软性膀胱镜应用的探讨

软性膀胱镜(简称软性镜)自Tsuchida等于1973年首先采用以来,已被临床证明可大大减轻患者的痛苦,但由于其分辨能力不及硬性镜,加上操作困难、价格较贵等原因,使其应用大大受到了限制,在我国至今尚未广泛应用.为了解决软性镜的这些问题,我们于1997年开发了软性镜操作的透明瓶练习法,使软性镜的操作变得容易掌握,继而开展了大量的临床检查及治疗工作,取得了良好的效果,现报告如下.     

软性膀胱镜的临床应用(附1 928例报告)

膀胱镜是泌尿外科最常用的检查工具之一 ,至今临床基本延用金属制硬性膀胱镜。随着腔内泌尿外科的发展 ,软性膀胱镜得以问世并在临床获得应用。 1 998年 1 0月以来 ,我们应用软性膀胱镜于临床检查及治疗 ,取得了良好的效果 ,报告如下。1　资料与方法1 .1 　 临床资料本组 1 92 8例 ,男 1 1 61例 ,女 767例 ,年龄 1 8～ 91岁 ,平均 5 6岁。膀胱内应用 1 5 2 6例 ,其中膀胱镜检查 1 471例 ,膀胱内取异物 5 5例 ;肾内应用40 2例 ,包括逆行肾盂造影 389例 ,术后经造瘘孔行肾内残石治疗 1 3例。1 .2 　 使用方法采用日本Pentax公司生产的FCR1 5…     

软性膀胱镜下铥激光切除治疗非肌层浸润性膀胱癌18例分析

目的 评价软性膀胱镜下铥激光切除治疗非肌层浸润性膀胱癌的疗效及安全性.方法 本组18例,均经病理证实为非肌层浸润性膀胱癌, 共有肿瘤22枚,直径平均1.5 cm(0.5～3.0 cm).所有患者均在喉罩麻醉下行软性膀胱镜下铥激光肿瘤切除.术后常规丝裂霉素膀胱灌注化疗,定期行膀胱镜检查.结果 18例患者全获随访,平均随访1年(3～18个月),平均手术时间30 min(20～40 min),术中无膀胱穿孔等并发症;4例多发肿瘤患者术后需膀胱冲洗;所有患者均获得肿瘤分期;无尿道狭窄;复发3例,包括异位复发2例,原位复发1例.结论 软性膀胱镜下铥激光切除治疗非肌层浸润性膀胱癌具有损伤小、无手术盲区、无闭孔神经反射,切割精确等优点,可作为非肌层浸润性膀胱癌的有效治疗方式之一,尤其适合一些特殊情况下的经尿道膀胱肿瘤切除术.缺点是对于体积较小的肿瘤难以获得术后病理.     

前列腺增生患者软性和硬性膀胱镜下逆行输尿管置管的比较研究

目的 探讨软性和硬性膀胱镜下逆行输尿管置管在前列腺增生患者中应用的有效性和安全性.方法 132例需行膀胱镜下逆行置管的前列腺增生患者随机分为2组,每组66例,分别行软性膀胱镜和硬性膀胱镜下逆行输尿管置管,比较两组的置管成功率、置管时间、视觉模拟疼痛评分和相关并发症的发生率.结果 两组患者年龄、上尿路疾病类型、前列腺体积、置管时间比较,差异均无统计学意义(P＞0.05).软镜组置管成功率(93.9％),大于硬镜组(60.6％),(P＜0.05).软镜组和硬镜组的视觉模拟疼痛评分分别为(3.0±1.1)分和(7.8±1.5)分,置管后增加的肉眼血尿发生率分别为3.0％和31.9％,急性尿潴留发生率分别为0％ (0/66)和13.6％ (9/66),尿路刺激症状发生率分别为4.5％和36.3％,发热发生率分别为6.0％和34.8％,以上各项指标两组间比较差异均有统计学意义(P＜0.05).结论 软性膀胱镜下逆行输尿管置管应用于前列腺增生患者是安全、有效的.     

软性膀胱镜在手术治疗复杂性肾结石中的应用价值

目的　提高复杂性肾结石的治疗效果。　方法　采用软性膀胱镜在术中经肾盂切口或经扩张输尿管 ,术后经肾盂造瘘取肾内残余结石 ,共治疗复杂性肾结石患者 31例。　结果　 11例于术中 ,16例于术后 ,4例分别于术中术后 ,共取出肾内残余结石 10 6枚。 2 8例取净结石 ,其中 2例配合ESWL治疗 ;3例肾内残余结石未能取净。　结论　软性膀胱镜协助手术可有效处理复杂性肾结石 ,且简便、安全、经济     

软性膀胱镜联合双极等离子电切治疗复杂性后尿道狭窄及闭锁

目的:提高复杂性后尿道狭窄及闭锁腔内手术的安全性及有效性。方法:总结7例后尿道狭窄或闭锁患者应用软性膀胱镜联合双极等离子电切治疗的临床经验。结果:7例患者均一次性手术成功,无手术并发症发生。随访4~28个月,排尿通畅,无复发。结论:软性膀胱镜联合双极等离子电切能迅速正确切除狭窄瘢痕,恢复尿道正常连续性,降低术后复发率,是一种新的安全有效的微创技术。     

硬、软性输尿管镜结合治疗内支架管管周继发多发结石9例临床分析

目的探讨硬、软性输尿管镜结合在输尿管内支架管管周继发多发结石中的疗效及手术技巧。方法回顾性分析本院2011年01月至2014年10月9例利用硬、软性输尿管镜治疗内支架管管周继发多发结石患者的临床资料,总结手术相关技巧。结果本组9例,所有滞留的输尿管内支架管均被成功取出,继发结石均被成功碎石,其中1例支架管被分5段取出,术后第1天复查KUB或泌尿系CT,所有患者肾盂内残留结石均2mm,1月后再复查残留结石全部排出,拔管成功率及结石清除率为100%,手术时间65~115(81.0±4.8)min;术后发热3例,无其他手术相关并发症发生。结论硬、软性输尿管镜结合治疗输尿管内支架管周继发多发结石具有手术时间短、患者损伤小,并发症少、拔管成功率及结石清除率高等优点,可以作为手术治疗输尿管内支架管管周继发多发结石的首选。     

局麻下利用软性膀胱镜联合铥激光治疗麻醉高风险膀胱肿瘤患者的经验

目的 探讨高龄、麻醉高风险患者在局麻（尿道黏膜麻醉）或无麻醉下利用膀胱软镜行铥激光膀胱肿瘤切除术（ThuLRBT）治疗的可行性。方法 天津医科大学第二医院2020年6月至2022年1月共12例经评估一般状态较差、麻醉手术风险较大的高龄膀胱癌患者,利用膀胱软镜行局麻下铥激光膀胱肿瘤切除治疗。术前利用麻醉分级、Essen卒中风险评分量表、运动耐量、改良心脏危险指数评分及心脏并发症发生率综合评估患者全麻术中及术后风险,利用Karnofsky功能状态评分标准、年龄校正察尔森合并症指数及衰弱筛查量表评分数粗略预测术后恢复情况及手术价值。术中即刻利用疼痛数字评分法评估患者耐受情况,同时收集术后尿管留置时间、术后住院时间、并发症发生情况等。术后随访至2023年1月或患者复发。结果 所有患者术中均未出现闭孔神经反射及膀胱穿孔等并发症,术后未出现持续膀胱出血及膀胱填塞。即刻疼痛评分（NRS）0～7分,中位评分2分。所有患者均可耐受手术过程,且痛苦较小。术后中位尿管留置时间2 d。术后中位住院时间2 d。术后12例患者定期随访,随访时间3～19个月,其中1例失访,1例患者术后5个月复发,1例患者术后13个...     

再谈做好软性输尿管镜术需重视的关键问题

随着软性输尿管镜技术及其相关科技的不断发展,软性输尿管镜术已成为上尿路结石等疾病治疗的重要手段。尽管文献报道软镜术在临床应用安全有效,但其严重并发症如尿脓毒症和严重输尿管损伤屡见不鲜。掌握手术要点熟悉技巧,重视一些关键问题,可以帮助提升手术效率及减少并发症发生。本文从围手术期的3个主要环节及器械维护等多个方面对软性输尿管镜术的相关技巧及需重视的一些关键问题作一综述。     

超声电子膀胱软镜在泌尿系疾病诊疗中的动物模型研究

目的 探讨超声电子膀胱软镜应用于泌尿系疾病诊疗的可行性. 方法 采用1 ～2岁雌性巴马香猪4只为实验模型,以超声支气管镜为雏形,通过B超模式观察不同膀胱充盈量下膀胱各层结构声像图,通过彩色多普勒超声模式观察膀胱周围重要血管的声像图,初步总结超声电子膀胱软镜的操作技巧和难点.采用专用一次性抽吸式活检针进行内镜超声引导下分层定位穿刺活检,活检组织送病理以验证超声分层定位的准确性,探讨超声电子膀胱软镜下穿刺的有效性和安全性. 结果 超声膀胱镜可同步显示内镜图像和超声图像.香猪膀胱充盈90 ml时,超声内镜下膀胱壁黏膜及黏膜下层、肌层、浆膜层层次清晰可辨并有助于穿刺针的分层定位,多普勒超声模式下,膀胱周围血管血流信号明显,超声引导穿刺可避免发生血管及周嗣脏器误伤.16处穿刺点送检组织病理结果与超声分层定位吻合. 结论 超声电子膀胱软镜诊断治疗泌尿系疾病安全可行,配套器械有待进一步改进.     

窄波成像电子膀胱软镜在膀胱肿瘤诊断中的应用价值

Objective To study the sensitivity and specifity for detection of bladder tumor by Narrow-band imaging flexible cystoscopy compared with WLI flexible systoscopy. Methods Between February 2009 and July 2009, NBI flexible cystoscopy and conventional WLI flexible cystoscopy with the same instrument (Olympus Exera Ⅱ endoscopy system) were both performed on 31 patients highly suspect of bladder neoplasm with same observed time and in a randomized sequenced paradigm. Every suspect mucosa lesion was biopsied in both NBI and WLI image to compare the diagnostic accuracy between them. Results Twenty-eight patients(90%) were pathologically bladder urothelial cell carcinoma (UCC). Of 28 patients 3 were Tis, 15 were Ta, 7 were T1, and 3 were T2. Twenty were low grade carcinom, 8 were high grade carcinoma and 16 had multiple tumors, 12 had a single tumor.Of 73 biopsied lesions, 61 were diagnosed UCC under WLI image with 84% sensitivity, while 80 of 91 diagnosed under NBI image with 88% sensitivity. WLI detected 23 patients with bladder UCC while NBI detected all 28 patients. NBI detected 19 additional UCC lesions in 15 of 28 patients, as compared with WLI(P＜0. 05). Conclusion NBI flexible cystoscopy can detect more bladder urothelial cell carcinoma than WLI flexible cystoscopy.     

窄波成像电子膀胱软镜在膀胱肿瘤诊断中的应用价值

Objective To study the sensitivity and specifity for detection of bladder tumor by Narrow-band imaging flexible cystoscopy compared with WLI flexible systoscopy. Methods Between February 2009 and July 2009, NBI flexible cystoscopy and conventional WLI flexible cystoscopy with the same instrument (Olympus Exera Ⅱ endoscopy system) were both performed on 31 patients highly suspect of bladder neoplasm with same observed time and in a randomized sequenced paradigm. Every suspect mucosa lesion was biopsied in both NBI and WLI image to compare the diagnostic accuracy between them. Results Twenty-eight patients(90%) were pathologically bladder urothelial cell carcinoma (UCC). Of 28 patients 3 were Tis, 15 were Ta, 7 were T1, and 3 were T2. Twenty were low grade carcinom, 8 were high grade carcinoma and 16 had multiple tumors, 12 had a single tumor.Of 73 biopsied lesions, 61 were diagnosed UCC under WLI image with 84% sensitivity, while 80 of 91 diagnosed under NBI image with 88% sensitivity. WLI detected 23 patients with bladder UCC while NBI detected all 28 patients. NBI detected 19 additional UCC lesions in 15 of 28 patients, as compared with WLI(P＜0. 05). Conclusion NBI flexible cystoscopy can detect more bladder urothelial cell carcinoma than WLI flexible cystoscopy.     

Prospective trial comparing intraoperative flexible,rigid, and no cystoscopy after ultrasound-guided transperineal permanent seed prostate brachytherapy

ObjectiveThis is a prospective trial comparing the impact of intraoperative flexible, rigid, and no cystoscopy on dysuria immediately after permanent seed prostate brachytherapy (PB). It prospectively documents the time course and characteristics of dysuria, as well as the rates of urinary retention post-PB. Furthermore, this study attempts to establish the utility of routine, post-PB cystoscopy, by documenting the incidence of finding significant pathology on cystoscopy.Materials and methodsBetween January 2003 and January 2007, 225 patients deemed by their physician to be candidates for PB alone were recruited to the study. Patients who had external beam radiation therapy and/or androgen deprivation therapy were excluded. Preimplant International Prostate Symptom Score (IPSS), urinary quality of life score, urine leakage score, Sexual Health Inventory for Men score, and Radiation Therapy Oncology Group Bowel Health Inventory Scores were obtained. Patients were assigned to one of the following three groups: intraoperative rigid cystoscopy, flexible cystoscopy, or no cystoscopy following PB. Patient self-administered questionnaires were given to the patient in the recovery room after PB. These questionnaires evaluated the intensity, type, and duration of urinary symptoms associated with the first four urinations post-PB. All patients were seen on postoperative Day 1 when the surveys were retrieved. Patients were then followed up every 3 months. Acute urinary retention (AUR) was documented in the follow ups. Frequencies of significant pathology (defined as bladder tumor, urethral stricture, or large blood clots) were documented at the time of cystoscopy. AUR rates were also evaluated by the isotope used (I¹²⁵, Pd¹⁰³, or Cs¹³¹).ResultsA total of 225 patients were enrolled into this study, but only 194 patients could be analyzed for dysuria. Thirty-one patients were excluded from analysis (6, 13, and 12 patients from the rigid, flexible, and no cystoscopy groups, respectively). These patients did not return the questionnaire, or were in retention, and thus did not have dysuria scores to report. Baseline characteristics for the 194 patients in terms of preimplant IPSS, quality of life, prostate volume, and isotope used were well balanced between all three groups. There were no significant differences in dysuria between the three cystoscopy groups at any time point following PB. The mean dysuria score across all time points was 5.5 of 10, with 0 representing “no pain” and 10 representing “the worst possible pain.” Pain was most often characterized as “burning” (78%), whereas dysuria most commonly was “only during urination” (56%). AUR rates (6.8–9.5%) and duration of catheter dependence (10.5–19 days) were not found to be significantly different between the assigned groups. When results were stratified by isotope, patients treated with I¹²⁵, Pd¹⁰³, and Cs¹³¹ seeds experienced a 6%, 14%, and 0% retention rate, respectively. The I¹²⁵ and Pd¹⁰³ patients had similar pretreatment IPSS and prostate volumes. Seven percent of patients undergoing cystoscopy had significant findings. The most common finding was “clots thought too large to void” (3%). Seeds in the bladder/urethra occurred in 1% of cases. Only 0.7% of patients were found to harbor unsuspected bladder tumors.ConclusionThere was no significant difference in dysuria in the first four urinations post-PB between patients in the rigid, flexible, and no cystoscopy groups. Larger blood clots that may have been difficult to void, seeds in the bladder and/or urethra, and other abnormalities were found in 7% of patients who had cystoscopy. This may suggest that cystoscopy may be worthwhile post-PB. The incidence of AUR was not significantly different between the three cohorts.     

窄波成像电子膀胱软镜在膀胱肿瘤诊断中的应用价值

目的 研究窄波成像(NBI)电子膀胱软镜在膀胱肿瘤诊断中的应用价值.方法 临床疑似膀胱肿瘤患者31例,采用Olympus ExeraⅡ电子膀胱软镜系统,分别在NBI和普通白光(WLI)视野下检查,顺序采用随机化法,观察时间相同.分别取2种视野下膀胱内所见可疑病灶活检,比较2种检查方法膀胱肿瘤诊断准确率.结果 31例患者中,经病理检查确诊为膀胱尿路上皮癌28例(90%),其中Tis 3例、Ta 15例、T1 7例、T2 3例;低级别癌20例、高级别癌8例;多发病灶16例、单发病灶12例.WLI下共取活检73处,癌组织61处,阳性率84%,确诊膀胱癌23例;NBI下共取活检91处,癌组织80处,阳性率88%,确诊膀胱癌28例.NBI发现癌组织较WLI多19处,2组检出准确率比较,差异有统计学意义(P＜0.05). 结论 NBI诊断膀胱肿瘤的准确率明显高于WLI电子膀胱软镜.     

Narrow-band imaging flexible cystoscopy in the detection of recurrent urothelial cancer of the bladder

OBJECTIVE

To investigate whether narrow‐band imaging (NBI) flexible cystoscopy improves the detection rate of urothelial carcinomas (UCs) of the bladder. NBI is an optical image enhancement technology in which the narrow bandwidth of light is strongly absorbed by haemoglobin and penetrates only the surface of tissue, increasing the visibility of capillaries and other delicate tissue surface structures by enhancing contrast between the two.

PATIENTS AND METHODS

Between November 2005 and May 2007 at the Queen Elizabeth Hospital, Birmingham, NBI flexible cystoscopy was performed on 29 patients with known recurrences of UC of the bladder after initial conventional white‐light imaging (WLI) flexible cystoscopy with the same instrument (Olympus Lucera sequential RGB endoscopy system).

RESULTS

Subjectively, NBI provided a much clearer view of bladder UCs and in particular their delicate capillary architecture. Objectively, NBI detected 15 additional UCs in 12 of 29 patients (41%), as compared with WLI. The mean (sd ) difference was 0.52 (0.74) UCs per patient (P < 0.001, Wilcoxon signed‐rank test).

CONCLUSIONS

Even in the few patients studied there is strong evidence that NBI differs from WLI in the number of UCs it detects, with a significantly increased detection rate. We feel that further evaluation of NBI flexible cystoscopy in more patients will show this technique to be highly valuable in the detection of both new and recurrent bladder UCs, and this work is continuing in our unit.     

The effect on pain experienced by male patients of watching their office-based flexible cystoscopy

OBJECTIVE

To confirm the recently published positive effect on visual analogue pain (VAS) scale levels for men watching their flexible cystoscopy.

PATIENTS AND METHODS

From June 2007 to September 2007, 154 men had a flexible cystoscopy for various indications, all carried out by one urologist. Patients were randomized into two groups; those in group 1 were allowed to watch the video screen together with the urologist during the procedure; those in group 2 were not allowed to watch the procedure on the video screen. All patients received the same real‐time explanation during the cystoscopy. After the cystoscopy procedure the patients were asked to record their experience of pain on the 100 mm VAS as soon as they left the room. The two groups were further stratified by the number of previous cystoscopies experienced to evaluate the possible modifying effect of their previous experience.

RESULTS

Although the results suggested a small decrease in perceived pain there were no statistically significant differences between the groups, regardless of cystoscopy experience.

CONCLUSIONS

Our results show that, in contrast to an earlier report, the pain experienced by men undergoing a first or repeated flexible cystoscopy is not strongly influenced by watching the procedure.     

Office based flexible cystoscopy may be less painful for men allowed to view the procedure

PURPOSE: An experienced urology nurse observed that patients seemed to tolerate the procedure better when allowed to see the monitor in real time during office based cystoscopy. We assessed the impact of this on visual analog scale pain scores. MATERIALS AND METHODS: A total of 100 consecutive male patients underwent flexible cystoscopy, as performed by a single surgeon during the study period. Patients were randomized into 2 groups. Patients in group 1 were allowed to visualize the video screen with the surgeon, while patients in group 2 had the screen positioned so that only the surgeon could visualize the procedure. Water soluble lubricant was used on all endoscopes and all men received 10 cc 2% viscous lidocaine intraurethral before cystoscopy. No sedatives or analgesics were administered. All patients provided consent before the procedure and they were asked to record their pain experience on a 100 mm visual analog pain scale as soon as the surgeon left the room. RESULTS: Men who were allowed to visualize the cystoscopy had lower visual analog scale pain scores than those who were unable to visualize the screen (14 vs 23, Wilcoxon rank sum test p=0.02). CONCLUSIONS: To our knowledge no study has shown the impact of distraction of cystoscopic findings on procedure pain levels. Men viewing cystoscopy on the video monitor experienced an approximately 40% decrease in the pain level compared to those who did not view the procedure on the monitor. We encourage office urologists to incorporate this useful point of technique during flexible cystoscopy.