Flexible cystoscopy compared with ultrasound in the detection of recurrent bladder tumours

A combination of transrectal and transabdominal ultrasound was compared with flexible cystoscopy as a means of detecting recurrent bladder tumours. The study group comprised 50 patients who had previously had rigid cystoscopy. They underwent combination ultrasound in the out-patient department 1 week before flexible cystoscopy. Combination ultrasound identified 25 patients with recurrent tumours and flexible cystoscopy identified 26. Thirty-four patients (68%) preferred ultrasound, 10 (20%) preferred flexible cystoscopy, 3 (6%) preferred general anaesthesia and rigid cystoscopy and 3 (6%) had no preference. The main objection to ultrasound was the use of the transrectal probe.     

Detection of recurrent bladder tumours by transrectal and abdominal ultrasound compared with cystoscopy

Transrectal and transabdominal ultrasound was used to detect the recurrence of bladder tumours and compared with conventional cystoscopy. Forty patients with a previous history of bladder tumour were examined by these methods; 50% had a recurrence. Transabdominal and transrectal ultrasound together identified 95% of recurrences; 1 tumour (diameter 1 mm) was missed. The false positive rate was 5% and these areas, identified wrongly by ultrasound as tumour, were shown to be scars on cystoscopy. Combination ultrasound may be used as an alternative to check cystoscopy in certain categories of bladder tumour.     

Transurethral ultrasonography,fiberoptic cystoscopy and bladder washout cytology in the evaluation of bladder tumours

The impact of transurethral ultrasonography, fiberoptic cystoscopy and bladder washout cytology on assessment of bladder tumours was investigated in this study. Transurethral ultrasonography had an accuracy rate of 96.5% in diagnosing and staging bladder tumours. The accuracy rates of fiberoptic cystoscopy and washout cytology were 90.9% and 73.7%, respectively, in diagnosis. The efficacy of transurethral ultrasonography was found to be high enough for routine employment in the evaluation of the bladder tumours. Fiberoptic cystoscopy in conjunction with washout cytology as a combination relatively easy to perform can be used especially for follow-up purposes of the bladder tumours.     

The use of transabdominal ultrasound in the detection of early bladder tumours

We have studied the accuracy of transabdominal ultrasound (TAUS) in the diagnosis of early superficial bladder carcinoma. One hundred and twenty-six patients returning for check cystoscopy were scanned pre-operatively with the Technicare Autosector Scanner and the results compared with the endoscopic findings. Forty-four patients (37%) had a tumour recurrence. TAUS demonstrated a lesion in 50% of these with a false positive rate of 11%. The diagnostic accuracy was proportional to the tumour size (82% of patients with tumours above 5 mm were detected compared with 38% below 5 mm), but was not affected by grade, stage or position in the bladder. TAUS may prove a useful adjunct to cytology as a screening test for bladder cancer.     

Outpatient flexible cystoscopy and fulguration of recurrent superficial bladder tumors

Flexible cystoendoscopy and fulguration were used in the outpatient management of 185 patients with superficial bladder tumors followed for 24 months. This method provided optimal surveillance for recurrence and successful tumor control in selected cases.     

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.     

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.     

Routine follow-up cystoscopy in detection of recurrence in patients being monitored for bladder cancer

BACKGROUND AND AIMS: Cystoscopy and urine cytology are the standard tools for monitoring superficial bladder cancer. The sensitivity of cystoscopy is, however, limited to the tumours that can be visualised, and the sensitivity of cytology is relatively low in low-stage/low-grade tumours. Therefore, new tumour markers have been developed. BTA stat has been reported to have high sensitivity in detecting both primary and recurrent bladder tumours, and may have the potential to detect tumours that cannot be visualised by routine cystoscopy including recurrences in upper tract. The objective of the study was to analyse the reliability of routine follow-up cystoscopy by further investigating patients with positive marker status, BTA stat Test and urine cytology, but negative cystoscopy. MATERIAL AND METHODS: 446 consecutive patients being followed for bladder cancer were analysed in a prospective multicenter study. A voided urine sample was obtained prior to cystoscopy and split for culture, cytology and BTA stat testing. In the case of positive marker status, BTA stat Test or urine cytology, but negative cystoscopy patients were further investigated by i.v. urography or renal ultrasound and random biopsies. The sensitivity of routine follow-up cystoscopy is reported. RESULTS: Of 446 patients 131 (29.4%) had a bladder cancer recurrence at routine cystoscopy. Of the remaining 315 patients not having recurrent tumour at cystoscopy, 56 patients (17.8%) had positive BTA stat Test result, 6 (1.9%) had positive cytology and 5 were positive by both tests. Nine recurrences that were missed at routine follow-up cystoscopy were detected by further investigations making the total number of bladder confined recurrent tumours 140 (140/446, 31.4%). Five of these 9 recurrences were high grade lesions (1 T1G3, 4 CIS), of which 4 were detected by positive cytology. The overall sensitivity of cystoscopy was 93.6%. CONCLUSIONS: We found that routine follow-up cystoscopy may miss over five percent of the recurrent tumours. Although cystoscopy remains the gold standard for bladder cancer follow-up, it is suggested that even with negative cystoscopy patients with positive marker status, BTA stat Test and especially urine cytology, should be considered at risk for coexisting, and in some case even high grade recurrence.     

Intravesical ultrasound for staging bladder tumours

Intravesical ultrasonic scanning was performed in 74 patients with 84 bladder tumours. Two tumours located, respectively, at the neck and in the dome of the bladder could not be visualized. In the other 82 the degree of infiltration was ultrasonically assessable. The tumours could be assigned to three categories: superficial, noninfiltrating (Ta to T1), infiltrating the bladder wall (T2 to T3a) and infiltrating extravesically (T3b to T4). The stage was correctly determined with intravesical ultrasound in 77 (94%) of the 82 tumours. The method is particularly valuable for differentiating between superficial, noninfiltrating and more advanced growths.     

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.     

腹腔镜膀胱部分切除术治疗膀胱憩室和良性肿瘤的探讨

目的：探讨腹腔镜膀胱部分切除术治疗膀胱憩室、膀胱良性肿瘤的可行性和应用效果。方法：采用经腹腔途径行腹腔镜膀胱部分切除术治疗3例膀胱憩室和1例膀胱副神经节瘤患者,手术操作包括膀胱部分切除和完全的腔内膀胱缝合。结果：4例手术均获得成功,平均手术时间80（60～120）min,术中平均出血76（40～100）ml,术中、术后无明显并发症,平均术后住院5（3～7）天。结论：采用腹腔镜膀胱部分切除术治疗膀胱憩室和良性肿瘤是安全、可行的方法,具有微创、恢复快、住院时间短等优点,是治疗膀胱憩室和良性肿瘤的可选择的手术方法之一。     

Technic of flexible cystoscopy

After brief training, flexible cystoscopy allows complete investigation of the vesical cavity in the surgeon's office. In particular, this technique facilitates the examination of the anterior wall and the base of the bladder. The low flow rate of the irrigating channel prohibits the use of this technique in cases with severe haematuria.     

门诊患者对软性膀胱镜和硬性膀胱镜的耐受性比较

目的:为进一步阐明软性膀胱镜在门诊检查中患者耐受性方面的优势。方法:132例门诊患者随机接受软性膀胱镜检查(77例)和硬性膀胱镜检查(55例),用数字分级法对患者检查前、检查中、检查后15min和3天的疼痛指数进行评估。结果:85%的软镜组患者为检查中轻微疼痛(评分为0~3),而硬镜组仅为47%(P<0.05)。检查中疼痛评分软镜组为2.3vs硬镜组3.4(P<0.05)。软镜组检查后15min疼痛评分恢复到检查前水平(0.5vs0.2),而硬镜组(2.3vs0.3)3天后才恢复到检查前水平。结论:软性膀胱镜的耐受性明显好于硬镜,更适于门诊患者的检查。