Objective: The varicocoele exist in approximately 35-40% of primary male factor infertility while two to 10 percent of cases presents with pain.1 Most surgeons favor subinguinal microscopic varicocoelectomy because it offers superior improvement in semen parameters and reproductive outcome with the least complication rate. This study aimed to show an innovative surgical technique in the management of men with varicoceles. Methods: Subinguinal varicocelectomies were performed by a single surgeon on all patients starting with a standard cystoscope stabilized by a customized mechanical holding system attached to the operating bed. All the presumed vascular channels, vas deferens and lymphatics were isolated and marked with vascular loops and surgical ties. After all the presumed vessels were tagged, the standard operating microscope was brought to the operative field and full microsurgical dissection was carried out. Results: Ten varicocelectomies were performed on six men with a mean age of 30.5 years. 13 arteries, 84 veins, and 20 lymphatics were identified by the cystoscope while 18 arteries, 93 veins, and 29 lymphatics were identified by the standard operating microscope. Comparing the two modalities, 72%, 90%, and 69% of the arteries, veins, and lymphatics, respectively, were correctly identified by the cystoscope when compared to the latter. Conclusion Subinguinal varicocelectomy using a standard cystoscope could be offered as an alternative surgical approach in men with varicoceles as it can identify veins comparable with that of the standard operating microscope. In addition, a standard cystoscope can also identify, to some degree, lymphatics and arteries during surgical dissection. This innovative surgical technique can serve as a valuable option in the treatment of men with varicoceles.
Cystoscopes ; Veins ; Arteries

PURPOSE: A flexible cystoscopic examination is well tolerated compared to a rigid cystoscopic examination in male patients. A modified flexible cystoscope was designed, and its discomfort and efficacy evaluated compared with a rigid cystoscope. MATERIALS AND METHODS: 104 patients underwent a cystoscopic examination, of which 37 underwent both rigid and modified flexible cystoscopic examinations, and 37 and 30 only a modified flexible cystoscopic or rigid cystoscopic examination, respectively. An observer visual analog pain scale was applied after the procedure, and the rating of discomfort recorded. RESULTS: In the group that underwent both examination types, the mean pain scores were 1.8 and 6.4 after the modified flexible cystoscopic and rigid cystoscopic examinations, respectively (p<0.001). In the individual cystoscopic groups, the mean pain scores were 2.6 and 6.0 after the modified flexible and rigid cystoscopic examinations, respectively (p<0.001). The vision of modified flexible and rigid cystoscopes was the same. CONCLUSIONS: A modified flexible cystoscopic examination was well tolerated by patients, and can be routinely used in place of the rigid counterpart for follow-up of bladder tumors and as a diagnostic procedure for a gross hematuria. Some modifications, such as a more ample working channel and an integral video camera, will be needed.
Cystoscopes ; Cystoscopy* ; Follow-Up Studies ; Hematuria ; Humans ; Male* ; Pain Measurement ; Urinary Bladder Neoplasms

BACKGROUND: Cystoscopic procedure is a very common practice in the field of urology due to its ability to survey the bladder for a variety of indications. However, patients who undergo cystoscopy feel intense pain and discomfort. This study investigated the half maximal effective concentration (EC50) of remifentanil in preventing cystoscope insertion pain under sedation using dexmedetomidine. METHODS: The study was prospectively conducted on 18 male patients, aged 18 to 65. Remifentail infusion was initiated together with dexmedetomidine, and started at a dose of 2.4 ng/ml on the first patient. The effect-site concentration (Ce) of remifentanil for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.3 ng/ml. Patients received a loading dose of 1.0 microg/kg dexmedetomidine over 10 minutes, followed by a maintenance dose of 0.6 microg/kg/hr. After the patient's OAA/S score (Observer's Assessment of Alertness/Sedation scale) reached 3-4, and the Ce of remifentanil reached target concentration, the urologist was allowed to insert the cystoscope and the pain responses were observed. RESULTS: The effect-site concentration of remifentanil required to prevent cystoscope insertion pain in 50% of patients under sedation using dexmedetomidine was 1.30 +/- 0.12 ng/ml by Dixon's up-and-down method. The logistic regression curve of the probability of response showed that the EC50 and EC95 values (95% confidence limits) of remifentanil were 1.33 ng/ml (1.12-1.52 ng/ml) and 1.58 ng/ml (1.44-2.48 ng/ml), respectively. CONCLUSIONS: Cystoscopic procedure can be carried out successfully without any pain or adverse effects by optimal remifentanil effect-site concentration (EC50, 1.33 ng/ml; EC95, 1.58 ng/ ml) combined with sedation using dexmedetomidine.
Cystoscopes ; Cystoscopy* ; Dexmedetomidine* ; Humans ; Logistic Models ; Male ; Prospective Studies ; Urinary Bladder ; Urology

Primary bladder amyloidosis is a rare disease causing hematuria which is difficult to be differenciated from bladder cancer at cystoscope. We report a case of primary bladder amyloidosis who was diagnosed at other procedure for distal ureteral stone failed in repeated ESWL disintegration. Transurethral resection of bladder mass and the pathologic results revealed amyloidosis. The systemic studies for the detection of the site of other amyloidosis were failed to get positive result. There were massive hematuria after a few hours later from the transurethral resection of the bladder mass and the bleeding was controlled with 1% alum bladder irrigation. The patient is followed regularly for recurrent amyloidosis.
Amyloidosis* ; Cystoscopes ; Hematuria ; Hemorrhage ; Humans ; Rare Diseases ; Ureter ; Urinary Bladder Neoplasms ; Urinary Bladder*

A 50-year-old man with bladder cancer had spinal anesthesia for transurethral resection of bladder. After he had spinal block at the T8 level, he developed a persistent penile erection, making it impossible to introduce the 24 French cystoscope. To treat a persistent penile erection, intravenous glycopyrrolate was incrementally given for a total of 0.4 mg. A persistent penile erection was markedly subsided 5 minutes after last 0.2 mg glycopyrrolate was given. Then corpus cavernosum blood was aspirated. The cystoscope was easily introduced, and transurethral resection of bladder proceeded without further complication.
Anesthesia, Spinal* ; Cystoscopes ; Glycopyrrolate ; Humans ; Male ; Middle Aged ; Penile Erection* ; Urinary Bladder ; Urinary Bladder Neoplasms

PURPOSE: The aim of this research was to evaluate the efficacy of the cystoscopic extraction and external drainage techniques for unsuccessful antegrade stenting in transplanted severe ureteral obstruction. MATERIALS AND METHODS: A total of 26 patients with severe transplanted ureteral obstruction in whom the cystoscopic extraction technique and/or external drainage technique was performed were retrospectively evaluated. After the severe obstruction was successfully traversed, balloon dilatation followed by double-J stent insertion was performed. RESULTS: Of the 26 patients (male:female, 9:4; mean age, 38.1 years) who underwent failed ureteral stenting with the conventional procedure, 16 patients underwent successful stenting with the cystoscopic extraction technique, and 10 patients underwent successful stenting following external drainage. The mean serum creatinine of the 26 patients before stenting was 42.9 mg/dL (range, 32.7 to 54.1 mg/dL), which decreased to 10.3 mg/dL (range, 8.7 to 11.8 mg/dL) after stenting. The complications of the procedure were lower abdominal pain in 22 patients and gross hematuria in 9 patients. All complications were relieved with medical care within 3 to 5 days after the procedure. No major complications occurred. CONCLUSIONS: The cystoscopic extraction technique and external drainage technique are safe and useful for traversing a severe transplanted ureteral obstruction after a failed conventional procedure.
Abdominal Pain ; Creatinine ; Cystoscopes ; Dilatation ; Drainage* ; Hematuria ; Humans ; Retrospective Studies ; Stents ; Transplantation ; Ureter* ; Ureteral Obstruction*

The treatment of traumatic disruption of the urethra must be tailored to the anatomical situation. It is too hard to know true length and situation of urethral stricture by concomitant retrograde and voiding cystourethrography, due to the bladder neck failed to open usually, Sometimes urologist have performed cystoscope or sound through by suprapubic cystostomy on retrograde urethrography to confirm the length of the urethral stricture. But these methods are complicated and invasive. Alpha adrenoceptor has been known to do important role in the bladder neck and prostatic urethra. So alpha adrenoceptor blocker( terazosin) has been used to decrease tone of internal urethral sphincter of the patient with benign prostatic hypertrophy. Under that theory, we tried terazosin per oral route when we performed the concomitant retrograde and voiding cystourethroscopy in 3 patients with complete membranous urethral stricture and 3 patients with bulbomembranous and 2 patients with bulbar urethral stricture. Dosage of terazosin was 1 to 10mg. The length and site of the stricture were not visualized by usual method without terazosin. In that cases we performed concomitant retrograde and voiding cystourethrography 1 hour after intake of terazosin. Terazosin well visualized site of the urethral stricture in 7 patients who had intact internal urethral sphincter.
Constriction, Pathologic ; Cystoscopes ; Cystostomy ; Humans ; Neck ; Prostatic Hyperplasia ; Urethra ; Urethral Stricture* ; Urinary Bladder

We describe our experience with visual primary urethral realignment, a new approach devised by authors, in the management of 5 male patients with proximal urethral injuries (3 bulbomembranous and 2 bulbous), utilizing a simple procedure with a flexible cystoscope through the tract made by a suprapubic cystostomy using a Campbell trocar set. No significant complication was experienced except for urethral strictures in 3 patients, easily corrected by visual internal urethrotomy. The new technique offers an alternative, much simpler with several advantages over the conventional methods : could be performed under a local anesthesia for the patients without accompanying damage to the intraperitoneal organs, enables the surgeon to visualize the damaged portion of the urethra for more accurate assessment of the damage, and does not require an open laparatomy, thus, offering an economical and a less invasive alternative approach with shorter hospitalization days and reduced pain for the patient.
Anesthesia, Local ; Cystoscopes ; Cystostomy ; Hospitalization ; Humans ; Male ; Surgical Instruments ; Urethra ; Urethral Stricture

OBJECTIVE: The aim of this study is to compare the efficacy of the TVT and TOT which have been widely used in the surgical management of stress urinary incontinence. METHODS: The study was carried on 22 patients with stress urinary incontinence who had operation at Seoul National University Bundang Hospital from April to December 2004. Review of medical records was done and clinical characteristics were compared according to the operation procedure. RESULTS: The TVT was done on 11 patients and TOT on 11 patients. There were no significant differences in patients' age, parity, body mass index, menopausal status, and severity of incontinence. The operation time was significantly shorter in TOT than in TVT. Complication rate and hospital stay were not significantly different between TVT and TOT. The cure rate (patients' satisfaction) was 90.9% in TVT, 100% in TOT. CONCLUSION: The TVT and TOT are both effective surgical treatment for stress urinary incontinence. The TOT is simple and time saving procedure because it can be done without cystoscope.
Body Mass Index ; Cystoscopes ; Female ; Humans ; Length of Stay ; Medical Records ; Parity ; Seoul ; Suburethral Slings* ; Urinary Incontinence*

BACKGROUND: This study compared the following three endoscopic techniques used to treat bladder stones: transurethral cystoscope used with a pneumatic lithoclast or nephroscope used with a pneumatic lithoclast and nephroscope used with an ultrasonic lithoclast.METHODS: Between January 2013 and May 2016, 107 patients with bladder stones underwent endoscopic treatment. Patients were classified into three groups based on the endoscopic techniques and energy modalities used in each group as: group 1 (transurethral stone removal using a cystoscope with pneumatic lithoclast), group 2 (transurethral stone removal using a nephroscope with pneumatic lithoclast), and group 3 (transurethral stone removal using a nephroscope with ultrasonic lithoclast). Baseline and perioperative data were retrospectively com-pared between three groups.RESULTS: No statistically significant intergroup differences were observed in age, sex ratio, and stone size. A statistically significant intergroup difference was observed in the operation time—group 1, 71.3±46.6 min; group 2, 33.0±13.7 min; and group 3, 24.6±8.0 min. All patients showed complete stone clearance. The number of urethral entries was higher in group 1 than in the other groups. Significant complications did not occur in any patient.CONCLUSION: Nephroscopy scores over cystoscopy for the removal of bladder stones with respect to operation time. Ultrasonic lithoclast is a safe and efficacious modality that scores over a pneumatic lithoclast with respect to the operation time.
Cystoscopes ; Cystoscopy ; Humans ; Retrospective Studies ; Sex Ratio ; Ultrasonics ; Urinary Bladder Calculi ; Urinary Bladder