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

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

Intravesical onabotulinumtoxinA (BoNT-A) injection is an effective treatment for overactive bladder syndrome (OAB) that is refractory to antimuscarinics. An injectable dose of 100 U has been suggested to achieve the optimal balance of benefit and safety in patients with OAB. BoNT-A (total volume of 10 mL) was administered as evenly distributed intradetrusor injections (5 U) across 20 sites approximately 1 cm apart (0.5 mL per site) using a flexible or rigid cystoscope. Treatment with BoNT-A was generally well tolerated by most patients, and most treatment-related adverse events were localized to the urinary tract. The prevalence of OAB increases with age, and elderly patients are more vulnerable to complications. The short-term efficacy of intravesical BoNT-A injection for refractory OAB with no treatment-related complications in the elderly population has been documented. Frail elderly patients can experience the same treatment results, such as significantly improved urgent urinary incontinence and quality of life, as young and nonfrail elderly patients with 100-U BoNT-A injections. However, increased risk of larger postvoid residual (PVR) urine and lower long-term success rates were noted in frail elderly patients; around 11% had acute urinary retention, while 60% had PVR urine volume >150 mL after treatment. In addition, intravesical injection of BoNT-A effectively decreased urgency symptoms in elderly patients with OAB and central nervous system lesions. The adverse effects were acceptable, while the long-term effects were comparable to those in patients with OAB without central nervous system lesions. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization in this vulnerable population requires careful evaluation before treatment with intravesical BoNT-A. In conclusion, the current findings indicate that intravesical BoNT-A is an effective and safe treatment for OAB in elderly patients.
Administration, Intravesical ; Aged ; Botulinum Toxins, Type A ; Catheterization ; Catheters ; Central Nervous System ; Cystoscopes ; Frail Elderly ; Humans ; Muscarinic Antagonists ; Prevalence ; Quality of Life ; Urinary Bladder, Overactive* ; Urinary Incontinence ; Urinary Retention ; Urinary Tract ; Vulnerable Populations

OBJECTIVETo determine the exact location of the opening of the ejaculatory duct in men and provide some basic anatomical evidence for seminal vesiculoscopy and the treatment of ejaculatory duct obstruction.

METHODSWe performed ureterocystoscopy for 21 male patients aged 26 - 47 years with hematuria (n = 12), hematospermia (n = 2), glandular cystitis (n = 6), and anejaculation after radical resection of rectal carcinoma (n = 1), and meanwhile, with the consent of the patients, massaged the prostate and ejaculatory duct and observed the outlet of the expelled fluid. Under the microscope, we described the fluid samples with sperm as the expulsion from the ejaculatory duct.

RESULTSUreterocystoscopy showed that the exact anatomical sites of the expulsion of prostatic fluid and semen in the patients were the side and lower side of the prostatic utricle opening above the verumontanum and the ventral side of the verumontanum. Quantities of sperm were found in the expulsion fluid of 13 of the patients, and no expulsion, including semen, was seen from the prostatic utricle opening.

CONCLUSIONAnatomically, the ejaculatory duct openings of males are located at the two sides of the verumontanum adjacent to the opening of the prostatic utricle, rather than in the prostatic utricle above the verumontanum.

Adult ; Cystoscopes ; Ejaculation ; physiology ; Ejaculatory Ducts ; anatomy & histology ; physiology ; Endoscopy ; instrumentation ; methods ; Hematuria ; Hemospermia ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prostate ; anatomy & histology ; physiology ; Rectal Neoplasms ; surgery ; Semen ; secretion ; Spermatozoa

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

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*

PURPOSE: The present study was done to examine the effect of music therapy on anxiety and pain in patients for whom a ureteral stent was inserted under local anesthesia. METHOD: The participants in this study were 22 patients who received a ureteral stent at the Day Surgery Center of C University Hospital during the period from May to October in 2006. The patients were divided into a control group (n=11) and an experimental group (n=11). For the experimental group, music was played according to their musical preference using headphones. The music was provided from the point when the patient took the posture for the operation and was covered with a sterilized drape to the point when the cystoscope was removed after finishing the operation. The control group was only provided with ordinary nursing services. RESULTS: The results show that the provision of music therapy to these patients is effective in reducing the patients' salivary cortisol and Vas-anxiety score and stabilizing their systolic blood pressure. CONCLUSION: We conclude that music therapy can be actively used as a nursing intervention for reducing anxiety in patients who receive operations under local anesthesia.
Ambulatory Surgical Procedures ; Anesthesia, Local* ; Anxiety* ; Blood Pressure ; Cystoscopes ; Humans ; Hydrocortisone ; Music Therapy* ; Music* ; Nursing ; Nursing Services ; Posture ; Stents* ; Ureter*

OBJECTIVE: This study was performed to evaluate the efficacy and safety of Trans-obturator tape (TOT) in the surgical treatment of stress incontinence and analyze the postoperative clinical outcome. METHODS: Between August 2004 and September 2005, females diagnosed as having stress incontinence (pure or mixed) were operated on using TOT. Eighty cases with more than three-month follow-up period were included for this study. RESULTS: Patient age ranged from 28 to 74 years (mean, 58). After surgical treatment using TOT, 74 cases (92.5%) of stress incontinence showed complete recovery, 4 cases (5%) showed partial recovery, and 2 cases (2.5%) were unchanged without further functional deterioration. Urgency in the mixed incontinence was improved in 30 in 36 cases (83.3%) and frequency was changed for the better in 20 of 27 cases (62.9%). The mean operation time was 14.3 minutes and the mean hospital stay was six hours. Postoperative evaluation with cystoscope was unnecessary. The postoperative complication rate was 10% (8/80). Postoperative wound bleeding occurred in one case and intraoperative bladder perforation happened in one case. Postoperative transient urgency was developed in one case and postoperative transient frequency developed in three cases. Two patients complained of weak urinary stream. CONCLUSION: The surgical treatment using TOT is thought to be a safe and efficient means for the outpatient management of stress incontinence. And also, this method appears to have an effect on urgency and frequency.
Cystoscopes ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Length of Stay ; Outpatients ; Postoperative Complications ; Rivers ; Suburethral Slings* ; Urinary Bladder ; Wounds and Injuries

PURPOSE: The aim of this study was to evaluate the long-term results of endoscopic primary realignment of a posterior urethral rupture accompanied by a pelvic bone fracture. MATERIALS AND METHODS: Our study population consists of 7 patients who were able to be followed up for at least 5 years, of an initial 8 that underwent endoscopic primary realignment of a posterior urethral rupture due to a pelvic bone fracture. Operations were carried out in the following order; the bladder was incised to allow a metal sound, with stitching fiber then tied at its end so it could be advanced into the injured proximal urethra through the bladder neck. The fiber was then traced using a cystoscope and connected to a urethral catheter, which could be indwelled in the bladder by pulling the sound back. RESULTS: The mean follow-up period was 8.1 (5.2-9.7) years. The mean operation time was 48.3 (28-71) minutes. There were no severe disruptions of the pelvic hematoma, transfusions or other additive injuries during the operations. Post-operation complications were observed in 4 patients; 3 cases of mild urethral stricture, which were treated with an endoscopic intra-urethrotomy followed by clean intermittent catheterization, 3 cases of erectile dysfunction and 1 case each of urinary incontinence and a urethral stone. CONCLUSIONS: This study clearly implies that endoscopic primary realignment of a severe posterior urethral rupture accompanied by a pelvic bone fracture is less invasive and a safer method, without pelvic hemorrhage or additional injuries. Early endoscopic intervention also improves the quality of life by reducing the possibility of an invasive procedure, and also prevents severe urethral stricture and the resultant complications by maintaining the continuity of the urethra.
Cystoscopes ; Cystostomy* ; Erectile Dysfunction ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Intermittent Urethral Catheterization ; Male ; Neck ; Pelvic Bones* ; Quality of Life ; Rupture* ; Urethra ; Urethral Stricture ; Urinary Bladder ; Urinary Catheters ; Urinary Incontinence

PURPOSE: To describe our initial experience of laparoscopic pyeloplasty, with retrograde stenting, using flexible cystoscopes, in 9 cases of ureteropelvic junction obstruction (UPJO). MATERIALS AND METHODS: Between September, 2004 and January, 2006, 9 cases of UPJO were treated by laparoscopic pyeloplasty. All of the medical records were reviewed retrospectively. The cases comprised of 5 males and 4 females, with a mean age of 37 years (13-58). All patients showed a preoperative grade 4 hydronephrosis. RESULTS: Two laparoscopic pyeloplasty approaches were performed; a transperitoneal approach in 5 cases and a retroperitoneal approach in the other 4. All cases were treated with dismembered Anderson-Hynes pyeloplasty. The mean operating time was 249 minutes (170-324), including a mean of 7.1 minutes (6.5-8) for ureteral stenting. The patients were found to have aberrant vessels and renal stones in 1 and 3 cases, respectively. There were no intra-operative complications or open conversion. Of the 9 cases, 8 (89%) showed a decrease in their hydronephrosis grade on the excretory urographs taken 12 weeks postoperatively. The remaining case showed a marked improvement in the hydronephrosis, despite having no change in the hydronephrosis grade. No case experienced postoperative flank pain or recurrence of acute pyelonephritis. Therefore, symptomatic improvements were observed in all our cases (100%). CONCLUSIONS: Laparoscopic pyeloplasty, with retrograde stenting, using flexible cystoscopes, can be considered an effective and convenient method for the treatment of UPJO.
Cystoscopes* ; Cystoscopy ; Female ; Flank Pain ; Humans ; Hydronephrosis ; Laparoscopy ; Male ; Medical Records ; Pyelonephritis ; Recurrence ; Retrospective Studies ; Stents* ; Ureter ; Ureteral Obstruction