PURPOSE: Transurethral resection of bladder tumor (TURBT) can be a challenging procedure for an inexperienced surgeon. We suggest an easy technique for TURBT, which we have named the "grasp and bite" technique. We describe this technique and compare its effectiveness and safety with that of conventional TURBT. MATERIALS AND METHODS: Monopolar TURBT (24-Fr Karl Storz) was performed in 35 patients who had superficial bladder tumors. After defining the tumor margin, the tumor and surrounding mucosa were grasped by use of a loop electrode and resectoscope sheath. With tight grasping, linear moving resection was performed. The patients' demographic, intraoperative, and postoperative data were analyzed between the conventional and grasp and bite TURBT groups. RESULTS: Of 35 patients, 16 patients underwent conventional TURBT (group 1), and the other 19 patients underwent grasp and bite TURBT (group 2). Both groups were similar in age, tumor multiplicity, size, anesthesia method, and location. Grasp and bite TURBT could be performed as safely and effectively as conventional TURBT. There were no significant differences in irrigation duration, urethral catheterization, postoperative hemoglobin drop, or length of hospital stay. No significant side effects such as bladder perforation, severe obturator reflex, or persistent bleeding occurred. There were no significant pathological differences between specimens according to the type of resection technique. CONCLUSIONS: The grasp and bite TURBT technique was feasible for superficial bladder tumors. It may be a good tool for inexperienced surgeons owing to its convenient and easy manner.
Aged ; Cystoscopy ; Electrodes ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Urinary Bladder/pathology/*surgery ; Urinary Bladder Neoplasms/pathology/*surgery ; Urologic Surgical Procedures/instrumentation/*methods

To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricture disease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlay substitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethral plate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixed as a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperative or postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of follow-up, the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplasty appears to be a safe and feasible technique for the management of bulbar urethral strictures.
Cystoscopy/methods ; Humans ; Male ; Middle Aged ; Mouth Mucosa/*transplantation ; Urethra/surgery ; Urethral Stricture/diagnosis/*surgery ; Urologic Surgical Procedures, Male/methods

PURPOSE: To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness. MATERIALS AND METHODS: We retrospectively analyzed 393 patients who underwent transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) from January 2010 to June 2013. All patients underwent cystoscopy, urine cytology, urinalysis, and computed tomography (CT) at 3 and 6 months after TURBT. In 62 cases, abnormal bladder lesions were identified on cystoscopy within 6 months. Suspicious lesions were confirmed pathologically by TURBT or biopsy. Patients were grouped by modalities: group I, urine cytology; group II, CT; group III, urinalysis; group IV, urine cytology plus CT; group V, urine cytology plus urinalysis; group VI, CT plus urinalysis; group VII, combination of all three modalities. Each group was compared by cost per cancer detected. RESULTS: Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence rate was 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041). CONCLUSIONS: Routine urine cytology may not be useful for follow-up of bladder cancer in terms of practicality and cost-effectiveness. Application of urine cytology needs to be adjusted according to each patient.
Aged ; Aged, 80 and over ; Cost-Benefit Analysis ; Cystoscopy/economics ; Cytodiagnosis/economics/methods ; Female ; Health Care Costs/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis/economics/pathology ; Neoplasm Staging ; Republic of Korea ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/economics ; Urinalysis/economics/methods ; Urinary Bladder Neoplasms/*diagnosis/economics/pathology/surgery ; Urine/*cytology

OBJECTIVESTo evaluate the value of narrow band imaging (NBI) cystoscopy in detection of bladder cancer.

METHODSLiteratures on narrow-band imaging cystoscopy in diagnosis of bladder cancer, controlled clinical research was searched in PubMed, Cochrane Library,EMbase, and the Chinese Biomedical Literature Database. The literatures were selected according to the inclusion and exclusion criteria. The Meta-DiSc 1.4 software was used to review management and analysis.

RESULTSThe 8 studies met the inclusion criteria. On a per-people analysis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) of NBI cystoscopy and white light imaging (WLI) cystoscopy were respectively 0.943 (95%CI: 0.914-0.964) and 0.848 (95%CI: 0.803- 0.885), 0.847 (95%CI: 0.812-0.878) and 0.870 (95%CI: 0.831-0.903), 7.038 (95%CI: 3.357-14.754) and 6.938 (95%CI: 2.052-23.465), 0.054 (95%CI: 0.012-0.237) and 0.181 (95%CI: 0.091-0.361), 185.32 (95%CI: 45.714-751.260) and 42.931 (95%CI: 8.088-227.880). The areas under the curve (AUC) and Q* of NBI cystoscopy and WLI cystoscopy were 0.978 and 0.894, 0.934 and 0.825 respectively.

CONCLUSIONNBI cystoscopy is accurate with high diagnostic precision for diagnosis of bladder cancer. NBI cystoscopy is prior to WLI cystoscopy, but it needs more clinical evidence for further affirmance.

Cystoscopy ; methods ; Humans ; Narrow Band Imaging ; Sensitivity and Specificity ; Urinary Bladder Neoplasms ; diagnosis

PURPOSE: To find patients at high risk of obstructive remnant leaflets after valve ablation among boys with posterior urethral valve (PUV), we evaluated any possible relationship between preoperative findings in our patients and residual obstructive leaflets after valve ablation. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 55 patients with PUV that was treated by the same surgeon between 2008 and 2012. Of these, 37 patients (67.3%) had no obstructive remnant leaflets (group A) and 18 patients (32.7%) had obstructive remnant leaflets (group B) in follow-up cystoscopy. Preoperative clinical and radiological findings were evaluated and compared between the groups. RESULTS: Among all the preoperative data we examined, the analysis revealed that age at the time of surgery (median age: group A, 15 months; group B, 7 months; p=0.017), echogenicity of kidneys (p<0.05), presence of vesicoureteral reflux (p<0.05), and grade of reflux (p<0.05) were significantly different between the groups. Method of valve ablation, anterior-posterior diameters of the renal pelvis, renal cortical thickness, bladder wall thickening, and scarring on the dimercaptosuccinic acid scan showed no significant differences between the two groups. CONCLUSIONS: In our patients, younger age at surgery time, hyperechogenicity of renal parenchyma, presence of vesicoureteral reflux, and grade 4 or 5 reflux before surgery had a significant relationship with residual valves. More studies may result in enhanced management of patients at high risk of residual valves after PUV ablation, because the sooner the obstruction is resolved entirely, the better the outcome.
Cicatrix ; Cystoscopy ; Follow-Up Studies ; Humans ; Kidney ; Kidney Pelvis ; Medical Records ; Methods ; Retrospective Studies ; Succimer ; Urinary Bladder ; Vesico-Ureteral Reflux

Cystitis ; diagnosis ; Cystoscopy ; methods ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Tomography, X-Ray Computed ; Xanthomatosis ; diagnosis

BACKGROUNDIn 2008, infants in some areas of China suffered from stones of the urinary system which were caused by melamine-contaminated milk formula. Most of the infants were asymptomatic, and a few suffered from acute renal failure induced by urinary obstruction by stones. This study aimed to assess the significance of blood purification therapy in treatment of infants with acute obstructive oligo-anuric renal failure. Corrective perception, timely diagnosis, and active treatment of this complex disease are critical factors that guarantee a quick recovery of renal function of infants and help them to prevent multiple organ system failure.

METHODSThirteen infants with acute renal failure induced by urinary multiple obstruction caused by melamine-containing stones who had been admitted to Beijing Children's Hospital Affiliated to Capital Medical University in 2008 were investigated for the epidemiological characteristics, image features and indications of dialysis. All these infants were treated with dialysis. The efficacy of dialysis was compared with that of two control groups treated with cystoscopic retrograde catheterization into the ureter and medical treatment for the recovery of renal function.

RESULTSThe 13 infants with life-threatening complications treated with dialysis showed a blood urea nitrogen (BUN) level of (30.9+/-7.9) mmol/L and a creatinine (Cr) level of (572+/-173) micromol/L. Of these infants, 8 were treated with peritoneal dialysis (PD), and 5 with hemodialysis (HD). Ten infants recovered to urinate 24-72 hours after dialysis and 3 infants with persistent ureteral obstruction were further treated with cystoscopic retrograde catheterization into the ureter for drainage, and urination resumed soon after the operation. The average time of PD and HD were (2.1+/-0.8) days and (1.2+/-0.4) days, respectively. The total average time of PD and HD dialysis was (1.77+/-0.83) days. The recovery time of renal function of infants after dialysis was (3.08+/-1.20) days, comparable to that of the two control groups treated with catheterization with a cystoscope or by medication. There was no significant difference in the recovery time of renal function among the three groups (P>0.05).

CONCLUSIONSMelamine-contaminated milk formula may cause urinary stones and obstructive acute renal failure in infants. Dialysis is suggested to treat life-threatening complications such as hyperkalemia, oliguria or anuria if surgical intervention fails. If possible, hemodialysis or peritoneal dialysis can be performed early. Blood purification is feasible to help the infants overcome the critical stage of acute renal failure. Surgical measures can be taken to remove the obstruction if necessary.

Acute Kidney Injury ; chemically induced ; surgery ; therapy ; Child, Preschool ; China ; Cystoscopy ; methods ; Female ; Humans ; Infant ; Kidney Function Tests ; Male ; Peritoneal Dialysis ; methods ; Renal Dialysis ; methods ; Treatment Outcome ; Triazines ; poisoning

Adenocarcinoma ; diagnosis ; secondary ; surgery ; Aged ; Biopsy ; Cystoscopy ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Prostatic Neoplasms ; diagnostic imaging ; pathology ; surgery ; Radiography ; Transurethral Resection of Prostate ; methods ; Ureteral Neoplasms ; diagnosis ; secondary ; surgery ; Ureteroscopy ; Urethral Neoplasms ; diagnosis ; secondary ; surgery ; Urothelium ; pathology

OBJECTIVETo analyze the clinical characteristics of 2 microm continuous wave laser vaporization resection for the treatment of bladder tumors.

METHODSA total of 56 patients with 68 bladder tumors underwent 2 microm laser vaporization resection via a transurethral cystoscope under caudal anesthesia. In the operation, the wall of the urinary bladder was vaporized and cut, the muscular layers were removed, and then the specimens were sent for pathological inspection separately. The following variables were recorded: operation time, blood loss, complications during and after the operation, pathology staging of the tumors, and follow-up visit time.

RESULTSAll patients endured the operation. The mean surgery time was 8.8 +/- 3.3 minutes (range, 4 to 15 minutes). Blood loss was minimal, no patient experienced an obturator nerve reflection, or a hemorrhage after the operation. The pathology staging of the tumors were as follows: 40 cases (total 47 tumors) were T1 stage; 16 cases (total 21 tumors) were T2 stage. The follow-up periods were between 12 to 17 months, and the mean period was 14.5 months. Tumor recurrences were found in 3 cases, and one patients suffered two recurrences, the total recurrence rate was 5.3%. There was no primary recurrence.

CONCLUSIONSThe 2 microm continuous wave laser is a new, safe and efficacious method for the treatment of bladder tumors. Because the 2 microm laser can vaporize and cut the muscular layers of the bladder finely, it can not only treat superficial bladder tumors efficiently, but also treat some types of invasive tumors of the bladder.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cystoscopy ; Female ; Follow-Up Studies ; Humans ; Laser Therapy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Urinary Bladder ; surgery ; Urinary Bladder Neoplasms ; surgery

OBJECTIVETo investigate the diagnoses and treatment of interstitial cystitis (IC).

METHODSThe clinical data of 16 IC patients were analyzed respectively. The patients with urinary frequency, urgency, suprapubic pain and chronic pelvic pain. They were misdiagnosed as chronic cystitis, pelvic inflammation, endometriosis, cystophthisis and urethral syndrome, and were diagnosed finally by the means of pathology or cystoscopy. Among the 16 patients, 4 cases had the operation of ileal reservoir, Two cases had sigmoid-cysto-plasty, and 10 cases had drug treatment. The methods of IC diagnosis and treatment were discussed with the review of literature.

RESULTSThe pelvic ache disappeared completely in 4 cases after the operation of ileal reservoir; Two cases after cystoplasty felt lightly discomfortable in perineum occasionally, and their bladder capacity was above 350 ml, no recurrence after operation having been found after follow-up for 24 months and 33 months; Ten cases treated with non-operative treatment improved obviously, with the O'Leary-Sant IC symptom index and IC problem index decreased from 15.4 +/- 4.1, 9.4 +/- 2.7 to 4.1 +/- 2.1 and 5.1 +/- 3.9, respectively.

CONCLUSIONSSufficient attention should be paid to the diagnosis and differential diagnosis of IC; Early diagnosis and therapeutic alliance with manifold measures can relieve the patients' symptom and improve the quality of life.

Adult ; Cystitis, Interstitial ; diagnosis ; therapy ; Cystoscopy ; Diagnostic Errors ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Urinary Diversion ; methods