Safety and efficacy of fluoroscopy-guided urethral catheterization in case of failed blind or cystoscopy-assisted urethral catheterization.

This retrospective study evaluated the safety and efficacy of fluoroscopy-guided urethral catheterization in patients who failed blind or cystoscopy-assisted urethral catheterization. We utilized our institutional database between January 2011 and March 2023, and patients with failed blind or cystoscopy-assisted urethral catheterization and subsequent fluoroscopy-guided urethral catheterization were included. A 5-Fr catheter was inserted into the urethral orifice, and the retrograde urethrography (RGU) was acquired. Subsequently, the operator attempted to pass a hydrophilic guidewire to the urethra. If the guidewire and guiding catheter could be successfully passed into the bladder, but the urethral catheter failed pass due to urethral stricture, the operator determined either attempted again with a reduced catheter diameter or performed balloon dilation according to their preference. Finally, an appropriately sized urethral catheter was selected, and an endhole was created using an 18-gauge needle. The catheter was then inserted over the wire to position the tip in the bladder lumen and ballooned to secure it. We reviewed patients' medical histories, the presence of hematuria, and RGU to determine urethral abnormalities. Procedure-related data were assessed. Study enrolled a total of 179 fluoroscopy-guided urethral catheterizations from 149 patients (all males; mean age, 73.3 ± 13.3 years). A total of 225 urethral strictures were confirmed in 141 patients, while eight patients had no strictures. Urethral rupture was confirmed in 62 patients, and hematuria occurred in 34 patients after blind or cystoscopy-assisted urethral catheterization failed. Technical and clinical success rates were 100%, and procedure-related complications were observed in four patients (2.2%). The mean time from request to urethral catheter insertion was 129.7 ± 127.8 min. The mean total fluoroscopy time was 3.5 ± 2.5 min and the mean total DAP was 25.4 ± 25.1 Gy cm2. Balloon dilation was performed in 77 patients. Total procedure time was 9.2 ± 7.6 min, and the mean procedure time without balloon dilation was 7.1 ± 5.7 min. Fluoroscopy-guided urethral catheterization is a safe and efficient alternative in patients where blind or cystoscopy-assisted urethral catheterization has failed or when cystoscopy-urethral catheterization cannot be performed.

Optimizing practices to prevent urinary tract infection after cystoscopy and urodynamics in women: A quality improvement study.

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.

[The interpretation of the updated American Urological Association guideline of interstitial cystitis/bladder pain syndrome in 2022].

In 2022, American Urological Association updated the guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). A significant change has been made in treatment recommendations. The updated guideline no longer divided treatments into first-line through sixth-line tiers. Instead, treatment is categorized into behavioral/non-pharmacologic, oral medicines, bladder instillations, procedures, and major surgery. This change emphasizes the heterogeneity of IC/BPS patients and the importance of individualized treatment, overturns traditional unreasonable ideas about hierarchical and progressive treatment, and encourages patients and physicians to make treatment decisions together. At the same time, the panel emphasized the importance of early implementation of cystoscopy in patients suspected of Hunner lesions and warned against the possibility of pentosan polysulfate causing a unique retinal pigmentary maculopathy. Urinary reconstruction surgery was considered to only be used as a last resort for the treatment of IC/BPS, and there is uncertainty about the overall balance between benefits and risks/burdens. The updated guideline provides a new understanding and decision-making basis for the diagnosis and treatment of IC/BPS. However, it should be noted that the clinical characteristics of Chinese patients should be considered in practice and the application of the guideline should be localized.

The Diagnostic Accuracy of Cystoscopy for Detecting Bladder Cancer in Adults Presenting with Haematuria: A Systematic Review from the European Association of Urology Guidelines Office.

CONTEXT: Haematuria can be macroscopic (visible haematuria [VH]) or microscopic (nonvisible haematuria [NVH]), and may be caused by a number of underlying aetiologies. Currently, in case of haematuria, cystoscopy is the standard diagnostic tool to screen the entire bladder for malignancy. OBJECTIVE: The objective of this systematic review is to determine the diagnostic test accuracy of cystoscopy (compared with other tests, eg, computed tomography, urine biomarkers, and urine cytology) for detecting bladder cancer in adults. EVIDENCE ACQUISITION: A systematic review of the literature was performed according to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for diagnostic test accuracy studies' checklist. The MEDLINE, Embase, Cochrane CENTRAL, and Cochrane CDSR databases (via Ovid) were searched up to July 13, 2022. The population comprises patients presenting with either VH or NVH, without previous urological cancers. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). EVIDENCE SYNTHESIS: Overall, nine studies were included in the qualitative analysis. Seven out of nine included trials covered the use of cystoscopy in comparison with radiological imaging. Overall, sensitivity of cystoscopy ranged from 87% to 100%, specificity from 64% to 100%, positive predictive value from 79% to 98%, and negative predictive values between 98% and 100%. Two trials compared enhanced or air cystoscopy versus conventional cystoscopy. Overall sensitivity of conventional white light cystoscopy ranged from 47% to 100% and specificity from 93.4% to 100%. CONCLUSIONS: The true accuracy of cystoscopy for the detection of bladder cancer within the context of haematuria has not been studied extensively, resulting in inconsistent data regarding its performance for patients with haematuria. In comparison with imaging modalities, a few trials have prospectively assessed the diagnostic performance of cystoscopy, confirming very high accuracy for cystoscopy, exceeding the diagnostic value of any other imaging test. PATIENT SUMMARY: Evidence of tests for detecting bladder cancer in adults presenting with haematuria (blood in urine) was reviewed. The most common test used was cystoscopy, which remains the current standard for diagnosing bladder cancer.

Intrauterine device migration into the bladder leading to stones formation.

An intrauterine device (IUD) is a popular method of contraception mainly used in developing countries. Perforation is one of the most serious but a rare complication secondary to the insertion of an IUD, while perforation into the intravesical organs such as the bladder is even more rare. A 30-year-old multipara in early 30s, with two previous caesarean sections (CS) and one curettage, was found to have her IUD puncturing the bladder during a cystoscopy procedure to remove her bladder stones. Transvesical migration of an IUD is an uncommon complication with a high rate of calculi formation, which is thought to be caused by the IUD's lithogenic potential. Imaging approaches such as ultrasound and pelvic X-rays are considered imperative in the accurate diagnosis. Any migrated IUD should be removed regardless of location. Prompt and continual monitoring of women using an IUD is essential and in a case where the IUD has migrated, the removal using the endoscopic approach is a safe and effective method.

D-Mannose Plus Saccharomyces boulardii to Prevent Urinary Tract Infections and Discomfort after Cystoscopy: A Single-Center Prospective Randomized Pilot Study.

Background and Objectives: Patients undergoing cystoscopy can experience discomfort or pain during the procedure. In some cases, a urinary tract infection (UTI) with storage lower urinary tract symptoms (LUTS) may occur in the days following the procedure. This study aimed to assess the efficacy of D-mannose plus Saccharomyces boulardii in the prevention of UTIs and discomfort in patients undergoing cystoscopy. Materials and Methods: A single-center prospective randomized pilot study was conducted between April 2019 and June 2020. Patients undergoing cystoscopy for suspected bladder cancer (BCa) or in the follow-up for BCa were enrolled. Patients were randomized into two groups: D-Mannose plus Saccharomyces boulardii (Group A) vs. no treatment (Group B). A urine culture was prescribed regardless of symptoms 7 days before and 7 days after cystoscopy. The International Prostatic Symptoms Score (IPSS), 0-10 numeric rating scale (NRS) for local pain/discomfort, and EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) were administered before cystoscopy and 7 days after. Results: A total of 32 patients (16 per group) were enrolled. No urine culture was positive in Group A 7 days after cystoscopy, while 3 patients (18.8%) in Group B had a positive control urine culture (p = 0.044). All patients with positive control urine culture reported the onset or worsening of urinary symptoms, excluding the diagnosis of asymptomatic bacteriuria. At 7 days after cystoscopy, the median IPSS of Group A was significantly lower than that of Group B (10.5 vs. 16.5 points; p = 0.021), and at 7 days, the median NRS for local discomfort/pain of Group A was significantly lower than that for Group B (1.5 vs. 4.0 points; p = 0.012). No statistically significant difference (p > 0.05) in the median IPSS-QoL and EORTC QLQ-C30 was found between groups. Conclusions: D-Mannose plus Saccharomyces boulardii administered after cystoscopy seem to significantly reduce the incidence of UTI, the severity of LUTS, and the intensity of local discomfort.

Abdominopelvic Surgery: Intraoperative Ureteral Injury and Prophylaxis in the United States, 2015-2019.

INTRODUCTION: Preoperative ureteral catheterization/stenting (stenting) and intraoperative diagnostic cystoscopy (cystoscopy) may help prevent or identify intraoperative ureteral injuries (IUIs) during abdominopelvic surgery. In order to provide a comprehensive, single source of data for health care decision makers, this study aimed to catalog the incidence of IUI and rates of stenting and cystoscopy across a wide spectrum of abdominopelvic surgeries. METHODS: We conducted a retrospective cohort analysis of United States (US) hospital data (October 2015-December 2019). IUI rates and stenting/cystoscopy use were investigated for gastrointestinal, gynecological, and other abdominopelvic surgeries. IUI risk factors were identified using multivariable logistic regression. RESULTS: Among approximately 2.5 million included surgeries, IUIs occurred in 0.88% of gastrointestinal, 0.29% of gynecological, and 1.17% of other abdominopelvic surgeries. Aggregate rates varied by setting and for some surgery types were higher than previously reported, especially in certain higher-risk colorectal procedures. Prophylactic measures were generally employed at a relatively low frequency, with cystoscopy used in 1.8% of gynecological procedures and stenting used in 5.3% of gastrointestinal and 2.3% of other abdominopelvic surgeries. In multivariate analyses, stenting and cystoscopy use, but not surgical approach, were associated with a higher risk of IUI. Risk factors associated with stenting or cystoscopy, as well as those for IUI, largely mirrored the variables reported in the literature, including patient demographics (older age, non-White race, male sex, higher comorbidity), practice settings, and established IUI risk factors (diverticulitis, endometriosis). CONCLUSION: Use of stenting and cystoscopy largely varied by surgery type, as did rates of IUI. The relatively low use of prophylactic measures suggests there may be an unmet need for a safe, convenient method of injury prophylaxis in abdominopelvic surgeries. Development of new tools, technology, and/or techniques is needed to help surgeons identify the ureter and avoid IUI and the resulting complications.

Do We Need a Urine Culture Before Cystoscopy? Time to Shift Away from Routine Testing.

OBJECTIVE: To determine if cystoscopy could be safely performed without a urine culture by analyzing 2 prospectively cohorts of patients undergoing outpatient cystoscopy, 1 without urine culture and the other cohort screened and treated for ASB as per protocol. We aim to report the rate of symptomatic UTI and the rate of urinary sepsis within 30 days of cystoscopy. METHODS: All patients who underwent cystoscopy between 2021 and 2022 were invited to participate. Patients were prospectively recruited in a 2:1 ratio. Cohort A: patients who did not require urine culture before cystoscopy. Cohort B: patients who were required to have sterile urine before the procedure. Primary endpoint was the occurrence of symptomatic UTI ≤ 30 days after cystoscopy. RESULTS: A total of 461 patients were recruited, 316 for cohort A and 145 for cohort B. Fifteen patients had symptomatic UTIs between both groups, 8 in Cohort A and 7 in Cohort B. The overall rate of symptomatic UTI was 3.2%, 2.5% for Cohort A and 4.8% for Cohort B. We had only 1 case of urinary sepsis in Cohort B. The RR for developing UTI in cohort B was 1.91 in the univariate model and 1.74 in the multivariate analysis. CONCLUSION: Routine urine culture before outpatient cystoscopy is unnecessary. In asymptomatic patients, subsequent UTIs are rare and can be easily treated. Avoiding routine urine culture helps prevent misuse of antibiotics, reduce cancellation rates, and ease the burden of patients that get cancelled because of ASB. The low risk of symptomatic UTI after the procedure must be discussed with the patient.

Scheduled or immediate cystoscopy: Which option reduces pain and anxiety?

INTRODUCTION: Office-based flexible cystoscopy is a common outpatient procedure in daily urology practice. Sometimes, cystoscopy procedures are performed on the initial day or scheduled on the following days. We designed this study to compare immediate versus scheduled cystoscopy in terms of anxiety and pain. METHODS: In this study, 160 patients were prospectively randomized to undergo office-based flexible cystoscopy by the same urologist between November 2017 and January 2018. Participants were grouped as scheduled for a cystoscopy on the third day of their application (group 1) and immediate cystoscopy on the same day of the application (group 2). A visual analog scale (VAS), State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI) were completed by the patients. RESULTS: Among men, immediate cystoscopy group experienced an increased state anxiety score compared to scheduled group (51.21 ± 8.108 vs 35.29 ± 10.553; p < 0.001). BAI scores were 16.51 ± 8.078 for group1 vs 31.92 ± 8.403 for group2 (p < 0.001). The mean VAS score was 3 ± 1.183 and 4.55 ± 1.155 in group1 and group2, respectively (p < 0.001). Among women, both the trait anxiety score and state anxiety score were found significantly low in scheduled group (mean trait anxiety scores 44.71 ± 6.051 and 49.3 ± 6.670, mean state anxiety scores were 33.71 ± 8.776 and 44.15 ± 7 in group1 and 2, respectively; p < 0.0001). BAI scores were also low in scheduled group (19.02 ± 7.786 vs 34.13 ± 8.367). Additionally, the mean VAS score was significantly high in immediate cystoscopy group compared to scheduled cystoscopy group (3.50 ± 0.784 vs 2.61 ± 0.919; p < 0.001). CONCLUSION: To reduce anxiety and pain, informing patients properly about the cystoscopy and scheduling the procedure would be helpful for a better cooperation of the patient.

Prospective randomized controlled trial to evaluate effectiveness of virtual reality to decrease anxiety in office-based flexible cystoscopy patients.

PURPOSE: To evaluate the effectiveness of immersive VR distraction technology in alleviating anxiety and pain during flexible cystoscopy. METHODS: We prospectively recruited 270 study participants who qualified for flexible cystoscopy and randomly assigned them to experimental and control groups. The experimental group consisted of 135 patients who employed a VR set during flexible cystoscopy, and the control group consisted of 135 patients who underwent the procedure without a VR set. Patient anxiety was determined quantitatively according to the State-Trait Anxiety Inventory. A visual analog scale for assessing pain intensity, satisfaction, and willingness to repeat the procedure was evaluated. In addition, difference in the hemodynamic parameter was also examined. RESULTS: The study findings demonstrated that the use of a VR set during flexible cystoscopy significantly improved the anxiety level over that of the control group (p = 0.001). Furthermore, this intervention led to a significantly increased level of satisfaction and willingness to repeat the procedure and a decrease in hemodynamic variables, specifically, systolic pressure, diastolic pressure, and heart rate (p = 0.001 in each case). Nonetheless, there were no significant differences between the groups with respect to the basic characteristic data, pain intensity, or oxygen saturation. CONCLUSIONS: Based on the present study, immersive VR can measurably decrease anxiety and increase satisfaction and willingness to repeat the procedure during flexible cystoscopy. TRIAL REGISTRATION DATE: 14 September 2019; number: TCTR20190914002.

Role of Flexible Cystoscopy in the Management of Postmenopausal Women With Recurrent Urinary Tract Infections.

OBJECTIVES: To evaluate office flexible cystoscopy findings in the evaluation and management of postmenopausal women with recurrent urinary tract infections (RUTIs). METHODS: An IRB-approved, prospectively maintained database of women evaluated for RUTIs at a tertiary care center was retrospectively reviewed by an independent investigator for flexible cystoscopy (FC) findings and related treatment decisions over three consecutive years. Data reviewed in the electronic medical record (EMR) included demographics, UTI history, history of diabetes, hormone replacement therapy (HRT), prior urological surgeries, sexual activity, coital antibiotic prophylaxis use, urine culture findings, antibiotic resistance/allergies, cystoscopy, and treatment plan. RESULTS: Between 2017 and 2019, 113 consecutive postmenopausal women, mostly Caucasian, underwent flexible office cystoscopy to complete their RUTI evaluation. Eighty-four women (74%) had abnormal cystoscopy findings. The rate of overall abnormal findings on cystoscopy increased yearly, including findings of trigonitis (p = 0.022). Other abnormal cystoscopy findings, as well as post-evaluation treatment plans, did not significantly differ over time. Trigonitis was the most common (67%) finding on cystoscopy. RUTI management included exposed urethral/bladder mesh removal and/or electrofulguration of chronic cystitis areas. CONCLUSIONS: Flexible cystoscopy, as an office diagnostic procedure, can provide valuable information of underlying etiology of RUTIs and allow directed management.

Bladder stone causing vesicovaginal fistula and migration into the vagina.

Bladder stone is a known complication in a neurogenic bladder that can very rarely cause vesicovaginal fistula (VVF). We are presenting the case of a woman in her late 70s, bed bound with progressive multiple sclerosis (MS), who was referred to urology for consideration of suprapubic catheter due to difficulty in managing her indwelling urethral catheter. The ultrasonogram (USG) identified a 4.7 cm bladder stone with right-sided hydronephrosis (HN) and left atrophic kidney. A CT scan later showed that a 5 cm bladder stone has migrated through a VVF into her vagina. She had a cystoscopy and transvaginal retrieval of the stone. Given her performance status and intraoperative finding of a small contracted bladder, it was agreed to manage her VVF conservatively.To the best of our knowledge, this is the first case of a primary bladder stone migrating into the vagina through a VVF.

Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection after Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study.

OBJECTIVES: The objective of the study was to determine practice patterns of prescribing prophylactic antibiotics against urinary tract infection (UTI) for urodynamic studies (UDS) and outpatient cystoscopy in women. DESIGN: A cross-sectional survey study was conducted of North American female pelvic medicine and reconstructive specialists (FPMRS). METHODS: An online survey was used to assess prophylactic prescribing patterns of FPMRS that perform UDS and outpatient cystoscopy. This survey was developed and then electronically disseminated through the American Urogynecologic Society to 699 eligible physicians. RESULTS: A total of 138 surveys were completed. Approximately half of physicians did not prescribe any antibiotic prophylaxis for UDS or for cystoscopy (54% and 43%, respectively). For patients with perceived risk factors (recurrent UTIs, immunosuppression, known neurogenic lower urinary tract dysfunction, indwelling catheter use, elevated postvoid residual/bladder outlet obstruction, genitourinary anomalies, and diabetes), 32% and 41% of physicians prescribed antibiotic prophylaxis for UDS and cystoscopy, respectively. A minority of physicians always prescribed antibiotics for UDS and cystoscopy (13% and 17%, respectively). LIMITATIONS: The response rate was a limitation of the study; however, this rate is in keeping with other physician survey studies published within this subspecialty. Selection and response biases may have contributed to the results of this survey study. CONCLUSION: There was no uniform approach to UTI prophylaxis for UDS and outpatient cystoscopy in women which reflects the lack of current guidelines and the low level of evidence on which they are based. This nonuniform practice calls for more research to better define an evidence-based standard of care.

Comparison of Neural Network and Logistic Regression Analysis to Predict the Probability of Urinary Tract Infection Caused by Cystoscopy.

Purpose: Urinary tract infections (UTIs) are the most common infections among hospitalized patients. Cystoscopy is a minimally invasive procedure to check bladder disease, among the patients receiving procedure, approximately 10% of patients may experience UTI. In this study, a neural network model with high accuracy, sensitivity, and specificity was developed to predict the probability of UTIs caused by cystoscopic procedures. To reduce antibiotic overuse during cystoscopic procedures, the model can provide clinicians with a rapid assessment of whether patients require prophylactic antibiotics. Materials and Methods: Patients who underwent cystoscopic procedures at China Medical University Beigang Hospital from 2016 to 2019 were retrospectively reviewed. A total of 1647 patients were enrolled, and 147 cases of urinary tract infection occurred. An artificial neural network (ANN) and logistic regression analysis were used to develop the prediction models, and the two models were compared. Results: The logistic regression analysis model had an accuracy of 91%, sensitivity of 2%, and specificity of 99%, indicating that the logistic regression model predicted that most patients had a low risk of infection. The neural network model had a high accuracy of 85%, sensitivity of 80%, and specificity of 88%. Conclusions: Because the logistic regression model had low sensitivity and missed most cases of UTI, the logistic regression model is inappropriate for clinical application. The neural network model has superior predictive ability and can be considered a tool in clinical practice.

A Retrospective Cohort Study to Identify the Risk Factors for Urinary Tract Infection After Office Procedures.

OBJECTIVE: The objective of this study is to identify the incidence of and risk factors for urinary tract infection (UTI) after office cystoscopy and urodynamic studies (UDS) in a female population. METHODS: This was a retrospective cohort study investigating incidence of and risk factors for UTI after office testing. Inclusion criteria included women presenting for either cystoscopy or UDS from September 2019 to February 2020. Modified Poisson regression with robust error variance was used to identify risk factors for UTI after cystoscopy and UDS in a female population. RESULTS: A total of 274 patients met inclusion criteria. One hundred eighty-five patients underwent office cystoscopy. Nine (4.8%) had a postcystoscopy UTI. Significant risk factors for postcystoscopy UTI included recurrent UTI (relative risk, 7.51; 95% confidence interval, 1.66-34.05) and a history of interstitial cystitis (relative risk, 4.56; 95% confidence interval, 1.52-13.73). Of those with recurrent UTI, 13.7% had a postcystoscopy UTI. Among patients with interstitial cystitis, 25% had a postcystoscopy UTI. One hundred ninety-two patients underwent UDS. Ten (5.2%) developed a post-UDS UTI. No risk factors were identified. CONCLUSIONS: Patients with recurrent UTI were 7.51 times more likely to develop a UTI after cystoscopy, whereas those with interstitial cystitis were 4.56 times more likely to develop a UTI after cystoscopy. The incidence of UTI after UDS was low overall. Understanding who is at higher risk of postprocedural UTIs may help identify subpopulations that may benefit from prophylactic strategies.

Effects of Heating Therapy on Pain, Anxiety, Physiologic Measures, and Satisfaction in Patients Undergoing Cystoscopy.

PURPOSE: Cystoscopy is the most common procedure used to diagnose urological diseases; however, it is invasive and can be associated with pain and anxiety. Although pain relieving medications, such as lidocaine lubricants, are used during cystoscopy, the procedure still causes discomfort. Therefore, non-medical intervention is needed to reduce pain and anxiety during the procedure and increase patient satisfaction. The aim of this study was to evaluate the effect of heating therapy on pain, anxiety, physiologic measures, and satisfaction during cystoscopy. METHODS: This was a single-blinded, single-center, randomized controlled trial. A total of 145 participants who underwent cystoscopy between August 2017 and October 2017 were recruited and randomly assigned to an experimental or control group. Before and after cystoscopy, all the participants self-reported the degree of pain they felt, while pain was objectively assessed by trained nurses. Anxiety was evaluated using the validated Korean version of the State-Trait Anxiety Inventory. Blood pressure and pulse rate were also recorded as physiologic measures. After cystoscopy, satisfaction was measured in the experimental group only using the Korean version of the Client Satisfaction Questionnaire. RESULTS: Heating therapy reduced both subjective and objective pain and anxiety in the experimental group compared to the control group. Heating therapy also decreased the systolic and diastolic blood pressure and pulse rate in the experimental group compared to the control group. Women reported significantly greater satisfaction than men. CONCLUSION: Heating therapy during cystoscopy is a convenient and effective nursing intervention that decreases pain and anxiety and enhances patient satisfaction. The study has been registered with the Clinical Research Information Service Registry, and the trial registration number is [12616000803493].

Gross Hematuria in an Adolescent Secondary to a Rare Bladder Tumor: A Case Report and Review of Inflammatory Myofibroblastic Tumors of the Urinary Bladder.

Inflammatory myofibroblastic tumor (IMT) is a tumor of unknown neoplastic potential that rarely arises in the genitourinary tract. We present the case of an otherwise healthy 16-year old boy with gross hematuria who underwent cystoscopy and transurethral resection of the bladder tumor without complication. Biopsy and immunohistochemistry were consistent with anaplastic lymphoma kinase-positive IMT. In addition to presenting this case of IMT, we review presentations, management and prognosis of bladder IMT.

Retrograde Cystonephroscopy for Complex Renal Calculi Using Novel Dual-Action Aspiration, Irrigation Cystoscope: Initial Case Series.

Introduction: Percutaneous nephrolithotomy is the gold standard treatment for kidney stones ≥2 cm; however, it remains an invasive procedure with significant risks especially in individuals with severe medical comorbidities. In contrast, while ureteroscopy is far less morbid, a major impediment to its use for larger calculi is the inability to evacuate the many fragments created during laser lithotripsy. Herein, we describe two patients with large-volume calculi and a third high-risk patient with a smaller stone who were treated with cystonephroscopy using a recently released, 16F flexible cystoscope equipped with dual aspiration and irrigation capabilities. Materials and Methods: Three consecutive female patients underwent retrograde cystonephroscopy from June 2021 to July 2021 with a novel 16F aspiration-enabled flexible cystoscope. Demographic data were collected. Preoperative and postoperative CT scan images were reviewed to determine linear stone dimensions and scalene ellipsoid volume. Results: The three female patients had an average age of 72.3 years and an American Society of Anesthesiologists (ASA) physical status score of 3. The mean preoperative stone volume was 4950 mm3. The average postcystonephroscopy stone volume was 217 mm3, resulting in a total stone clearance rate of 97%. No major complications occurred. The average procedure time was 176 minutes. Conclusions: Among the three high-risk female patients, two with large-volume calculi, retrograde cystonephroscopy with a novel aspiration-enabled cystoscope allowed for the procedure to be effectively completed solely via a retrograde approach.

Characterization of a Novel Implant Intended to Expand and Reshape the Prostatic Urethra for the Treatment of Benign Prostatic Hyperplasia: A Pre-Clinical Feasibility Study in the Canine Model.

OBJECTIVE: To evaluate the safety, feasibility, and tissue response of a novel device for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia, using the first-generation Urocross Expander System (Mercury Expander System). METHODS: The implant was deployed and retrieved using flexible cystoscope in 8 adult male canines, separated into three study arms by retrieval date (1-, 6-, and 12- months post-deployment). Cystoscopy and urethrograms verified implant position/diameter; bladder neck and external sphincter function/changes; prostatic tissue response; and implant condition. One-month post-retrieval, the prostate and surrounding tissue was sectioned and evaluated by a veterinary pathologist. RESULTS: All implants were successfully deployed in the prostatic urethra. Urethral width was increased (6.9 ± 1.8 mm to 10.2 ± 0.6 mm, P = .012) and preserved through the dwell period. Urethral length and sphincter diameters didn't significantly change. All subjects (n = 8) remained continent without obstruction or retention. Adverse events included incisional site bleeding (n = 2) and transient hematuria (n = 3). One implant migrated into the bladder and spontaneously repositioned into the prostatic urethra. Post-retrieval, explant surfaces demonstrated no tissue growth, encrustation or stone formation. Imaging revealed contact site erythema and indentation, but no stones, strictures, perforations, erosions, nor ulcerations. Histopathology revealed glandular acinar changes, inflammation, and fibrosis. CONCLUSION: The first generation of the Urocross Expander System demonstrated a favorable safety profile in the canine model. Changes in the prostatic urethra shape were noted with an increase in urethral width during the dwell period with minimal tissue changes. Further, the implant didn't demonstrate any encrustation, tissue growth or stone formation.

Association between cystoscopy at the time of hysterectomy performed by a gynecologic oncologist and delayed urinary tract injury.

OBJECTIVE: Guidance regarding the use of cystoscopy at the time of hysterectomy is lacking in gynecologic oncology. We compare the rate of delayed urinary tract injury in women who underwent cystoscopy at the time of hysterectomy performed by a gynecologic oncologist for benign or malignant indication with those who did not. METHODS: This was a retrospective cohort study of patients who had a hysterectomy performed by a gynecologic oncologist recorded in the National Surgical Quality Improvement Program between January 2014 and December 2017. The primary outcome was delayed urinary tract injury in the 30-day post-operative period. Secondary outcomes were operative time and urinary tract infection rate. The exposure of interest was cystoscopy at the time of hysterectomy and bivariable tests were used to examine associations. RESULTS: We identified 33 355 women who underwent hysterectomy for benign (41%; n=13 621) or malignant (59%; n=19 734) indications performed by a gynecologic oncologist. Surgical approach was open (39%; n=12 974), laparoscopic or robotic-assisted laparoscopic (55%; n=18 272), and vaginal or vaginally-assisted (6%; n=2109). Overall, 12% of women (n=3873) underwent cystoscopy at the time of surgery; cystoscopy was more commonly performed in laparoscopic (15%; n=2829) and vaginal (12%; n=243) approaches than with open hysterectomy (6%; n=801) (p<0.001). There was no difference in the rate of delayed urinary tract injury in patients who underwent cystoscopy at the time of surgery compared with those who did not (0.4% vs 0.3%, p=0.32). However, patients who underwent cystoscopy were more likely to be diagnosed with a urinary tract infection (3% vs 2%, RR 1.3, 95% CI 1.1 to 1.6). In cases where cystoscopy was performed, median operative time was increased by 9 min (137 vs 128 min, p<0.001). CONCLUSION: Cystoscopy at the time of hysterectomy performed by a gynecologic oncologist does not result in a lower rate of delayed urinary tract injury compared with no cystoscopy.