Quality of care perceived by patients during cystoscopy and affecting factors.

It is necessary and important for quality of care to ensure the comfort of patients during the procedure, as well as before and after surgery. According to literature, it is necessary to know what patients experience and how they perceive the care they receive. This study aimed to investigate the quality of care perceived by patients during cystoscopy and the factors affecting it. This descriptive study was conducted in the surgical clinic of a teaching and research hospital, with 105 patients who underwent cystoscopy in 2022. Data collection forms consisting of a Sociodemographic and Disease Characteristics Questionnaire and the Good Perioperative Nursing Care Scale (for Patients) (GPNCS) were used for data collection, with face-to-face interviews on the first day after the procedure. This study was conducted in accordance with the principles of the Declaration of Helsinki. The study included patients with urinary tract stones, transurethral prostatectomy, and transurethral bladder resection. Of the participants, 72.4% were male, and 81.9% were married. The mean age of the patients was 50.09 ± 16.79 years. The mean total score was 143.56 ± 16.62. It was higher in single patients and those who had not previously undergone surgery. It was found that the mean of the environment sub-dimension was the highest at 18.57 ± 2.51 and the mean of the support sub-dimension was the lowest at 16.01 ± 3.44. The results of this study showed that patients undergoing cystoscopy have a good perception of the quality of their peri-operative nursing care.

Manejo exitoso de síndrome de vejiga hiperactiva refractaria con toxina botulínica A / Successful management of refractory overactive bladder syndrome with botulinum toxin A

Introducción: El síndrome de vejiga hiperactiva (VHA) afecta hasta al 43% de las mujeres. La terapia escalonada incluye cambios de hábitos, fármacos y neuromodulación. Hasta el 40% de las pacientes llegan a requerir terapia avanzada alternativa, como toxina botulínica (TB). Objetivo: Reportar los resultados del tratamiento con toxina botulínica en mujeres con VHA refractaria a tratamiento de primera y segunda línea, en un hospital público en Chile. Método: Estudio de cohorte retrospectivo desde una base de datos recolectada prospectivamente del Hospital Sótero del Río entre 2018 y 2022. Se incluyeron 33 pacientes con tratamiento farmacológico y neuromodulación previa, con una edad promedio de 57 años, sometidas a inyección cistoscópica de TB a detrusor, analizando datos demográficos, antecedentes y complicaciones. Se realizó seguimiento con frecuencia miccional, paños/día, escala de gravedad de Sandvik (ISI) y encuesta Patient Global Impression Improvement (PGI-I). Resultados: Los datos comparativos pre/post TB, respectivamente, fueron: frecuencia miccional diurna 11/6 y nocturna 5/1; paños/día 5/3; ISI 8/3. Veinte de 33 mujeres refirieron estar excelente o mucho mejor (PGI-I). Conclusiones: Es posible realizar manejo con TB en mujeres con VHA refractaria a primera y segunda línea, con buenos resultados e impacto significativo en la calidad de vida.

Introduction: Overactive bladder syndrome (OABS) affects up to 43% of women. Staggered therapy includes habit changes, drugs, and peripheral neuromodulation. Up to 40% of patients may require advanced alternative therapy such as botulinum toxin A (BT). Objective: To report the results of treatment with TB in women with OABS refractory to first- and second-line treatment in a public hospital in Chile. Method: Retrospective cohort study from prospectively collected database from Hospital Sótero del Río between 2018 and 2022. Thirty-three patients with previous pharmacological treatment and neuromodulation were included, with an average age of 57 years, undergoing cystoscopic injection of TB to detrusor. Demographic data, history, and complications were analyzed. Follow-up was performed with voiding frequency, cloths/day, Sandvik Severity Scale (ISI) and Patient Global Impression Improvement (PGI-I) survey. Results: Comparative data pre/post TB, respectively showed: daytime voiding frequency 11/6 and nighttime 5/1; cloths/day 5/3; ISI 8/3. 20 of 33 women reported being excellent or much better (PGI-I). Conclusions: TB management in women with OABS refractory to first- and second-line treatment has good results and significant impact on quality of life.

A Randomized Controlled Trial on the Effect of Music Listening on Procedural Pain, Anxiety and Comfort Levels during Cystoscopy.

This study aimed to determine the effect of music listening on procedural pain intensity, anxiety, and comfort levels in patients during cystoscopy. This study was a prospective, randomized controlled trial. Study participants were randomly assigned to either a control or music group. The outcome measures were assessed using the Visual Analogue Scale, State Anxiety Scale, and General Comfort Questionnaire. A total of 36 patients in each group completed the study. The mean scores of pain in the music and control groups immediately after cystoscopy were 3.22 (SD, 1.72) and 5.22 (SD, 1.92), respectively. A statistically significant difference (between-group effect) was found, indicating that pain scores in the music group were significantly lower than those of the control group (group: F = 15.756, p < .001). However, no statistically significant difference was noted between the two groups regarding anxiety and comfort scores 20 min after cystoscopy (t1 = 1.156, p = .526; t1 = -0.586, p = .560, respectively). Music listening is a safe, economical, and effective method in pain management in patients undergoing cystoscopy.

Music during flexible cystoscopy for pain and anxiety - a patient-blinded randomised control trial.

OBJECTIVES: To assess the role of music in reducing the pain and anxiety associated with flexible cystoscopy using a blinded trial design. PATIENTS AND METHODS: A patient-blinded randomised control trial of music during flexible cystoscopy was performed comparing the pain, measured by visual analogue scale (VAS), anxiety, measured by the State-Trait Anxiety Inventory (STAI), and vital signs of 109 patients across two public hospitals in New South Wales, Australia. The purpose and hypothesis of the study was concealed from patients until after results had been collected. RESULTS: There were no statistically significant differences detected between the No Music and Music groups in VAS pain score (mean [SD] 2.04 [1.94] vs 2.10 [1.90], P = 0.86), change in STAI anxiety score (mean [SD] 4.87 [9.87] vs 6.8 [11.07], P = 0.33) or post-procedural vital signs (mean [SD] heart rate 74 [14] vs 72 [13] beats/min, P = 0.66; systolic blood pressure 144 [20] vs 141 [19] mmHg, P = 0.47) between the two groups. CONCLUSION: Music does not appear to decrease perceived pain or anxiety when used during flexible cystoscopy. These findings may differ from the literature due to several factors, most significantly blinding of participants, but also potentially due to the ethnic composition of the study population or lack of choice of music.

A randomized trial regarding antimicrobial prophylaxis (AMP) in transurethral resection of bladder tumor (TURB).

PURPOSE: To determine whether omitting antimicrobial prophylaxis (AMP) in TURB is safe in patients undergoing TURB without an indwelling pre-operative catheter/nephrostomy/DJ and a negative pre-operative urinary culture. MATERIALS AND METHODS: A multi-centered randomized controlled trial (RCT) from 17-09-2017 to 31-12-2019 in 5 hospitals. Patients with a pre-operative indwelling catheter/DJ-stent or nephrostomy and a positive pre-operative urinary culture (> 104 uropathogens/mL) were excluded. Post-operative fever was defined as body temperature ≥ 38.3 °C. A non-inferiority design with a 6% noninferiority margin and null hypothesis (H0) that the infection risk is at least 6% higher in the experimental (E) than in the control (C) group; H0: C (AMP-group) - E (no AMP-group) ≥ Δ (6% noninferiority margin). A multivariable, logistic regression was performed for AMP and post-TURB fever with covariates: tumor size and (clot-) retention. The R Project® for statistical computing was used for statistical analysis and a p value of 0.05 was considered as statistically significant. RESULTS: 459 Patients were included and 202/459 (44.1%) received AMP vs 257/459 (55.9%) without AMP. Fever occurred in 6/202 [2.9%; 95% CI (1.2-6.6%)] patients with AMP vs 8/257 [3.1%; 95% CI (1.5%-6.1%)] without AMP (p = 0.44). Multivariable, logistic regression showed no significant harm in omitting AMP when controlled for (clot-)retention and tumor size (p = 0.85) and an adjusted risk difference in developing post-TURB fever of 0.0016; 95% CI [- 0.029; 0.032]. CONCLUSION: Our data suggest the safety of omitting AMP in patients undergoing TURB without an indwelling, pre-operative catheter/nephrostomy/DJ and a negative pre-operative urinary culture.

The Importance of Cystoscopy in Diagnosis and Treatment of Urethral Stricture Following Transurethral Prostatectomy.

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.

Transurethral resection in women with symptomatic keratinizing squamous metaplasia of urinary bladder: A retrospective study of 92 cases.

OBJECTIVES: To investigate the efficacy of transurethral resection (TUR) on relieving urinary symptoms in patients with keratinizing squamous metaplasia (KSM) of the urinary bladder. METHODS: Data were analyzed from a retrospective study of patients receiving transurethral bipolar plasma resection (bi-TUR) treatment for symptomatic KSM. Urinary symptoms were assessed by the International Prostate Symptom Score (IPSS) and a numeric rating scale pain score. Efficacy was assessed using the IPSS to determine changes from baseline in lower urinary tract symptoms (LUTS). Self-reported quality of life (QoL) was assessed by the last question of the IPSS questionnaire. RESULTS: A total of 92 female patients were included in the analysis. The median age was 42 years. LUTS, pain, and hematuria were the most common symptoms that affected patients. The median follow-up duration was 51 months. There were significant improvements in LUTS from baseline IPSS after TUR (P < .001). The percentage of the patients with moderate to severe LUTS went down from 52.2% to 18.5%. The median Numeric Rating Scale (NRS)-11 pain score reduced from 3 at baseline to 0 at the last visit. Twenty-one out of 40 patients reported that the pain symptoms disappeared completely. No patients reported hematuria symptoms at the final follow-up. Improvement of self-reported QoL was significant (P < .001). A total of 57.6% of patients reported an improvement, 26.1% of patients reported no improvement, and 16.3% reported deterioration. CONCLUSIONS: Bi-TUR therapy significantly relieved urinary symptoms in women with KSM. Improvement of QoL was acceptable with a success rate of 57.6%. Considering the very low complication rate, our study supported bi-TUR as an alternative treatment for patients who are resistant to medical therapy.

Development of a high-precision bladder hyperthermic intracavitary chemotherapy device for bladder cancer and pharmacokinetic study.

BACKGROUND: Bladder hyperthermic intracavitary chemotherapy (HIVEC) has good effectiveness for bladder cancer, but conventional HIVEC systems lack precision and convenient application. To test the safety of a new HIVEC device (BR-TRG-II-type) in pigs and to perform a preliminary clinical trial in patients with bladder cancer. METHODS: This device was tested on six pigs to optimize the temperature and time parameters. Then, 165 patients (HIVEC after transurethral resection (TUR), n = 128; or HIVEC, n = 37) treated between December 2006 and December 2016 were recruited. Mitomycin C (MMC) was the chemotherapeutic agent. A serum pharmacokinetic study was performed. The primary endpoints were tumor recurrence, disease-free survival (DFS), and cumulative incidence rate (CIR) during follow-up. The adverse effects were graded. RESULTS: The animal experiment showed that 45 °C for 1 h was optimal. HIVEC was successful, with the infusion tube temperature stably controlled at about 45 °C, and outlet tube temperature of about 43 °C in all patients, for three sessions. Serum MMC levels gradually increased during HIVEC and decreased thereafter. The mean DFS was 39 ± 3.21 months (ranging from 8 to 78 months), and the DFS rate was 89.1% during follow-up. No adverse events occurred. CONCLUSION: The use of the BR-TRG-II-type HIVEC device is feasible for the treatment of bladder cancer. Future clinical trials in patients with different stages of bladder cancer will further confirm the clinical usefulness of this device. TRIAL REGISTRATION: chictr.org.cn: ChiCTR1900022099 (registered on Mar. 252,019). Retrospectively registered.

Long-Term Prospective Outcomes of Patients with Non-Muscle Invasive Bladder Cancer After Holmium Laser Ablation.

Objectives: To evaluate the long-term tumor recurrence, progression, and cancer-specific mortality (CSM) of patients after holmium laser ablation of non-muscle invasive bladder cancer (NMIBC) under topical anesthesia. To identify variables that help to predict risk of tumor recurrence, progression, and CSM. Materials and Methods: A prospective study of 251 consecutive patients with 399 recurrent NMIBC who underwent outpatient Holmium yttrium aluminium garnet laser ablation under topical anesthesia was carried out between September 2006 and September 2018. All patients underwent primary transurethral resection of bladder tumor to obtain histology. All patients completed a patient satisfaction questionnaire and visual analogue scale (VAS) for procedure-related pain. Results: All 251 patients were analyzed with an average age of 75.2 years and follow-up of 69.8 months. The majority of patients had multiple comorbidities with an American Society of Anesthesiologists of 3 or 4. The proportion of tumor grade 1, 2, and 3 disease and tumor stage Ta and T1 was 43.4%, 41.5%, 15.1%, 78.5%, and 21.5%, respectively. Overall, 57.8% of patients had at least one tumor recurrence with an average time of 16.3 months. Risk factors were tumor grade, number of tumors at time of first laser ablation, and tumor stage. Overall, 19.1% of patients demonstrated tumor progression with an average time of 51 months. Only 5.6% of patients had progression to muscle invasive bladder cancer, and the CSM rate was 5.2% with an average time to death of 71.2 months. Risk factors for CSM were tumor grade, stage, and the patient's age. The average VAS for pain was 0.6 out of 10, with all patients willing to have the procedure repeated if required. Conclusion: Laser ablation of NMIBC is a safe, effective, and well-tolerated long-term option for patients, particular in those who have moderate-to-severe co-morbidities. The long-term cancer outcomes are best for younger patients with primary low-grade and low-stage disease.

Three Distraction Methods for Pain Reduction During Cystoscopy: A Randomized Controlled Trial Evaluating the Effects on Pain, Anxiety, and Satisfaction.

BACKGROUND: Cystoscopy is a safe diagnostic procedure commonly used to evaluate lower urinary tract symptoms. This can cause pain, anxiety, and dissatisfaction in patients undergoing cystoscopy. OBJECTIVES: The aim of this study was to compare the effects on pain, anxiety, and satisfaction of distraction methods used during cystoscopy. DESIGN: Single-center, open-label, randomized, parallel-group trial. SETTING: Cystoscopy unit of a training and research hospital in Turkey. PARTICIPANTS: Male patients ≥18 years of age who underwent rigid cystoscopy for the first time. METHODS: A total of 120 male patients were recruited and randomized into four groups as music, stress ball, video, and control group. Data were collected using visual analog scale for pain and satisfaction, State-Trait Anxiety Inventory for anxiety, and hemodynamic parameters. The primary outcome was the difference with respect to pain scores among intervention groups. Other outcome measures were anxiety and satisfaction scores. RESULTS: Pain severity during cystoscopy was found to be significantly lower in the intervention groups than the control group. In the video group, the severity of pain during cystoscopy was also found to be significantly lower than music and stress ball groups (p = 0.006, p < 0.001). After cystoscopy, anxiety levels were significantly lower and satisfaction levels were significantly higher in the intervention groups than in the control group. Anxiety levels were significantly lower in the video group than music and stress ball groups (p < 0.001, p < 0.001). Satisfaction levels were also significantly higher after cystoscopy in the video group than in the music and stress ball groups (p = 0.018, p = 0.018). CONCLUSIONS: According to this study, distraction methods used during rigid cystoscopy were found to have a reducing effect on pain, anxiety, and dissatisfaction. As the results of the study are evaluated, video should be recommended to be the first preferred distraction method during rigid cystoscopy.

Can tumor recurrence be reduced with plasma-kinetic vaporization of the area around the tumor in nonmuscle invasive bladder cancer?

Purpose: To investigate the effect on recurrence of vaporization of the tumor surroundings and suspicious areas with a plasma-kinetic (PK) system after transurethral resection (TUR) of nonmuscle invasive bladder cancer. Materials and Methods: The study included 121 patients with a primary superficial bladder tumor who were randomized as those who underwent TUR with the PK system (Group 1, n=62) and those who underwent TUR with the monopolar system (Group 2, n=59). The vaporization procedure was performed by suppressing the cutting option of the PK system for a period, which would accumulate energy sufficient to make swelling-waves on the mucosa very close to the area of the loop to be vaporized. Results: A total of 121 patients who met the study criteria were included for evaluation. Recurrence was determined in 21 patients in Group 1 (33.87%) and in 29 patients in Group 2 (49.15%) (p=0.088). Recurrence was close to the old resection site in 6 of 21 patients in Group 1, and in 13 patients in Group 2 (p=0.028); the difference was statistically significant. No statistically significant difference was determined between the two groups with respect to age, gender, number of tumor foci, rate or range of additional treatments applied, cigarette smoking rate, repeat TUR rate and rate of tumor en- countered in repeat TUR, T-stage, and tumor grade. Conclusions: The effect of vaporization on recurrence by the PK system may seem similar to the effect of standard TUR, the recurrence- lowering effect surrounding nonmuscle invasive bladder cancers is better.

Three-Year Treatment Outcomes of Water Vapor Thermal Therapy Compared to Doxazosin, Finasteride and Combination Drug Therapy in Men with Benign Prostatic Hyperplasia: Cohort Data from the MTOPS Trial.

PURPOSE: We evaluated the long-term outcomes of treatment of lower urinary tract symptoms due to benign prostatic hyperplasia to compare a 1-time water vapor thermal therapy procedure with daily medical therapy in cohorts from the MTOPS (Medical Therapy of Prostatic Symptoms) study. MATERIALS AND METHODS: Results in the treatment arm of a randomized, controlled trial of thermal therapy using the Rezum® System were compared to MTOPS subjects treated with doxazosin and/or finasteride. Evaluations were restricted to medical therapy subjects, representing 1,140 of the original 3,047 (37.4%), with a prostate volume of 30 to 80 cc and an International Prostate Symptom Score of 13 or greater to include men who met key criteria of the Rezum and MTOPS trials. Outcomes were compared during 3 years for symptom changes and clinical progression rates. RESULTS: Thermal therapy improved symptom scores by approximately 50% throughout 36 months (p <0.0001). Symptom improvement was greater than with either drug alone but similar to that of combination drugs (p ≤0.02 and 0.73, respectively). The peak flow rate improved 4 to 5 ml per second after thermal therapy and doxazosin while thermal therapy was superior to finasteride and combination drugs for 24 and 12 months (p <0.001 and <0.01, respectively). Observed rates of clinical progression during 3 years corroborate these outcomes with approximately 5 times greater progression for any medical therapy vs a single thermal therapy procedure. CONCLUSIONS: A single water vapor thermal therapy procedure provided effective and durable improvements in symptom scores with lower observed clinical progression rates compared to daily long-term use of pharmaceutical agents.

La colocación de catéteres doble J con anestesia local en régimen ambulatorio es un procedimiento seguro y eficiente para el manejo de distintas patologías ureterales / Office stent placement under local anesthesia is a safe and efficient procedure for the management of multiple ureteral disorders

Objetivo: Evaluar los resultados de la colocación de catéteres doble J con anestesia local para el manejo de distintas patologías ureterales. Métodos: Estudio retrospectivo de 45 cateterismos ureterales consecutivos con anestesia local desde enero de 2015 hasta julio de 2016. Se incluyeron pacientes hemodinámicamente estables con una obstrucción o fístula urinaria o para la identificación ureteral durante una cirugía abdominopélvica. Cinco minutos antes del procedimiento se instilaron 10 ml de gel-lidocaína y 50 ml de suero-lidocaína en la vejiga. Se colocaron catéteres 4,8 Fr mediante un cistoscopio flexible de 15,5 Fr y escopia. Se analizaron las características y resultados de los procedimientos. Resultados: Se realizaron 45 procedimientos (33 colocaciones, 12 recambios) en 37 pacientes, de los cuales 40 (89%) fueron exitosos. Con una edad media de 58,6 años (±17,5), se intervinieron 10 hombres (27%) y 27 mujeres (73%). Las principales indicaciones fueron litiasis (37,8%), compresiones extrínsecas del uréter (28,9%) y la localización intraoperatoria ureteral (22,2%). Los intentos infructuosos fueron debidos a la incapacidad para ascender la guía/catéter en 4 casos (8,8%) o para identificar el meato ureteral en uno (2,2%). Ocho pacientes (17,8%) presentaron alguna complicación postoperatoria (7 Clavien I, uno Clavien IIIa). Ningún procedimiento se interrumpió por dolor. El análisis estadístico no encontró ningún factor predictor de éxito. El régimen ambulatorio fue 4 veces más barato. Conclusiones: La colocación de catéteres ureterales se puede realizar de forma eficaz y segura bajo anestesia local en el gabinete de cistoscopias. Este procedimiento podría ahorrar tiempo operatorio, reducir costes y minimizar los efectos secundarios de la anestesia general

Objective: To assess the outcomes of ureteral stent placement under local anesthesia for the management of multiple ureteral disorders. Methods: Retrospective study of 45 consecutive ureteral stents placed under local anesthesia from January 2015 to July 2016. Inclusion criteria were hemodynamically stable patients with urinary obstruction, urinary fistula or for prophylactic ureteral localization during surgery. Five minutes before the procedure, 10 ml of lidocaine gel and 50 ml of lidocaine solution were instilled in the bladder. A 4.8 Fr ureteral stent was placed using a 15.5 Fr flexible cystoscope under fluoroscopic control. Characteristics of procedures and outcomes were analysed. Results: A total of 45 procedures (33 placement, 12 replacements) were attempted in 37 patients, of which 40 (89%) were successful. There were 10 male (27%) and 27 female patients (73%) with a mean age of 58.6 years (±17.5). Main indications for stent placement were stones (37.8%), extrinsic ureteral compression (28.9%) and surgery ureteral localization (22.2%). The reasons for failing to complete a procedure were the inability to pass the guidewire/stent in 4 cases (8.8%) or to identify the ureteral orifice in 1 (2.2%). Postoperative complications occurred in 8 patients (17.8%) (7 Clavien I, 1 Clavien IIIa). No procedure was prematurely terminated due to pain. Statistical analysis did not find significant successful predictors. The outpatient setting provided a fourfold cost decrease. Conclusions: Ureteral stent placement can be safely and effectively performed under local anesthesia in the office cystoscopy room. This procedure could free operating room time, reduce costs and minimize side effects of general anesthesia

Impact of Allergy and Resistance on Antibiotic Selection for Recurrent Urinary Tract Infections in Older Women.

OBJECTIVES: To review the impact of antibiotic allergy and resistance in older women with recurrent urinary tract infections (RUTIs) as determinants for a suitable oral antibiotic treatment choice. METHODS: A prospectively maintained database of women 65 years old and older with documented RUTIs (≥3 UTI/y) and trigonitis on cystoscopy was reviewed. Demographic data, known drug allergies, renal function, antibiotic susceptibility of most recent urine culture, allergy, or resistance to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, and nitrofurantoin were obtained. RESULTS: From 2006 to 2014, 86 women with RUTIs met study criteria. Mean age was 77.9 ± 7.8, with 94% being Caucasian. An estimated glomerular filtration rate >30 mL/min was noted in 94%. The percentage of women allergic, resistant, or both allergic and resistant to TMP-SMX was 33%, 29%, and 15%, to fluoroquinolones was 14%, 34%, and 8.1%, or nitrofurantoin was 16%, 14%, and 5%, respectively. Twenty-eight percent (24 of 86) of women who were allergic and/or resistant to TMP-SMX and fluoroquinolones were sensitive to nitrofurantoin. Twenty percent (17 of 86) were allergic and/or resistant to all 3 antibiotics. Women who were allergic or resistant to TMP-SMX had a significantly higher number of other antibiotic resistances compared with women sensitive to TMP-SMX (4.9 ± 3.6 vs 2.1 ± 2.3; P < .0001). Similarly, women with fluoroquinolone allergy or resistance had significantly more antibiotic resistances than those who were fluoroquinolone sensitive (5.8 ± 3.5 vs 2.3 ± 2.5; P < .0001). CONCLUSION: Because of allergy and/or antibiotic resistance, several first-line antibiotics are not available for many older women with RUTIs. In nearly a third of women, nitrofurantoin was the only viable alternative.

Can bladder preservation therapy come to the center stage?

Decision-making in urological cancer care requires a multidisciplinary approach for refinement, but its impact on urothelial carcinoma of the bladder has not been fully addressed for the past three decades, except for the latest immunological checkpoint inhibitor approved by the U.S. Food and Drug Administration for metastatic muscle-invasive bladder cancer that is resistant to platinum-based chemotherapy. For the time being, radical cystectomy is the gold standard of curative therapy for muscle-invasive bladder cancer. Trimodal therapy that combines chemotherapy for the purpose of radiation sensitization, external beam radiotherapy and transurethral resection of bladder tumor has emerged as a potential alternative treatment option that preserves the bladder. In lack of randomized studies for bladder preservation therapy compared with surgery, the principles of management of urothelial carcinoma of the bladder have evolved in recent times, with an emphasis on bladder preservation. A number of bladder preservation techniques are available to the surgeon; however, appropriately selected patients with muscle-invasive bladder cancer should be offered the opportunity to discuss various treatment options, including organ-sparing trimodal therapy. The aim of the present study was to compare the primary outcomes of the available treatment methods and identify the sources of variance among studies. A review of various bladder preservation techniques in vogue for the management of urothelial carcinoma of the bladder is discussed.

Toxina botulínica intravescal con anestesia local como procedimiento ambulante / Intravesical botulinum toxin under local anestesia as ambulatory procedure

El síndrome de hiperactividad vesical se define como la presencia de "urgencia miccional, habitualmente asociada a una frecuencia miccional diurna aumentada y nicturia, con o sin incontinencia urinaria, en ausencia de infección del tracto urinario u otra patología obvia", la OnanobotulinumtoxinA es una alternativa recomendable en caso de fracaso, intolerancia, contraindicación o rechazo del tratamiento conservador u otras alternativas terapéuticas no farmacológicas. La aplicación de TBA en detrusor se ha realizado bajo anestesia local, regional o general y como procedimiento en el quirófano convencional, quirófano de cirugía mayor ambulatoria o en sala de cistoscopias. El objetivo de este trabajo es describir el procedimiento para realizar el tratamiento con TBA de forma ambulante con anestesia local intravesical en la sala de cistoscopias, describiendo sus ventajas y limitaciones

Bladder hyperactivity is described as the presence of "voiding urgency, generally associated with increased daytime frequency and nocturia, with or without urinary incontinence, in the absence of urinary tract infection or other obvious pathology". Onabo-tulinum toxin A (BTA) is a recommendable therapeutic option in case of failure, contraindication or refusal of the conservative therapy or other non-pharmacological therapies. The injection of BTA in the detrusor has been performed under local, regional or general anesthesia either in the conventional or major ambulatory surgery operative room or in the cystoscopy room. The objective of this paper is to describe the procedure to perform BTA therapy as an ambulatory operation under intravesical local anesthesia in the cystoscopy room, describing its advantages and limitations

Jack stone in the bladder: case report of a rare entity.

BACKGROUND: Jackstone is a bladder stone that has a similar appearance to toy jacks. However review of the English language medical literature revealed only a few previous reports of jackstone calculus. CASE PRESENTATION: We report a case in which a large jackstone calculus was incidentally detected during the evaluation of 67 year old male presenting with lower urinary tract symptoms. X-Ray kidney, ureter, bladder showed a large irregular shaped radio-opaque shadow in the pelvic region. He underwent cystolitholapaxy and transurethral resection of the prostate. CONCLUSION: It is important to recognize the characteristic shape of the urinary bladder calculi in the diagnosis of the jack stones and to treat the primary cause of calculi formation.

Estudio prospectivo no aleatorizado sobre el uso de profilaxis antibiótica en la uretrocistoscopia flexible / Prospective non-randomized study on the use of antibiotic prophylaxis with ciprofloxacin in flexible urethrocystoscopy

OBJETIVO: La uretrocistoscopia flexible es un procedimiento que se realiza de rutina en urología para el seguimiento de tumores vesicales y como diagnóstico en pacientes con síntomas del tracto urinario inferior y hematuria entre otra sintomatología. El objetivo de este estudio es analizar la necesidad o no de profilaxis antibiótica en este procedimiento ambulatorio. MÉTODOS: Estudio observacional prospectivo no aleatorizado en el que se incluyen 100 pacientes divididos en dos grupos: - Grupo 1: 48 pacientes con profilaxis de 500 mg de ciprofloxacino 1 h antes de la uretrocistoscopia; - Grupo 2: 52 pacientes sin profilaxis antibiótica. Previamente a la inclusión en el estudio se comprueba ausencia de infección urinaria mediante urocultivo obtenido 3 días antes del procedimiento. Se analiza indicación de cistoscopia, resultado de cistoscopia, presencia de comorbilidades, urocultivo a los 7 días, síntomas urinarios durante los 7 días siguientes. Análisis estadístico con SPSS 20.0 y significación estadística p≤0,05. RESULTADOS: La edad media de los pacientes del grupo 1 fue de 66,7±12,4 años versus 65,6±10,8 años del grupo 2 (p = 0,6). No hubo diferencias en el porcentaje de hombres/mujeres incluidos entre los grupos. El 14% de los pacientes del grupo 1 presentó bacteriuria frente al 12% del grupo 2, sin diferencias significativas. En el estudio multivariante, se observa que ni la edad, diabetes, tabaquismo, síntomas del tracto urinario inferior ni inmunosupresión se relacionan con la aparición de bacteriuria entre grupos. CONCLUSIÓN: El uso de ciprofloxacino como profilaxis en la cistoscopia flexible no lo consideramos indicado en nuestra área de salud, ya que no disminuye la presencia de infección urinaria o bacteriuria

OBJECTIVE: The goal of this study is to analyze whether there is a need for antibiotic prophylaxis in this outpatient procedure. METHODS: Prospective observational non-randomized study including 100 patients divided into two groups: - Group 1: 48 patients receiving 500 mg of ciprofloxacin prophylaxis 1 hour before urethrocystoscopy; - Group 2: 52 patients without antibiotic prophylaxis. Before inclusion of the patients in the study, we checked the absence of urinary tract infection by means of a urinalysis obtained 3 days before the procedure. We analyze: cystoscopy indication, cystoscopy results, presence of comorbidities, urinalysis 7 days after the procedure, and urinary symptoms within 7 days of the procedure. The statistical analysis was performed using SPSS 20.0 and the statistical significance was p≤0.05. RESULTS: The average age of patients in group 1 was 66.7±12.4 versus 65.6±10.8 years in group 2 (p = 0.6). There are no differences in the percentage of men/women included in the groups. 14% of patients of group 1 and 12% of group 2 presented bacteriuria, without showing any significant differences. In the multivariate study, it is observed that neither age, nor diabetes, smoking, lower urinary tract symptoms, nor immunosuppression are related with the onset of bacteriuria in the groups. CONCLUSION: We do not consider the use of ciprofloxacin as prophylaxis for flexible cystoscopy is appropriate in this area of health, since it does not reduce the presence of urinary infection or bacteriuria

Percepción del dolor en cistoscopia flexible con el uso de lidocaína intrauretral / Perception of pain in flexible cystoscopy using intraurethral lidocaine

OBJETIVO: La cistoscopia flexible es una técnica utilizada en el diagnóstico de la patología del tracto urinario inferior. El objetivo de este estudio es evaluar la eficacia del anestésico local intrauretral en la percepción del dolor en el paciente. MÉTODOS: Estudio observacional prospectivo no aleatorizado que incluye 142 hombres a los que se realiza cistoscopia flexible. Se dividen en dos grupos en función del uso o no de anestésico local intrauretral (Grupo 1: 70 hombres con anestésico intrauretral [lidocaína 2%]; Grupo 2: 72 hombres sin anestésico intrauretral). Se analiza escala visual analógica y cuestionario del dolor. Análisis estadístico con SPSS 17.0 y significación estadística p≤0,05. RESULTADOS: La edad media del grupo 1 fue de 64,7±10,3 años frente a 66,7±10,8 años en el grupo 2, sin diferencias significativas. La puntuación en la escala visual analógica en el grupo 1 fue 2,23±2,20 frente a 1,69±1,74 en el grupo 2 (p = 0,1). La intensidad del dolor total y actual en el cuestionario del dolor fue de 1,81 ± 0,87 y 1,66 ± 1,65, respectivamente, en el grupo 1 y de 1,72 ± 0,72 y 1,21±1,45, respectivamente, en el grupo 2 (no diferencias significativas). Tras dividir a los pacientes en función de una puntuación en la escala visual analógica ≤ 2, se observa que la causa que motivó la cistoscopia es un factor independiente asociado a la percepción del dolor, incrementando el riesgo de percibir más dolor en 1,89. CONCLUSIÓN: El uso de anestésico local como lubricante previo a cistoscopia flexible no parece disminuir el dolor y consideramos que no está indicado de rutina en esta técnica diagnóstica

OBJECTIVE: The aim of this study is to evaluate the efficacy of a local intraurethral anesthetic on the pain perceived by the patient during flexible cystoscopy. METHODS: An observational, prospective, nonrandomized, study was conducted on 142 males subjected to a flexible cystoscopy. The patients were divided into two groups: Group 1: 70 patients with intraurethral anesthetic (lidocaine 2%), and Group 2:72 patients without intraurethral anesthetic. The results were scored on a visual analog scale and a pain questionnaire and analyzed. The statistical analysis was performed using SPSS 17.0 and with a statistical significance of p ≤ 0.05. RESULTS: The mean age of Group 1 was 64.7 ± 10.3 years compared to 66.7 ± 10.8 years in Group 2, with no significant differences. The score on the visual analog scale in Group 1 was 2.23 ± 2.20 versus 1.69 ± 1.74 in Group 2 (p = 0.1). The overall and current pain intensity in the pain questionnaire was 1.81 ± 0.87 and 1.66 ± 1.65, respectively, in Group 1, and 1.72 ± 0.72 and 1.21 ± 1.45, respectively, in Group 2 (no significant differences). After dividing the patients into groups according to a visual analog scale score ≤ 2, it was observed that the cause that led to cystoscopy was an independent factor associated with the perception of pain, increasing the risk of perceiving more pain by 1.89. CONCLUSIÓN: The use of local anesthetic as a lubricant prior to flexible cystoscopy does not appear to reduce pain, and we consider that its routine use is not indicated