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Objectives Patients and Methods Results Conclusion To compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high‐risk non‐muscle‐invasive bladder cancer (HRNMIBC).We performed real‐world clinical data‐driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens—surveillance intensity escalation and de‐escalation—which had a surveillance intensity moderately higher and lower, respectively, than the guideline‐recommended regimens. We evaluated the 10‐year cumulative incidence of muscle‐invasive bladder cancer (MIBC), cancer‐specific survival (CSS), overall survival (OS), and cost‐effectiveness from a United States healthcare payer perspective.The guideline‐recommended surveillance regimens led to an estimated 10‐year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10‐year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3–10.7%), CSS of 95.4% (95% CI 95.2–95.5%), and OS of 69.9% (95% CI 69.6–70.1%), vs 11.9% (95% CI 11.7–12.1%), 94.9% (95% CI 94.8–95.1%), and 69.6% (95% CI 69.3–69.9%), respectively, from surveillance intensity de‐escalation. By increasing surveillance intensity, the number‐needed‐to‐treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer‐related mortality. Compared to surveillance intensity de‐escalation, higher‐intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality‐adjusted life year gained, which well exceeded conventional willingness‐to‐pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer‐related mortality avoided.In microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de‐escalation appears associated with an insignificant change in 10‐year OS and furthermore is cost‐effective vs higher‐intensity surveillance regimens. These results suggest that moderate surveillance de‐escalation can reduce costs of care without compromising life expectancy for many patients. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To analyze the results of excluding confusable diseases in patients with a presumptive diagnosis of interstitial cystitis (IC).We retrospectively reviewed the electronic medical records of consecutive patients with IC between October 2005 and December 2019.Patients with pelvic pain underwent an initial workup. Of these, 646 patients (164 men, 25.4%; 482 women, 74.6%) underwent observational cystoscopy under the suspicion of IC. Fourteen patients had genitourinary tract malignancies (2.2%) (bladder cancer, n = 13; prostate cancer, n = 1). Of the 13 patients with bladder cancer, three were diagnosed during initial observation cystoscopy. The remaining 10 patients were diagnosed during subsequent follow‐up cystoscopic surgery. Urinary tuberculosis was identified in seven (1.1%) of 646 patients during the examination. Five (0.8%) of the six patients with suspected urinary tuberculosis at baseline imaging were positive for tuberculosis in the acid‐fast bacillus test. One patient developed tuberculous granulomas in the bladder tissue after a cystectomy for intractable pelvic pain.Our results show that continuous efforts to rule out bladder tumors or tuberculosis are still essential in the follow up of patients with suspected IC, even if these diseases are not excluded at the initial examination. Imaging studies are necessary to rule out tuberculosis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare clinical outcomes between patients receiving second TUR after initial white‐light transurethral resection of bladder tumor (WL‐TURBT) and initial photodynamic diagnosis (PDD)‐assisted TURBT. Methods: A total of 1007 patients were divided into four groups based on the treatment pattern: WL‐TURBT with second TUR (161 patients, WL‐second group) or without second TUR (540 patients, WL‐alone group) and PDD‐TURBT with second TUR (112 patients, PDD‐second group) or without second TUR (194 patients, PDD‐alone group). Oncologic outcomes (bladder cancer recurrence, progression, urothelial cancer‐specific mortality) and rates of residual tumor and risk stratification of non‐muscle‐invasive bladder cancer (NMIBC) after second TUR were evaluated. Results: After propensity score‐matching 121 patients were included each in the WL‐alone and WL‐second groups, and 63 patients each in the PDD‐alone and PDD‐second groups. In the WL group, the second TUR was significantly associated with improved progression‐free (p = 0.012) and urothelial cancer‐specific free survival (p = 0.011), but not with recurrence‐free survival (p = 0.93). Patients initially treated with PDD‐TURBT, and with a tumor diameter <30 mm and multifocality had a relatively high benefit from second TUR. The rates of residual tumor and risk stratification of NMIBC did not significantly differ between WL‐TURBT and PDD‐TURBT groups. Conclusions: Our findings suggested that a second TUR could be omitted after an initial PDD‐TURBT in selected patients with high‐risk NMIBC. [ABSTRACT FROM AUTHOR]

Introduction: Methoxyflurane (MEOF) (Penthrox™) is an inhaled, self-administered, nonopioid analgesic approved by Health Canada for the short-term relief of moderate to severe acute pain associated with trauma or interventional medical procedures. In this pilot study, we evaluated the feasibility of using MEOF as an anesthetic agent in 11 patients undergoing outpatient cystoscopic procedures. Methods: The average duration of the procedure was 24 (range 20–35) minutes and this included 10 minutes of administration time of the drug and five minutes of wait time before the procedure. The average monitoring time from start to end of the procedure was 23 (range 20–35) minutes and this included 15 minutes of monitoring post-procedure. On a scale of 0–10, patients on average rated the pain 4/10 (standard deviation [SD] 2.6). Results: Global performance was on average 3/4 (SD 1.3) for the patients and 3/4 (SD 1.1) for the operator. Of the 11 patients, four reported adverse events; two experienced euphoria, one experienced dizziness, and one was unable to tolerate the medication. Two patients noted their adverse events to be of moderate intensity, while the other two were of mild intensity. None of the adverse events was deemed serious. Conclusions: Our findings in this pilot study provide proof of principle for the design of a randomized control trial to evaluate MEOF as an anesthetic in an outpatient cystoscopic procedural setting. As more urologic procedures are being performed in an outpatient setting, this may offer significant clinical benefit. [ABSTRACT FROM AUTHOR]

Fibroepithelial polyps are rare, benign, non-epithelial tumors of the urinary system. They can occur throughout the entire urinary system, including the renal pelvis, ureter, bladder, and urethra, which are lined with urothelium. These polyps originate from the stromal structure, formed by the combination of mesodermal and urothelial cells. The most common clinical complaint of patients with fibroepithelial polyps is unilateral flank pain. In some cases, this pain may be accompanied by hematuria, dysuria, and pollakiuria, which are irritative lower urinary tract symptoms. In this case report, a case of a giant ureteral fibroepithelial polyp in a patient who was admitted to our clinic with macroscopic hematuria and left flank pain was presented. Following the diagnosis of a giant polyp in the left ureter, we treated the patient with endoscopic ablation using a Holmium-YAG laser device under ureteroscopy guidance. [ABSTRACT FROM AUTHOR]

Purpose: Urothelial bladder cancer (UCB) care requires frequent follow-up cystoscopy and surgery. Confocal laser endomicroscopy (CLE) is a probe-based optical technique that can provide real-time microscopic evaluation with the potential for outpatient grading of UCB. This study aims to investigate the diagnostic accuracy and interobserver variability for the grading of UCB with CLE during flexible cystoscopy (fCLE). Methods: Participants scheduled for transurethral resection of papillary bladder tumors were prospectively included for intra-operative fCLE. Exclusion criteria were flat lesions, fluorescein allergy or pregnancy. Two independent observers evaluated fCLE, classifying tumors as low- or high-grade urothelial carcinoma (LGUC/HGUC) or benign. Interobserver agreement was calculated with Cohens kappa (κ) and diagnostic accuracy with 2 × 2 tables. Histopathology was the reference test. Results: Histopathology of 34 lesions revealed 14 HGUC, 14 LGUC and 6 benign tumors. Diagnostic yield for fCLE was 80–85% with a κ of 0.75. Respectively, sensitivity, specificity, NPV and PPV were: for benign tumors 0–20%, 96–100%, unmeasureable-50% and 87%, for LGUC 57–64%, 41–58%, 44–53% and 54–69% and for HGUC 38–57%, 56–68%, 38–57% and 56–68%, with an interobserver agreement of κ 0.61. Conclusion: fCLE is currently insufficient to grade UCB. [ABSTRACT FROM AUTHOR]

Objectives: To assess the intra/inter‐observer reliability of cystoscopic sphincter evaluation (CSE) in men undergoing sling surgery for urinary incontinence and if possible to evaluate its correlation with the final clinical decision. Patients and methods: Two expert urologists prospectively filmed and recorded, incontinent patient's cystoscopies according to a standard scenario. Anonymised recordings where randomly offered to the same observer twice. The observers (medical students, urology residents and full urologist with 0–5, 5–10, >10 years of practice, respectively) were asked to assess and score the recordings without knowing any of the patients' characteristics. Results: In total, 37 recordings were scored twice by the 26 observers. The intraclass correlation coefficient (ICC) for intra‐observer reliability of the CSE was 0.54 (moderate), 0.58 (moderate) and 0.60 (substantial) for medical students, residents, and urologists, respectively. However, when stratifying observers according to their experience, the lowest agreement values were found between experts with >10 years of experience. The inter‐observer reliability for the CSE ICCs ranged between 0.31and 0.53, with the lowest ICC value observed between urologists (0.31). Conclusions: The study demonstrates poor intra‐ and inter‐observer reliability of the CSE. According to these results, a CSE does not add valuable information to the clinical evaluation. In this scenario, it should not be considered in isolation from the patient's characteristics. [ABSTRACT FROM AUTHOR]

Enfortumab vedotin (EV) is a novel treatment option for patients with advanced/metastatic urothelial carcinoma who have progressed after chemotherapy and immunotherapy. Two patients at two different New England tertiary cancer care centers were treated with EV while concurrently receiving hemodialysis (HD), where a complete response to EV in both patients was noted. The use of EV in patients requiring HD is extrapolated from the available pharmacokinetic and pharmacodynamic literature on monoclonal antibodies in patients requiring HD. There is a paucity of data for the use of antibody-drug conjugates like EV in patients needing dialysis. [ABSTRACT FROM AUTHOR]

Background: Urothelial carcinoma (UC) is the second most common urological malignancy. Despite numerous molecular markers have been evaluated during the past decades, no urothelial markers for diagnosis and recurrence monitoring have shown consistent clinical utility. Methods: The methylation level of tissue samples from public database and clinical collected were analyzed. Patients with UC and benign diseases of the urinary system (BUD) were enrolled to establish TAGMe (TAG of Methylation) assessment in a training cohort (n = 567) using restriction enzyme-based bisulfite-free qPCR. The performance of TAGMe assessment was further verified in the validation cohort (n = 198). Urine samples from 57 UC patients undergoing postoperative surveillance were collected monthly for six months after surgery to assess the TAGMe methylation. Results: We identified TAGMe as a potentially novel Universal-Cancer-Only Methylation (UCOM) marker was hypermethylated in multi-type cancers and investigated its application in UC. Restriction enzyme-based bisulfite-free qPCR was used for detection, and the results of which were consistent with gold standard pyrosequencing. Importantly, hypermethylated TAGMe showed excellent sensitivity of 88.9% (95% CI: 81.4–94.1%) and specificity of 90.0% (95% CI: 81.9–95.3%) in efficiently distinguishing UC from BUD patients in urine and also performed well in different clinical scenarios of UC. Moreover, the abnormality of TAGMe as an indicator of recurrence might precede clinical recurrence by three months to one year, which provided an invaluable time window for timely and effective intervention to prevent UC upstaging. Conclusion: TAGMe assessment based on a novel single target in urine is effective and easy to perform in UC diagnosis and recurrence monitoring, which may reduce the burden of cystoscopy. Trial registration ChiCTR2100052507. Registered on 30 October 2021 [ABSTRACT FROM AUTHOR]

INTRODUCTION: Prior studies suggest that white light cystoscopy (WLC) alone can fail to detect cases of non-muscle invasive bladder cancer (NMIBC) vs. blue light cystoscopy (BLC). We describe bladder cancer outcomes and the impact of BLC among NMIBC patients in an equal access setting. MATERIALS AND METHODS: We assessed 378 NMIBC patients within the Veterans Affairs system that had a CPT code for BLC from December 1, 2014 to December 31, 2020. We determined recurrence rates and time to recurrence prior to BLC (ie, after previous WLC if available) and following BLC. We used the Kaplan-Meier method to estimate event-free survival and Cox regression to determine association between BLC and recurrence, progression, and overall survival; and further, whether these outcomes differed by race. RESULTS: Of 378 patients with complete data, 43 (11%) were Black and 300 (79%) White. Median follow-up was 40.7 months from bladder cancer diagnosis. Median time to first recurrence following BLC was longer vs. WLC alone (40 [33-NE] vs. 26 [17-39] months). Recurrence risk was significantly lower following BLC (Hazard Ratio [HR] 0.70; 95% Confidence Interval [CI], 0.54-0.90). There was no significant difference in recurrence (HR 0.69; 95% CI, 0.39-1.20), progression (HR 1.13; 95% CI, 0.32-3.96), and overall survival (HR 0.74; 95% CI, 0.31-1.77) following BLC by Black vs. White race. CONCLUSION: In this study from an equal access setting in the VA, we observed significantly decreased recurrence risk and prolonged time interval to recurrence following BLC vs. WLC alone. There was no difference in bladder cancer outcomes by race.

Abstract Background We report a rare and unusual case of intravesical migration of an intrauterine device with stone formation. The intrauterine device (IUD) is the most common method of reversible contraception in women. However, its insertion is not without risk, it can cause early or late complications. IUD can perforate the uterus wall and migrate into adjacent structures. Case presentation A 35 year-old female 5 gravid, 4 para has been benefited from intrauterine contraceptive device (IUCD) 5 years ago, she was presented to gynecological consultation for chronic pelvic pain with urinary symptoms. There was history of a good IUD insertion 5 years ago, considered expelled after one month of its pose. Physical examination was normal, but a pelvic ultrasound and a plain abdominal radiography allowed the detection of an IUD outside the uterine cavity, but inside bladder. A diagnostic and therapeutic cystoscopy was performed, and the IUD with calculus was successfully removed. There were no postoperative complications. Conclusion This case is reported to highlight and to reiterate the need to think about one of the rare complication of IUD insertion, which every practitioner must know, it’s the transuterovesical migration, before concluding wrongly to its expulsion. It’s a consequence of, non-compliance with the rules for inserting an IUD and poor monitoring. The evolution towards calcification is a certain consequence; its screening involves rigorous clinical monitoring.

A less common puerperal complication following a caesarean section is a bladder flap haematoma, characterised by the accumulation of blood in the vesico-uterine space. A young, unregistered primigravida was referred from a peripheral facility with preeclampsia and obstructed labour. Signs of obstructed labour were observed both before and intraoperatively, like dehydration, foetal distress, a stretched lower uterine segment, and oedematous bladder. The uterus was sutured in two layers to control bleeding, and the patient was closely monitored postoperatively. The diagnosis of haematoma was made by the increasing height of the uterus and a suprapubic bulge anterior to the uterus, along with postoperative haematuria. Imaging with ultrasonography and Computed Tomography (CT) helped to decide the management. The patient improved after exploratory laparotomy with haematoma drainage. No bladder injury was found during the cystoscopy. Early diagnosis and treatment were important in preventing complications such as haemodynamic instability, abscess formation, and sepsis. Authors present their experience in this patient with postcaesarean vesico-uterine haematoma, with frank haematuria, without an obvious bladder injury, who required re-exploration. The clinical presentation, course, and sonographic findings of this patient form the basis of this report.

Urinary dysfunction following treatment for rectal adenocarcinoma is a common and complex complication. We present a case of a 69-year-old male who underwent laparoscopic-assisted left hemicolectomy and loop ileostomy after receiving chemotherapy and radiation therapy for rectal adenocarcinoma. Postoperatively, it was incidentally discovered the patient had urinary frequency and urgency. Cystoscopy revealed radiation changes to the bladder walls and a bladder leak was confirmed by cystogram. The patient underwent successful repair of the urinary bladder leak, with challenges posed by prior radiation therapy. Effective prevention and management strategies for urinary dysfunction require a comprehensive preoperative risk assessment, consideration of nerve-preserving surgical techniques, and prompt identification and repair of postoperative complications.

Bladder cancer (BC) is the tenth most common cause of cancer worldwide and is the thirteenth leading cause of cancer mortality. The non-muscle invasive (NMI) variant represents 75% of cases and has a mortality rate of less than 1%; however, it has a high recurrence rate. The gold standard of management is transurethral resection in the case of new lesions. However, this is associated with significant morbidity and costs, so the reduction of these procedures would contribute to reducing complications, morbidity, and the burden to the health system associated with therapy. In this clinical scenario, strategies such as active surveillance have emerged that propose to manage low-risk BC with follow-up; however, due to the low evidence available, this is a strategy that is underutilized by clinicians. On the other hand, in the era of biomarkers, it is increasingly known how to use them as a tool in BC. Therefore, the aim of this review is to provide to clinical practitioners the evidence available to date on AS and the potential role of biomarkers in this therapeutic strategy in patients with low-grade/risk NMIBC. This is the first review linking use of biomarkers and active surveillance, including 29 articles.

Abstract:: Objective: To examine factors to predict the optimal stent pusher position when inserting ureteral stents under fluoroscopy. Methods: We retrospectively reviewed 327 patients who underwent ureteral stent insertion. We considered the pubic bone as a useful anatomical landmark to insert ureteral stents under fluoroscopic guidance. Thus, we categorized patients into three groups (proximal, middle, and distal groups) according to the position of the radiopaque tip of the push catheter when inserting the ureteral stent. Success was defined as a completely curled ureteral stent tail. We compared stent insertion success rates among the three groups. A multivariate analysis was performed to identify the factors affecting stent insertion success. Results: In men, 36 (63.2%) cases were deemed successful in the proximal group compared with 40 (80.0%) cases in the middle group and 12 (20.7%) cases in the distal group (p

Objective: The aim of this study was to determine the appropriate path to follow in the cystoscopic follow-up of patients with suspicious urine cytology but negative malignancy findings on cystoscopy. Methods: Data of 829 patients with bladder cancer between 2012 and 2023 were retrospectively analyzed. Patient data including age, gender, recurrence, progression, and urine cytology results were analyzed. Results: Approximately 65% of patients with suspicious urine cytology results had recurrence or progression of bladder cancer at subsequent follow-up. This highlights the importance of urine cytology as a screening tool and demonstrates its effectiveness as a diagnostic tool in detecting bladder cancer. However, it should be noted that even patients with suspicious urine cytology are at risk of developing bladder cancer in the future. Conclusion: Evaluation of suspicious urine cytology results is an important step in the early diagnosis of bladder cancer. Although the test has diagnostic accuracy, it should be clinically interpreted and used in conjunction with other investigations to determine the patient's cancer status.

Abstract Various guidelines recommend the first follow-up cystoscopy at 3 months; however, no data exist on the optimal timing for initial follow-up cystoscopy. We tried to provide evidence on the timing of the first cystoscopy after the initial transurethral resection of bladder tumor (TUR-BT) for patients with non-muscle invasive bladder cancer (NMIBC) using big data. This was a retrospective National Health Insurance Service database analysis. The following outcomes were considered: recurrence, progression, cancer-specific mortality, and all-cause mortality. Exposure was the time-to-treatment initiation (TTI), a continuous variable representing the time to the first cystoscopy from the first TUR-BT within 1 year. Additionally, we categorized TTI (TTIc) into five levels:

Introduction: Urothelial Bladder Cancer (BC) is the ninth most common cancer worldwide. It is classified into Non Muscle Invasive (NMIBC) and Muscle Invasive Bladder Cancer (MIBC), which are characterized by frequent recurrences and progression rate, respectively. The diagnosis and monitoring are obtained through invasive methods as cystoscopy and post-surgery biopsies. Thus, a panel of biomarkers able to discriminate BC based on grading or staging represents a significant step forward in the patients' workup. In this perspective, long non-coding RNAs (lncRNAs) are emerged as reliable candidates as potential biomarker given their specific and regulated expression. In the present work we propose two lncRNAs, the Small Ubiquitin Modifier 1 pseudogene 3 (SUMO1P3), a poorly characterized pseudogene, and the Urothelial Carcinoma Associated 1 (UCA1) as candidates to monitor the BC progression. Methods: This study was a retrospective trial enrolling NMIBC and MIBC patients undergoing surgical intervention: the expression of the lncRNA SUMO1P3 and UCA1 was evaluated in urine from 113 subjects (cases and controls). The receiver operating characteristic curve analysis was used to evaluate the performance of single or combined biomarkers in discriminating cases from controls. Results: SUMO1P3 and UCA1 expression in urine was able to significantly discriminate low grade NMIBC, healthy control and benign prostatic hyperplasia subjects versus high grade NMIBC and MIBC patients. We also demonstrated that miR-320a, which binds SUMO1P3, was reduced in high grade NMIBC and MIBC patients and the SUMO1P3/miR-320a ratio was used to differentiate cases versus controls, showing a statistically significant power. Finally, we provided an automated method of RNA extraction coupled to ddPCR analysis in a perspective of clinical application. Discussion: We have shown that the lncRNA SUMO1P3 is increased in urine from patients with high grade NMIBC and MIBC and that it is likely to be good candidate to predict bladder cancer progression if used alone or in combination with UCA1 or with miRNA320a. [ABSTRACT FROM AUTHOR]

To characterize differences between urologists and advanced practice providers (APPs) in the utilization of cystoscopy for hematuria. We identified patients initially evaluated for hematuria by a urologist or urology APP between 2015 and 2020 in the MarketScan Research Databases. We determined whether they received a cystoscopy within 6 months of their urology visit and the number of days until cystoscopy. We used multivariable regression to analyze the association between these outcomes and whether the urology clinician was an advanced practice registered nurse (APRN), physician assistant (PA), or urologist. We identified 34,470 patients with microscopic hematuria and 17,328 patients with gross hematuria. Patients evaluated by urologists more often received a same-day cystoscopy than those evaluated by APPs (13% vs 5.8%). The odds that patients evaluated for microscopic and gross hematuria received a cystoscopy were 46.2% and 26.2% lower, respectively, if they were evaluated by an APRN vs a urologist. Patients seeing an APRN for microscopic and gross hematuria also waited approximately 7 and 14 days longer for their cystoscopy, respectively. No differences were observed for patients evaluated by PAs vs urologists. Patients evaluated for hematuria by an APRN were less likely to receive a cystoscopy and had a longer wait until the procedure compared to those evaluated by a urologist; however, no differences were observed between PAs and urologists. Better understanding APP integration into urology clinics is warranted. [ABSTRACT FROM AUTHOR]

To evaluate the change in overall clinical encounter time and clinical capacity after transitioning to single-use cystoscopes (Ambu A/S, Ballerup, Denmark) in an outpatient urology setting. A single-institution prospective study in an outpatient urology procedure clinic was performed. Discrete categories for each portion of nursing care responsibilities were defined, and time spent during each category was recorded. Two separate clinic days were observed and analyzed: one where the clinic exclusively used reusable cystoscopes and the other after the transition to single-use cystoscopes occurred. Additionally, clinic schedules were reviewed from all procedure clinics in the 3-month periods before and after the transition to single-use cystoscopes. Outcomes included overall clinical encounter time and the number of procedures per clinic day. There were 12 flexible cystoscopies performed during each of the observed clinic days. Preliminary cystoscope cleaning and transportation tasks by nursing staff were eliminated when utilizing single-use cystoscopes. Average total encounter time decreased from 66 to 44 minutes, resulting in a 34% reduction in clinical encounter time. The median number of flexible cystoscopy procedures increased after the transition from 9 (IQR 7-12) to 16 (IQR 11-17), representing a 78% increase (P =.003). Transition to a completely single-use cystoscopy outpatient procedure clinic improved clinical efficiency and facilitated an increased number of procedures per clinic day. [ABSTRACT FROM AUTHOR]

Patients previously examined for cancer with a negative result may present in general practice with ongoing or new symptoms or signs suggestive of cancer. This paper explores the potential existence of a relatively safe period for cancer occurrence after receiving negative examination results for specific types of cancer, including lung (CT thorax), upper gastrointestinal (gastroscopy), colorectal (colonoscopy), bladder (cystoscopy), and breast (clinical mammography). Register-based time-to-event analyses. Denmark. All 3.3 million citizens aged 30–85 years who on January first, 2017, had not previously been diagnosed with the specific type of cancer were categorized based on the time since their most recent examination. Using 1-year follow-up, we calculated the age- and sex-adjusted hazard ratios of being diagnosed with the related cancer, with non-examined individuals as reference. Negative examination results were defined as the absence of a cancer diagnosis within 6 months following the examination. Previous negative examination results were common, also among those diagnosed with cancer during follow-up. For 10 years after a negative colonoscopy the risk of diagnosing a colorectal cancer was nearly halved. However, already 1 year after a clinical mammography and 2 years after a CT thorax the risk of diagnosing the related cancers was significantly higher among those with a previous negative result compared to non-examined individuals. This study did not identify a post-examination period in which the cancer risk, compared to non-examined individuals, was sufficiently low to confidently rule out any of the investigated cancers. What should one expect when considering re-examining a patient with a negative result of a previous examination for cancer? We found that previous negative examination results are common in the general population and among those subsequently diagnosed with cancer. We did not find a safe period after any of the examinations in which a negative result alone could safely rule out the presence of cancer. [ABSTRACT FROM AUTHOR]

Context.--There is limited literature describing gynecologic adenocarcinomas involving the urinary bladder and potential diagnostic pitfalls. Objective.--To describe key features distinguishing metastatic (or extension of) gynecologic adenocarcinomas from urothelial carcinomas with glandular differentiation. Design.--Retrospective review of surgical pathology cases of gynecologic adenocarcinomas involving the bladder from 2 different institutions, retrieved from surgical pathology archives, was performed. Morphologic features were recorded, along with immunohistochemistry results when available. Electronic medical records were reviewed for clinical and radiographic information. Results.--Sixteen cases of gynecologic adenocarcinomas (9 endometrial endometrioid adenocarcinomas, 4 endometrial serous carcinomas, 2 high-grade tubo-ovarian serous carcinomas, and 1 cervical adenosquamous carcinoma) involving the bladder were identified. All included cases had mucosal involvement potentially mimicking primary bladder neoplasms, including 4 cases originally diagnosed as urinary carcinomas. Tumors expressed keratin 7 (12 of 13; 92%), PAX8 (11 of 12; 92%), estrogen receptor (11 of 15; 73%), p16 (8 of 11; 73%), progesterone receptor (8 of 14; 57%), GATA3 (5 of 12; 42%), and p63 (3 of 11; 27%); all tumors were negative for keratin 20 (0 of 12). Features supportive of Mu ¨ llerian origin included prior history of gynecologic malignancy, lack of morphologic heterogeneity in nonendometrioid tumors, and immunophenotypic coexpression of PAX8 and estrogen receptor with absent GATA3. Potential pitfalls seen in a subset of cases included misleading radiologic and cystoscopic findings, replacement of the overlying urothelial mucosa by tumor mimicking precursor lesions, focal GATA3 and/or p63 positivity, and areas of squamous differentiation in tumors of endometrioid histology. Conclusions.--A combination of clinical history, certain morphologic features, and proper selection of immunohistochemical stains is key for the correct diagnosis of secondary gynecologic adenocarcinomas involving the urinary bladder. [ABSTRACT FROM AUTHOR]

Catheterisation of the urinary bladder is needed in many types of human disease models in pigs. Based on our extensive experience with the pig as an infection model, we here demonstrate an approach of catheterising domestic pigs (40 attempts) and Göttingen minipigs (10 attempts) using a blinded method, that is, without speculums or videoscopes to visualise the urethral opening. The procedure was tested on control animals and pigs with experimental Escherichia coli urinary tract infection (UTI) to assess the potential influence of this condition on procedural outcome. Lastly, we performed cystoscopy in three animals to visualise the route to the urethra and to localise potential anatomical obstacles. All domestic pigs were catheterised successfully in an average of 2 minutes and 23 seconds, and this was not influenced by UTI (p = 0.06) or bladder urine content at the time of catheterisation (p = 0.32). All Göttingen minipigs were successfully catheterised in an average of 4 minutes and 27 seconds. We conclude that blinded catheterisation is a fast and reliable approach that can be performed in pigs with or without UTI with minimal risk of trauma or contamination. [ABSTRACT FROM AUTHOR]

Intrauterine contraceptive devices (IUCD) are widely used as a reversible method of contraception. Although uterine perforation caused by an IUCD is rare, in some cases, the device may migrate to the pelvic/abdominal cavity or nearby structures. When the IUCD migrate to the bladder, it can lead to various symptoms. These include pain or discomfort in the lower abdomen, difficulties or pain during urination, frequent urinary tract infections, and the development of bladder stones. This article presents a case report of a 24-year-old woman with an intrauterine contraceptive device (IUCD) that had migrated completely into the bladder. She had an IUCD inserted by a midwife four years earlier and became pregnant a year later, unaware of the IUCD's presence. She later presented with lower abdominal pain, hematuria, and dysuria three months before being admitted to our hospital. Imaging confirmed the intravesical location of the IUCD. She underwent successful cystoscopy treatment to remove the migrated IUCD. Prompt diagnosis and appropriate management are crucial in preventing complications and improving patient outcomes. Clinicians should be aware of this potential complication and consider it when patients present with symptoms or complications after IUCD insertion. Regular monitoring and timely intervention can help detect and address IUCD migration effectively. [ABSTRACT FROM AUTHOR]

Introduction: Bladder cancer, with a greater incidence in males than in females, requires frequent cystoscopies. We aimed to evaluate the effect of music played through noise-canceling headphones on male bladder cancer patients during follow-up cystoscopy. Methods: A total of 160 male bladder cancer patients undergoing follow-up flexible cystoscopy were randomly divided into the noise-canceling headphones without music group and the noise-canceling headphones with music group (groups 1 and 2, respectively; n = 80 per group). The patients’ clinical characteristics were examined, and objective and subjective measurements were compared before and after cystoscopy. The primary outcomes that were evaluated included the visual analog scale (VAS, 0–10) and the state-trait anxiety inventory (STAI, 20–80). Other outcomes, including vital signs and scores for assessing satisfaction and the willingness to repeat the procedure, were also examined. Results: The characteristics of the patients in groups 1 and 2, and their pre-cystoscopy status, did not differ significantly. Although post-cystoscopy vital signs for the objective parameters and VAS pain scores were similar between the groups, subjective parameters were not. When compared with group 1, post-cystoscopy STAI-state scores were significantly lower in group 2, whereas patients’ satisfaction scores and the willingness to repeat the procedure were significantly higher in group 2 (p = 0.002, 0.001, and 0.001, respectively). Additionally, in group 2, STAI-state scores changed significantly after the procedure when compared with before the procedure (p = 0.002). Conclusion: Providing music to male bladder cancer patients through noise-canceling headphones was found to reduce anxiety during cystoscopy and to improve patient satisfaction and willingness to undergo repeat cystoscopy. [ABSTRACT FROM AUTHOR]

This document is an abstract journal from the ANZ Journal of Surgery, containing summaries of several research studies in the field of pediatric surgery. The studies cover a wide range of topics, including the management of empyema in children, fibroepithelial polyps in the ureter, congenital diaphragmatic hernias, randomized controlled trials and systematic reviews in pediatric surgery, minimally invasive correction of pectus carinatum, combined pelvi-ureteric and vesico-ureteric junction obstructions, and the use of the TWIST score in scrotal explorations for testicular torsion. Other studies focus on subdiaphragmatic extra-lobar sequestrations, neonatal inguinal herniotomy, meso-rex shunts, pain assessment in infants undergoing hernia repair, racial disparities in orchidopexy, cryoablation for postoperative pain management, congenital heart disease in patients with Hirschsprung's disease, pre-referral ultrasound for testicular descent disorders, esophageal atresia, trichobezoars, probiotic supplementation for necrotizing enterocolitis, and the incidence of small bowel obstruction post-appendicectomy. The abstracts provide brief overviews of each study's purpose, methodology, and key findings. [Extracted from the article]

Purpose: To assess the ability to deliver full-thickness bladder wall cryoablation through a cystoscopic approach using a new closed-loop 6F cryocatheter and thermal dose-controlled protocol. Materials and Methods: Evaluations were conducted using a chronic porcine model wherein 10 lesions/animal were created throughout the bladder (bladder wall, trigone region, ureteral orifice, and distal ureter). A 6F cryocatheter was passed through the working channel of a flexible cystoscope. Single 1- and 1.5-minute freeze protocols in a saline environment were evaluated and resultant lesion size was determined. A laparoscopic approach was utilized to observe the transmural extension of the ice propagation. Results: Studies demonstrated the generation of transmural lesions characterized by full-thickness histologic necrosis after freezing for 1.5 minutes regardless of tissue thickness (range 2–12 mm). All animals were found to have good overall health (maintained weight, appetite, mobility, and energy levels) throughout the recovery period. No significant deviations were noted in complete blood count and serum chemistry bloodwork except for elevated creatine kinase levels. Importantly, no fistulas or perforations were noted. Conclusions: The cryocatheter was able to rapidly and effectively freeze the bladder wall through a cystoscopic approach. The results showed the ability to consistently ablate an ∼1 cm diameter and up to 1.2 cm deep using a single 1.5-minute freeze protocol. Analysis of the ablation efficacy revealed ∼80% destruction within the frozen mass. Although further testing and refinement are needed, these studies demonstrate the potential of this new approach to provide a next-generation strategy for the treatment of bladder cancer. [ABSTRACT FROM AUTHOR]

White light cystoscopy is the gold standard for the diagnosis of bladder cancer. Automatic and accurate tumor detection is essential to improve the surgical resection of bladder cancer and reduce tumor recurrence. At present, Transformer-based medical image segmentation algorithms face challenges in restoring fine-grained detail information and local boundary information of features and have limited adaptability to multi-scale features of lesions. To address these issues, we propose a new multi-scale detail-enhanced reverse attention network, MDER-Net, for accurate and robust bladder tumor segmentation. Firstly, we propose a new multi-scale efficient channel attention module (MECA) to process four different levels of features extracted by the PVT v2 encoder to adapt to the multi-scale changes in bladder tumors; secondly, we use the dense aggregation module (DA) to aggregate multi-scale advanced semantic feature information; then, the similarity aggregation module (SAM) is used to fuse multi-scale high-level and low-level features, complementing each other in position and detail information; finally, we propose a new detail-enhanced reverse attention module (DERA) to capture non-salient boundary features and gradually explore supplementing tumor boundary feature information and fine-grained detail information; in addition, we propose a new efficient channel space attention module (ECSA) that enhances local context and improves segmentation performance by suppressing redundant information in low-level features. Extensive experiments on the bladder tumor dataset BtAMU, established in this article, and five publicly available polyp datasets show that MDER-Net outperforms eight state-of-the-art (SOTA) methods in terms of effectiveness, robustness, and generalization ability. [ABSTRACT FROM AUTHOR]

Simple Summary: Diagnosis of bladder cancer is reliant on cystoscopy, which is an invasive procedure. The aim of this study was to investigate the potential of tRNA-derived fragments from noninvasive liquid biopsies as biomarkers in bladder cancer. We identified several tRNA-derived fragments in extracellular vesicles from urine and serum as well as in serum supernatant, which potentially can be used to diagnose disease stages in bladder cancer. Bladder cancer (BC) diagnosis is reliant on cystoscopy, an invasive procedure associated with urinary tract infections. This has sparked interest in identifying noninvasive biomarkers in body fluids such as blood and urine. A source of biomarkers in these biofluids are extracellular vesicles (EVs), nanosized vesicles that contain a wide array of molecular cargo, including small noncoding RNA such as transfer RNA-derived fragments (tRF) and microRNA. Here, we performed small-RNA next-generation sequencing from EVs from urine and serum, as well as from serum supernatant. RNA was extracted from 15 non-cancer patients (NCPs) with benign findings in cystoscopy and 41 patients with non-muscle invasive BC. Urine and serum were collected before transurethral resection of bladder tumors (TUR-b) and at routine post-surgery check-ups. We compared levels of tRFs in pre-surgery samples to samples from NCPs and post-surgery check-ups. To further verify our findings, samples from 10 patients with stage T1 disease were resequenced. When comparing tRF expression in urine EVs between T1 stage BC patients and NCPs, 14 differentially expressed tRFs (DEtRFs) were identified. In serum supernatant, six DEtRFs were identified among stage T1 patients when comparing pre-surgery to post-surgery samples and four DEtRFs were found when comparing pre-surgery samples to NCPs. By performing a blast search, we found that sequences of DEtRFs aligned with genomic sequences pertaining to processes relevant to cancer development, such as enhancers, regulatory elements and CpG islands. Our findings display a number of tRFs that may hold potential as biomarkers for the diagnosis and recurrence-free survival of BC. [ABSTRACT FROM AUTHOR]

•we report the case of a 36-year-old female patient who presented to our hospital with a diagnosis of cystitis glandularis manifesting as a vesicovaginal fistula. She underwent cystoscopic biopsy at a local hospital, but anti-inflammatory treatment was ineffective, and the patient was experiencing low urination frequency and urgency, as well as pain. The patient underwent laparoscopic repair of a cystoscopy-confirmed vesicovaginal fistula. After surgery, the patient experienced a paroxysm of Crohn's disease with multiple small bowel fistulas and erosion of the external iliac vessels that ruptured to form an external iliac vessel small bowel fistula. The fistula was confirmed by surgical exploration, and the patient eventually died. [ABSTRACT FROM AUTHOR]

Various guidelines recommend the first follow-up cystoscopy at 3 months; however, no data exist on the optimal timing for initial follow-up cystoscopy. We tried to provide evidence on the timing of the first cystoscopy after the initial transurethral resection of bladder tumor (TUR-BT) for patients with non-muscle invasive bladder cancer (NMIBC) using big data. This was a retrospective National Health Insurance Service database analysis. The following outcomes were considered: recurrence, progression, cancer-specific mortality, and all-cause mortality. Exposure was the time-to-treatment initiation (TTI), a continuous variable representing the time to the first cystoscopy from the first TUR-BT within 1 year. Additionally, we categorized TTI (TTIc) into five levels: < 2, 2–4, 4–6, 6–8, and 8–12 months. A landmark time of 1 year after the initial TUR-BT was described to address immortal-time bias. We identified the optimal time for the first cystoscopy using Cox regression models with and without restricted cubic splines (RCS) for TTI and TTIc, respectively. Among 26,660 patients, 16,880 (63.3%) underwent cystoscopy within 2–4 months. A U-shaped trend of the lowest risks at TTI was observed in the 2–4 months group for progression, cancer-specific mortality, and all-cause mortality. TTI within 0–2 months had a higher risk of progression (aHR 1.36; 95% confidence intervals [CI] 1.15–1.60; p < 0.001) and cancer-specific mortality (aHR 1.29; 95% CI 1.05–1.58; p = 0.010). Similarly, TTI within 8–12 months had a higher risk of progression (aHR 2.09; 95% CI 1.67–2.63; p < 0.001) and cancer-specific mortality (aHR 1.96; 95% CI 1.48–2.60; p < 0.001). Based on the RCS models, the risks of progression, cancer-specific mortality, and all-cause mortality were lowest at TTI of 4 months. The timing of the first cystoscopy follow-up was associated with oncologic prognosis. In our model, undergoing cystoscopy at 4 months has shown the best outcomes in clinical course. Therefore, patients who do not receive cystoscopy at approximately 4 months for any reason need more careful follow-up to predict a poor clinical course. [ABSTRACT FROM AUTHOR]

Introduction: There is an absence of data on the environmental impact of single-use flexible cystoscopes. We wanted to review the existing literature about carbon footprint of flexible cystoscopy and analyze the environmental impact of the Isiris® (Coloplast©) single-use flexible cystoscope compared to reusable flexible cystoscopes. Methods: First, a systematic review on single-use and reusable cystoscope carbon footprint was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Second, carbon footprints of Isiris single-use flexible cystoscope and reusable cystoscope were analyzed and compared. Life cycle of the single-use flexible cystoscope was divided in three steps: manufacturing, sterilization, and disposal. For the reusable cystoscope, several steps were considered to estimate the carbon footprint over the life cycle: manufacturing, washing/sterilization, repackaging, repair, and disposal. For each step, the carbon footprint values were collected and adapted from previous comparable published data on flexible ureteroscope. Results: The systematic literature review evidenced total carbon emissions within a range of 2.06 to 2.41 kg carbon dioxide (CO2) per each use of single-use flexible cystoscope compared to a wide range of 0.53 to 4.23 kg CO2 per each case of reusable flexible cystoscope. The carbon footprint comparative analysis between Isiris single-use flexible cystoscope and reusable cystoscope concluded in favor of the single-use cystoscope. Based on our calculation, the total carbon emissions for a reusable flexible cystoscope could be refined to an estimated range of 2.40 to 3.99 kg CO2 per case, depending on the endoscopic activity of the unit, and to 1.76 kg CO2 per case for Isiris single-use cystoscope. Conclusion: The results and our systematic literature review demonstrated disparate results depending on the calculation method used for carbon footprint analysis. However, the results tend rather toward a lower environmental impact of single-use devices. In comparison to a reusable flexible cystoscope, Isiris compared favorably in terms of carbon footprint. [ABSTRACT FROM AUTHOR]

Bladder cancer (BC) is the tenth most common cause of cancer worldwide and is the thirteenth leading cause of cancer mortality. The non-muscle invasive (NMI) variant represents 75% of cases and has a mortality rate of less than 1%; however, it has a high recurrence rate. The gold standard of management is transurethral resection in the case of new lesions. However, this is associated with significant morbidity and costs, so the reduction of these procedures would contribute to reducing complications, morbidity, and the burden to the health system associated with therapy. In this clinical scenario, strategies such as active surveillance have emerged that propose to manage low-risk BC with follow-up; however, due to the low evidence available, this is a strategy that is underutilized by clinicians. On the other hand, in the era of biomarkers, it is increasingly known how to use them as a tool in BC. Therefore, the aim of this review is to provide to clinical practitioners the evidence available to date on AS and the potential role of biomarkers in this therapeutic strategy in patients with low-grade/risk NMIBC. This is the first review linking use of biomarkers and active surveillance, including 29 articles. [ABSTRACT FROM AUTHOR]

Simple Summary: Blue light cystoscopy (BLC) is a technique used to find bladder tumors more effectively. However, its performance across different races remains uncertain. In this study, we looked at how well BLC detects cancer in people of different races. We collected data from patients who had bladder tumor surgeries from 2014 to 2021. Overall, we found that BLC was better at spotting tumors compared to traditional white light cystoscopy (WLC). This was true for most races, especially for Caucasian and Asian patients. When BLC was added to WLC, it increased the detection of cancer by 10%, with the biggest improvement seen in Asian patients. Interestingly, Asian patients had the highest chance of BLC correctly identifying cancer, while Hispanic patients had the best chance of ruling out cancer. This suggests that combining BLC with WLC can improve the detection of bladder cancer irrespective of race. The use of blue light cystoscopy (BLC) has been shown to improve bladder tumor detection. However, data demonstrating the efficacy of BLC across different races are limited. Herein, we aim to evaluate heterogeneity in the characteristics of BLC for the detection of malignant lesions among various races. Clinicopathologic information was collected from patients enrolled in the multi-institutional Cysview® registry (2014–2021) who underwent transurethral resection or biopsy of bladder tumors. Outcome variables included sensitivity and negative and positive predictive values of BLC and white light cystoscopy (WLC) for the detection of malignant lesions among various races. Overall, 2379 separate lesions/tumors were identified from 1292 patients, of whom 1095 (85%) were Caucasian, 96 (7%) were African American, 51 (4%) were Asian, and 50 (4%) were Hispanic. The sensitivity of BLC was higher than that of WLC in the total cohort, as well as in the Caucasian and Asian subgroups. The addition of BLC to WLC increased the detection rate by 10% for any malignant lesion in the total cohort, with the greatest increase in Asian patients (18%). Additionally, the positive predictive value of BLC was highest in Asian patients (94%), while Hispanic patients had the highest negative predictive value (86%). Our study showed that regardless of race, BLC increases the detection of bladder cancer when combined with WLC. [ABSTRACT FROM AUTHOR]

Malignancy after augmentation cystoplasty (AC) is reported up to 5.5 %. We assessed the use of urine fluorescence in situ hybridization (FISH) screening for bladder malignancy after AC. In this study, 36/98 patients under follow-up who have completed tenth year after ileal AC were included prospectively. Twenty-four (66.7 %) patients were tested with FISH initially and overall 28 (77.8 %) patients with conventional cytology (CC). Twenty-four (66.7 %) patients with FISH analysis also had cytology analysis. Blinded from the cytology results, 32 (88.9 %) patients who were consented underwent cystoscopy with random biopsy (native bladder, ileal segment, ileovesical junction). Two patients those were tested with FISH did not consented cystoscopy. This study was registred to the government registry (No: 71146310). Mean follow-up time after AC was 15.4 ± 4.8 years. 2/32 (5.6 %) patients were diagnosed with adenocarcinoma in cyctoscopic biopsy. FISH analysis of 3/24 (12.5 %) patients demonstrated abnormal findings consistent with malignancy. Two FISH malignant patients were patients who had adenocarcinoma. The third patient's biopsy was benign and the third year control cystoscopy was normal. 2/4 patients with malignant CC had adenocarcinoma and 2/4 patients had benign biopsy. The sensitivity and specificity of FISH in our series were 100 % and 95 % respectively. Whereas the sensitivity and specificity of CC was 100 % and 91.6 % respectively. Despite limited number of patients in this study, FISH showed higher specificity than CC in this series. FISH is a promising tool for malignancy screening after AC. Diagnostic Studies. II. [ABSTRACT FROM AUTHOR]

Surgical excision of large deep endometriosis nodules infiltrating the bladder may be challenging, particularly when the nodule limits are close to the trigone and ureteral orifice. Bladder nodules have classically been approached abdominally. However, combining a cystoscopic with an abdominal approach may help to better identify the mucosal borders of the lesion to ensure complete excision without unnecessary resection of healthy bladder. This study aimed to compare classical excision of large bladder nodules by abdominal route with a combined cystoscopic-abdominal approach. Retrospective comparative study on data prospectively recorded in a database. Patients were managed from September 2009 to June 2022. Two tertiary referral endometriosis centers. A total of 175 patients with deep endometriosis infiltrating the bladder more than 2 cm undergoing surgical excision of bladder nodules. Excision of bladder nodules by either abdominal or combined cystoscopic-abdominal approaches. A total of 141 women (80.6%) were managed by abdominal route and 34 women (19.4%) underwent a combined cystoscopic-abdominal approach. In 99.4% of patients, the approach was minimally invasive. Patients with nodules requiring the combined approach had a lower American Fertility Society revised score and endometriosis stage and less associated digestive tract nodules, but larger bladder nodules. They were less frequently associated with colorectal resection and preventive stoma. Operative time was comparable. The rate of early postoperative complications was comparable (8.8% vs 22%), as were the rates of ureteral fistula (2.2% vs 2.9%), bladder fistula (2.2% vs 0), and vesicovaginal fistula (0.7% vs 2.9%). In our opinion, the combined cystoscopic-abdominal approach is useful in patients with large bladder nodules with limits close to the trigone and ureteral orifice. These large deep bladder nodules seemed paradoxically associated to less nodules on the digestive tract, resulting in an overall comparable total operative time and complication rate. [ABSTRACT FROM AUTHOR]

Introduction This study aimed o evaluate the efficacy of onabotulinumtoxin A (onaBTX-A) intradetrusor injections in women with refractory de novo overactive bladder (OAB) following midurethral sling (MUS) placement. Material and methods A retrospective single-center study was conducted. We screened 372 women who underwent MUS surgery between August 2009 and January 2022. 54/372 women diagnosed with pharmacologically refractory de novo OAB following MUS were evaluated using cystoscopy and urodynamics, and after tape erosion and obstructive voiding were excluded, they received on a BTX-A therapy. Outcomes were the reduction of self-reported OAB symptoms and leakage episodes, improvement of validated OAB scores and adverse events of the procedure after a follow-up of 3, 6, and 12 months. Results Successful results were reported in 81%, 68%, and 43% at 3, 6 and 12 months respectively. Postoperatively, median voiding frequency and median nocturia episodes were significantly improved in 70% and 77% of women, respectively, with a decrease in daily number of voids (-4.1, p = 0.0001) and nocturia episodes (-2.2, p = 0.005). At 3 months, 80% of women reported an >25% reduction in urgency severity and episodes following injection. The median number of pads used was significantly reduced after injection (-2 pads; p = 0.03). Repeat injections of onaBTX-A were performed in 61% of patients after a median of 11 months. Conclusions Intravesical onaBTX-A injections are clinically effective at 3- and 6-month follow-up for the treatment of refractory de novo OAB after MUS placement. Over 60% of the patients opted for retreatment with onaBTX-A due to a high level of satisfaction. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to reduce the incidence of urinary tract infection (UTI) in women undergoing outpatient cystoscopy and/or urodynamic studies (UDS) at our centre by identifying and then altering modifiable risk factors through an analysis of incidence variability among physicians. Methods: This was a quality improvement study involving adult women undergoing outpatient cystoscopy and/or UDS at an academic tertiary urogynecology practice. Prophylactic practices for cystoscopy/UDS were surveyed and division and physician‐specific UTI rates following cystoscopy/UDS were established. In consultation with key stakeholders, this delineated change concepts based on associations between prophylactic practices and UTI incidence, which were then implemented while monitoring counterbalance measures. Results: Two "Plan‐Do‐Study‐Act‐Cycles" were conducted whereby 212 and 210 women were recruited, respectively. Change concepts developed and implemented were: (1) to perform routine urine cultures at the time of these outpatient procedures, and (2) to withhold routine prophylactic antibiotics for outpatient cystoscopy/UDS, except in patients with signs of cystitis. There was no change in the incidence of early presenting UTI (9.0% vs. 9.2%, p = 0.680), but there were significantly fewer antibiotic‐related adverse events reported (8.5% vs. 1.5%, p = 0.001). There was no significant change in the total incidence of UTI rates between cycles (7.8% vs. 5.6%, p = 0.649). Conclusions: No specific strategies to decrease the incidence of UTI following outpatient cystoscopy/UDS were identified, however, risk factor‐specific antibiotic prophylaxis, as opposed to universal antibiotic prophylaxis, did not increase UTI incidence. [ABSTRACT FROM AUTHOR]

BackgroundBladder foreign bodies commonly arise as urgent issues in urology. These foreign bodies are typically extracted through cystoscopy or cystotomy. In general, these surgical approaches rarely lead to serious complications.MethodsA 34-year-old woman presented with a one-year history of frequent urination, urgency, and urodynia. Abdominal computed tomography (CT) scan revealed the presence of an intrauterine device (IUD) [a medium-sized (20 mm × 22 mm) circular IUD] near the posterior bladder wall. The object was successfully removed via cystoscopy. Two months later, the patient exhibited food residues in her urine. Enterography demonstrated a large amount of contrast agent had entered the bladder from the small intestine. We repaired the bladder with catheter for 2 weeks, removed the segment of small intestine with fistula, and anastomosed the intestine canal.ResultsPost-operation urine tests yielded negative results, and the patient resumed a normal diet.ConclusionsEvaluating the location between foreign body and bladder wall, which is based on medical history, CT scan, and cystoscopy examination, is essential for doctors before they remove the foreign body by cystoscopy or laparoscopy. It is necessary to check for leakage by applying radiopaque fluids under fluoroscopy after removing the foreign body, which migrates from other abdominal organs. If there is damage in the bladder or other organs, laparoscopic surgery or open surgery should be performed immediately.

This article discusses the treatment of low-grade non-muscle-invasive bladder cancer (NMIBC) and the potential for deintensifying treatment to avoid overtreatment while maintaining oncological safety. The study found that the majority of patients with low-grade NMIBC do not experience progression to high-grade disease, suggesting the potential for treatment de-intensification. Factors such as age were associated with an increased risk of high-grade recurrence. The study highlights the need for personalized follow-up and management for patients with low-grade NMIBC and suggests the use of less invasive approaches in selected patients. However, the study has limitations due to its retrospective design and limited sample size. Further research is needed to confirm these findings and provide more robust evidence. [Extracted from the article]

In the realm of unusual gynecological complications, the displacement of an intrauterine device (IUD) into the bladder, resulting in stone formation, stands out as an exceptionally rare and perplexing condition. Such occurrences challenge diagnostic and therapeutic protocols, often leading to unique case studies that expand our understanding of IUD-related complications. We present an interesting case of a 50-year-old woman with a stone-forming ectopic IUD in the bladder diagnosed with imaging modalities and treated with cystoscopy, with a subsequent resolution of symptoms. This case underscores the importance of considering ectopic IUD placement in the differential diagnosis of patients presenting with urinary symptoms and a history of IUD use. Moreover, it emphasizes the role of imaging in the accurate diagnosis of such cases and highlights cystoscopy as an effective treatment modality for the removal of IUD and stones. [ABSTRACT FROM AUTHOR]

The association is defined as two or more malformations with unclear relationships, which do not fit the criteria of a syndrome. This case report presents a rare finding of tubular colonic duplication in association with Mayer--Rokitansky--Küster--Hauser syndrome in an adolescent girl. The patient presented with gastrointestinal bleeding and abdominal pain, necessitating surgical intervention. The successful excision of the duplicated segment highlights the importance of prompt diagnosis and treatment in such cases. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to detect whether the use of alpha-blockers in posterior urethral valve (PUV) pediatric patients after valve ablation will improve the persistent obstructive symptoms despite the absence of obstruction and if there are associated side effects of its use. Patients and Methods: A prospective, single-blinded randomized study was conducted at the urology department of two hospitals on 50 male children between September 2019 and June 2021 with PUV. All children were treated by endoscopic ablation of PUV using the cold knife and were followed clinically for voiding symptoms and with ultrasonography and laboratory tests. All patients underwent second-look cystoscopy 1 month after primary valve ablation to see residual valves as a routine procedure confirming no remnant of the valve and still complaining of obstructive symptoms. They were divided into two equal groups 25 patients each. Group A was given alpha-blockers and Group B placebo for 1 month. Results: Marked improvement of obstructive symptoms in Group A reaching about 90% (21 patients), whereas no mentioned improvement in Group B was noticed with no side effects of both medication the alpha-blocker and the placebo during its use. Conclusion: The use of alpha-blockers improves the obstructive symptoms in pediatric patients with PUV after valve ablation and in the absence of any further urethral obstruction with no side effects noticed during the period of its use. [ABSTRACT FROM AUTHOR]

Abstract Background Flexible cystoscopy is a common procedure to diagnose and treat lower urinary tract conditions. Single-use cystoscopes have been introduced to eliminate time-consuming reprocessing and costly repairs. We compared the hands-on labor time differences between flexible reusable cystoscopes versus Ambu’s aScope™ 4 Cysto (aS4C) at a large urology Ambulatory Surgery Center (ASC). Methods Reusable and single-use cystoscopy procedures were shadowed for timestamp collection for setup and breakdown. A subset of reusable cystoscopes were followed through the reprocessing cycle. T-tests were calculated to measure the significance between groups. Results The average hands-on time necessary for reusable cystoscope preparation, breakdown, and pre-cleaning was 4′53″. Of this, 2′53″ were required for preparation, while 2′0″ were required for breakdown and pre-cleaning. The average hands-on time for reprocessing for reusable was 7’1” per cycle. The total time for single-use scopes was 2′22″. Of this, 1′36″ was needed for single-use preparation, and 45 s for breakdown. Compared to reusable cystoscopes, single-use cystoscopes significantly reduced pre and post-procedure hands-on labor time by 2’31”, or 48%. When including reprocessing, total hands-on time was 80% greater for reusable than single-use cystoscopes. Conclusion Single-use cystoscopes significantly reduced hands-on labor time compared to reusable cystoscopes. On average, the facility saw a reduction of 2′31″ per cystoscope for each procedure. This translates to 20 additional minutes gained per day, based on an 8 procedures per day. Utilizing single-use cystoscopes enabled the facility to reduce patient wait times, decrease turnaround times, and free up staff time.

Abstract Objectives To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography urography (CTU) and cystoscopy negative for urinary bladder cancer (UBC) and upper tract urothelial cancer (UTUC) and to identify potential factors associated with occurrence of recurrent macroscopic haematuria. Methods All patients older than 50 years who underwent urological investigation for macroscopic haematuria with both cystoscopy and CTU 2015–2017 were retrospectively reviewed. A descriptive analysis of the primary and later investigations for recurrent macroscopic haematuria was performed. To investigate the association between explanatory variables and the occurrence of recurrent macroscopic haematuria, a Poisson regression analysis was performed. Results A total of 1395 eligible individuals with primary standard investigation negative for UBC and UTUC were included. During a median follow‐up of 6.2 (IQR 5.3–7) years, 248 (18%) patients had recurrent macroscopic haematuria, of whom six patients were diagnosed with UBC, two with prostate cancer, one with renal cell carcinoma and one had a suspected UTUC at the repeated investigation. Within 3 years, 148 patients (11%) experienced recurrent macroscopic haematuria, of whom two patients were diagnosed with low‐grade UBC (TaG1–2), one with T2G3 UBC and one with low‐risk prostate cancer. The presence of an indwelling catheter, use of antithrombotic medication, pathological findings at CTU or cystoscopy or history of pelvic radiotherapy were all statistically significant independent predictors for increased risk for recurrent macroscopic haematuria. Conclusion In the case of recurrent macroscopic haematuria within 3 years of primary standard evaluation for urinary tract cancer, there was a low risk of later urological malignancies in patients initially negative for UBC and UTUC. Therefore, waiting 3 years before conducting another complete investigation in cases of recurrent macroscopic haematuria might be appropriate.

Colovesical fistula is an improper connection between the urinary bladder and intestinal tract. Although there are many possible causes of colonovesical fistula, Chen et al. have classified them into five main classes: congenital, traumatic, tumor, inflammatory, and other. Intestinal diverticulitis accounts for 50-70% of cases in Western countries, and nearly all of them are related to colonic or bladder fistulas. Malignant tumors (20%) rank second in Western countries as the most common cause, which are situated largely in the large intestine. Other related tumours include bladder, cervical, ovarian and prostate cancers, and non-Hodgkin's lymphoma in the small intestine. The third most prevalent cause is Crohn's disease (10%), which occurs mainly in the ileum. "Other causes" include iatrogenic injury; trauma; foreign bodies in the intestinal tract; radiotherapy; chronic appendicitis

Procedural sedation as an anesthesiological method performed in patients who are unable to tolerate the examination. Procedural sedation was defined for clinical situations which require conditions for performing a therapeutic or diagnostic procedure with protected spontaneous breathing, airway reflexes and hemodynamic stability, with absence of anxiety and pain. Endoscopic urological procedures represent a good therapeutic alternative to open surgical methods but with an incomparable advantage in diagnostics. Endoscopy experienced its expansion in the last 20 years as minimally invasive surgery. Cystourethroscopy is one of the most common procedures performed by a urologist. In a patient with an advanced bladder tumor, after examination with a cystoscope, bimanual palpation is performed requiring good muscle relaxation of the anterior abdominal wall. The Clinic for Urology and Nephrology has started with examination under a cystoscope during the sixties years of the last century. Originally without anesthesia condition, cystoscopies were performed under analgosedation conditions since 1980. Due to the length of the examination and the need to perform bimanual palpation examination this anesthetic approach was inadequate. Furthermore, cystoscopies were performed under general anesthesia, with the increasing dose of anxiolytics, followed with depolarizing muscle relaxants and hypnotics. Nowdays, cystoscopies are performed under general anesthesia, with inhalation anesthetic or propofol maintenance, both provided adequate conditions for examination. The changes of the anesthesiological method over time represents one of the testimonies of the evolutionary pharmacologicaly-technologicaly-personnel development of the anesthesiological specialty for the endoscopic procedure, which has not fundamentally and technically changed since the very beginning.