI: 10.1016/j.pdpdt.2022.103220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE We systematically reviewed the effectiveness of hexaminolevulinic acid (HAL) after traditional light cystoscopy vs. only white light cystoscopy (WLC) on nonmuscle-invasive bladder cancer (NMIBC) clinical outcomes. METHODS Systematic literature searches of PubMed, Embase, Web of Science, and the Cochrane database and reference lists were performed. A total of 12 randomized controlled trials (RCTs) of HAL fluorescent cystoscopy (FC) and WLC vs. white light cystoscopy alone for the diagnosis of initial or recurrent bladder cancer that reported bladder cancer recurrence, progression, recurrence-free survival (RFS), and other effects were selected for review. RESULTS Our results included 2,775 patients identified for analysis and showed that the HAL group had a lower recurrence rate than the white light cystoscopy group with a statistically significant difference (RR=0.77, 95% CI 0.69-0.85. P < 0.05), and this advantage still existed for patients receiving intravesical chemotherapy. There was also a statistically significant difference in favour of fluorescent cystoscopy in recurrence-free survival and progression rate (HR=0.79, 95% CI 0.67-0.92. P < 0.05, RR = 0.63, 95% CI 0.43-0.94. P < 0.05, respectively). The time to first recurrence was not significantly different from that in the WLC group (SMD=0.73, 95% CI, -0.39-1.85. P = 0.2). And the HAL group did not have a significantly reduced residual tumor rate (RR=0.59, 95% CI 0.23-1.51. P = 0.27). CONCLUSIONS Fluorescent cystoscopy was associated with a reduced risk of bladder cancer recurrence and reduced progression rate; it also has advantages for RFS. However, there was no significant difference in the rate of residual tumor and the time of first recurrence. More studies are needed to better understand the effects of the photosensitizer used on NMIBC patients.
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Affiliation(s)
- Hang Zhao
- Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing 100029, China; China-Japan Friendship School Clinical Medicine, Peking University, Beijing 100029, China
| | - Panxin Peng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Zhenkai Luo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hailong Liu
- Department of Joint Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Junwei Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Xuming Wang
- China-Japan Friendship School Clinical Medicine, Peking University, Beijing 100029, China; Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing 100029, China
| | - Qiang Jia
- Department of Anesthesiology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing 100029, China.
| | - Zhihao Yang
- Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing 100029, China; China-Japan Friendship School Clinical Medicine, Peking University, Beijing 100029, China.
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Gupta A, Khosa J, Barker A, Samnakay N. Clinical spectrum and management options for prostatic utricle in children. J Pediatr Surg 2022; 57:690-695. [PMID: 35101262 DOI: 10.1016/j.jpedsurg.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Prostatic utricle (PU) has been described in children with hypospadias, posterior urethral valves (PUV), variances of sex characteristics and normal external genitalia. Intervention may be required in symptomatic cases, but clinical characteristics vary, requiring individualisation of management. We describe our experience with this condition. METHODS Retrospective review of males noted to have PU on cystoscopy (2009-2020) at a single centre. Presentation, management and outcomes were recorded (Variances of sex characteristics excluded). RESULTS Of 1060 male children who underwent cystoscopy for various reasons, PU was recorded in 36 (3.4%), indications for cystoscopy being hypospadias in 28, PUV in 3, urinary tract infections (UTI) in 3 and hydronephrosis in 2. Six (16.7%) developed epididymo-orchitis. All 6 had Ikoma Grade II PU. Case 1 (16 years,UTI) was managed with intravenous antibiotics. Case 2 (8 years,hypospadias) underwent laying open of urethral stricture. Case 3 (5 years,PUV) underwent laparoscopic PU excision. Cases 4 and 5 (3 and 6 years, hypospadias) underwent cystoscopic injection of bulking agent near the insertion of the vasa. Case 6 (3 years,hypospadias) underwent laparoscopic PU excision with vasal disconnection (vasal openings at dome of utricle rather than base) following failed endoscopic management. Median follow-up was 36 (0-206) months. All remained asymptomatic with normal testicular volumes for age at current follow-up. CONCLUSION Multiple treatment options to address a symptomatic PU have been described and enable surgeons to individualise treatment based on clinical circumstances. It is important to identify variations in anatomy of vasal connection to PU to plan appropriate management. LEVEL OF EVIDENCE IV (Retrospective study).
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Affiliation(s)
- Alisha Gupta
- Department of Paediatric surgery and urology, Perth Children's Hospital, 15, Hospital Avenue, Nedlands, Western Australia, 6009, Australia.
| | - Japinder Khosa
- Department of Paediatric surgery and urology, Perth Children's Hospital, 15, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| | - Andrew Barker
- Department of Paediatric surgery and urology, Perth Children's Hospital, 15, Hospital Avenue, Nedlands, Western Australia, 6009, Australia
| | - Naeem Samnakay
- Department of Paediatric surgery and urology, Perth Children's Hospital, 15, Hospital Avenue, Nedlands, Western Australia, 6009, Australia; Clinical Associate Professor, Division of Surgery, Medical School, University of Western Australia
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Doizi S, Koskas L. [Impact of simulation-based training in endourology: A systematic review of the literature]. Prog Urol 2022; 32:813-829. [PMID: 36041956 DOI: 10.1016/j.purol.2022.07.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/26/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION The impact of simulation on the acquisition of surgical skills as well as their transfer to the operating room is still debated. The objective was to assess these two specific points, focusing on the field of endourology. METHODS A systematic review of the literature, following the PRIMA statement, was performed using Medline database through September 2021 without time limit. Studies focusing on the impact of simulators on the acquisition of surgical technical skills as well as their transfer to the operating room in the field of endourology were included. The endourological procedures were: cystoscopy, ureteroscopy, percutaneous nephrolithotomy, endoscopic treatment of benign prostatic hyperplasia, endoscopic bladder resection. RESULTS Among the 11,442 publications identified, fifty-two studies were included in the analysis. The majority reported an improvement in procedure time of the requested tasks and dexterity of participants, regardless of the type of simulator and procedure. The level of evidence of included studies was often low. Few studies evaluated the transfer of acquired skills from the simulator to the operating room. CONCLUSION This review showed the positive impact of simulation on the acquisition of technical skills in endourology. However, in order to include proficiency-based progression in the curriculum of trainees, some parameters such as the choice of reference simulators, choice of tasks, and method of validation of acquired skills must be validated in a consensual manner to offer a quality training.
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Affiliation(s)
- S Doizi
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 75020 Paris, France.
| | - L Koskas
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, 75020 Paris, France.
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中危非肌层浸润性膀胱癌的最佳膀胱镜监测强度. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54. [PMID: 35950390 DOI: 10.19723/j.issn.1671-167X.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine the optimal cystoscopic frequency for intermediate-risk non-muscle invasive bladder cancer. METHODS Patients with intermediate-risk non-muscle invasive bladder cancer, who underwent transurethral resection of bladder tumor in Peking University People's Hospital from January 2001 to October 2019, were retrospectively analyzed. Their clinical, pathological and follow-up data were collected. In postoperative 2-year period, the patients were underwent cystoscopy every 3 to 6 months. Depending on recurrence and progression of the patients, we hypothesized three strategies of surveillance intensity in the first 2 years after surgery: model 1: 3-month intervals, model 2: 6-month intervals, and model 3: 12-month intervals. The differences in the numbers and time of delayed detection of recurrence and progression were compared among the three models. RESULTS A total of 185 patients were enrolled, including 144 males (77.8%) and 41 females (22.2%). The median age was 68 (59-76) years. There were 118 cases (63.8%) with single tumor and 67 cases (36.2%) with multiple tumor. Of the patients 179 (96.8%) had stage Ta and 6 (3.2%) had stage T1. There were 108 cases (58.4%) with high-grade disease and 77 cases (41.6%) with low-grade disease. During the follow-up period of the first 2 years, 52 patients (28.1%) had recurrence, 133 cases (71.9%) had no recurrence, 11 cases (5.9%) had progression and 174 cases (94.1%) had no progression. Compared with model 1, 29 (55.8%) delayed detection of recurrence in model 2 vs. 41 (78.8%) delayed detection of recurrence in model 3, and the difference was statistically significant (P=0.012). The median delayed time of detecting recurrence was 1.00 months in model 1, 1.99 months in model 2 and 4.19 months in model 3, respectively. There were statistically significant differences between mode 1 and model 3 (P=0.001), and between model 2 and model 3 (P=0.013). Compared with model 1, 5 (45.4%) delayed detection of progression in model 2 vs. 8 (72.7%) delayed detection of progression in model 3, and the difference was not statistically significant. The median delayed time of detecting progression was 1.00 month in model 1, 2.00 months in model 2 and 3.00 months in model 3, respectively. There was no statistically significant difference among them. CONCLUSION Although providing slightly slower detection of tumor recurrence and progression, compared with 3-month intervals of cystoscopy, 6-month intervals do not result in serious adverse outcomes and reduce cost and pain of the patients, which is feasible in intermediate-risk non-muscle invasive bladder cancer.
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Lu ST, Liu MB, Liu LB. A new treatment of an intravesical eroded mesh after TVM: 3 mm trocar-assisted cystoscopic approach. Int Urogynecol J 2022; 33:2321-2322. [PMID: 35277737 DOI: 10.1007/s00192-022-05128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To present a novel technique to remove intravesical eroded mesh through a 3-mm trocar-assisted cystoscopy. METHODS First, a 3-mm trocar was inserted into the bladder under ultrasound guidance after the bladder had been infused with 600 ml normal saline. Second, we inserted the forceps through the trocar into the bladder and pulled the mesh through the 3-mm trocar. Last, cystoscopic scissors were used to remove the eroded mesh completely. RESULTS The patient was managed adequately in the inpatient department. The urethral catheter was left in situ for 3 days, and the patient was discharged within 5 days. CONCLUSION Surgery under 3-mm trocar-assisted cystoscopy offers the advantage of lower risk of morbidity and complications compared to other surgical techniques. It is an effective and feasible procedure for treatment of synthetic mesh erosion into the bladder after TVM surgery.
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Affiliation(s)
- Shen-Tao Lu
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, Yubei District, China
| | - Ming-Bo Liu
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, Yubei District, China
| | - Lu-Bin Liu
- Department of Gynecological Pelvic Floor and Oncology, Chongqing Health Center for Women and Children, Longshan Road 120, Chongqing, Yubei District, China.
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Rai BP, Luis Dominguez Escrig J, Vale L, Kuusk T, Capoun O, Soukup V, Bruins HM, Yuan Y, Violette PD, Santesso N, van Rhijn BWG, Hugh Mostafid A, Imran Omar M. Systematic Review of the Incidence of and Risk Factors for Urothelial Cancers and Renal Cell Carcinoma Among Patients with Haematuria. Eur Urol 2022; 82:182-192. [PMID: 35393159 DOI: 10.1016/j.eururo.2022.03.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/12/2022] [Accepted: 03/17/2022] [Indexed: 12/21/2022]
Abstract
CONTEXT The current impact of haematuria investigations on health care organisations is significant. There is currently no consensus on how to investigate patients with haematuria. OBJECTIVE To evaluate the incidence of bladder cancer, upper tract urothelial carcinoma (UTUC), and renal cell carcinoma (RCC) among patients undergoing investigation for haematuria and identify any risk factors for bladder cancer, UTUC, and RCC (BUR). EVIDENCE ACQUISITION Medline, Embase, and Cochrane controlled trials databases and ClinicalTrials.gov were searched for all relevant publications from January 1, 2000 to June 2021 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Prospective, retrospective, and cross-sectional studies with a minimum population of 50 patients with haematuria were considered for the review. EVIDENCE SYNTHESIS A total of 44 studies were included. The total number of participants was 229701. The pooled incidence rate for urothelial bladder cancer was 17% (95% confidence interval [CI] 14-20%) for visible haematuria (VH) and 3.3% (95% CI 2.45-4.3%) for nonvisible haematuria (NVH). The pooled incidence rate for RCC was 2% (95% CI 1-2%) for VH and 0.58% (95% CI 0.42-0.77%) for NVH. The pooled incidence rate for UTUC was 0.75% (95% CI 0.4-1.2%) for VH and 0.17% (95% CI 0.081-0.299%) for NVH. On sensitivity analysis, the proportions of males (risk ratio [RR] 1.14, 95% CI 1.10-1.17 for VH; 1.54, 95% CI 1.34-1.78 for NVH; p < 0.00001; moderate certainty evidence) and individuals with a smoking history (RR 1.41, 95% CI 1.24-1.61 for VH; 1.53, 95% CI 1.36-1.72 for NVH; p < 0.00001; moderate certainty evidence) appeared to be higher in BUR than in non-BUR groups. CONCLUSIONS Male gender and smoking history are risk factors for BUR cancer in haematuria, with bladder cancer being the commonest cancer. The incidence of RCC and UTUC in NVH is low. The review serves as a reference standard for future policy-making on investigation of haematuria by global organisations. PATIENT SUMMARY Our review shows that male gender and smoking history are risk factors for cancers of the bladder, kidney, and ureter. The review also provides information on the proportion of patients who have cancer when they have blood in their urine (haematuria) and will allow policy-makers to decide on the most appropriate method for investigating haematuria in patients.
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Affiliation(s)
- Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | | | - Luís Vale
- Department of Urology, Centro Hospital Universitário S. João, Porto, University of Porto, Porto, Portugal
| | - Teele Kuusk
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Otakar Capoun
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Viktor Soukup
- Department of Urology, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Harman M Bruins
- Department of Urology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, The Netherlands
| | - Yuhong Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | - Philippe D Violette
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Cochrane Canada Centre, McMaster University, Hamilton, ON, Canada
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - A Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
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Kitta T, Abe H, Ting-Wen H, Fujikawa M, Nakazono M, Sasa T, Doi Y, Toki S, Okada D, Ochi A, Suzuki K, Kitagawa Y, Shinohara N. Novel insight into the correlation between hernia orifice of cystocele and lower urinary tract function: a pilot study. BMC Womens Health 2022; 22:164. [PMID: 35562822 PMCID: PMC9102938 DOI: 10.1186/s12905-022-01747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been hypothesized that women with significant pelvic organ prolapse (POP), particularly of the anterior vaginal wall, may have voiding dysfunction (VD). Although the VD mechanism due to cystocele is not fully understood, different vaginal compartments have rarely been closely examined. This study attempted to further elucidate the correlation between POP and VD through a new subgroup classification using cystoscopy. METHODS This study reviewed clinical records of 49 women who underwent cystocele repair. All patients were scheduled for laparoscopic sacrocolpopexy, preoperatively underwent uroflowmetry and postvoid residual urine volume (PVR) measurement, and completed pelvic floor function questionnaires. Bladder examination by cystoscopy was additionally performed using the lithotomy position with the Valsalva maneuver. RESULTS Subjects were divided into four groups according to hernia orifice presence determined by cystoscopy, which included the trigone type, posterior wall type, trigone and urethra type, and trigone and posterior wall type. The posterior wall type had statistically higher PVR values versus the trigone and posterior wall type (P = 0.013). The posterior wall type had statistically lower values for average urine flow rate versus the urethra and trigone type (P = 0.020). There were no significant differences noted in the pelvic floor function questionnaires among the four groups. CONCLUSIONS A new bladder defect classification based upon hernia orifice location was associated with lower urinary tract function. Posterior wall hernia presence caused significant voiding function deterioration. This new subgroup classification, which can more clearly identify and indicate bladder function, is also comparable among patients.
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Affiliation(s)
- Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Kita 15 Nishi 7; Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Huang Ting-Wen
- Department of Urology, Ushikuaiwa General Hospital, Ushiku, Japan
| | | | - Minoru Nakazono
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Taiki Sasa
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Yukiko Doi
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Sari Toki
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Daigo Okada
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Atsuhiko Ochi
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | - Koichiro Suzuki
- Department of Urology, Kameda Medical Center, Kamogawa, Japan
| | | | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Kita 15 Nishi 7; Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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