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INTRODUCTION: During office cystoscopy and hospital consultations urologists may only have direct visualization cystoscopy available. Field of view and usability are often characterized as suboptimal compared to video tower based camera models. The endogo® HD, a portable, battery powered cystoscopic camera that attaches to a standard cystoscope, was created to more closely mimic the usability of the normal cystoscopic camera that connects to the video tower. We objectively evaluated the usefulness of this new device. METHODS: A total of 30 urology fellows, residents and students were consented and randomized to perform standard video tower cystoscopy, direct cystoscopy without a camera and cystoscopy with the endogo HD on a previously used Uro-Scopic Trainer bladder model (Limbs & Things USA, Savannah, Georgia). Participants were timed and evaluated using the previously validated OSATS (Objective Structured Assessment of Technical Skills). Each participant then rated the usability of and preferences for each of the 3 systems. All participants completed the 3 types of cystoscopy. RESULTS: Users found the field of view to be significantly better for the endogo HD than for direct cystoscopy (p = 0.03) and similar for the endogo HD and the tower (p = 0.7). Time needed to perform cystoscopy was significantly longer for endogo HD than for tower and direct cystoscopy (71.9 vs 43.3 and 46.8 seconds, respectively, p = 0.01). When comparing novices to experts (greater than 200 cases), experts completed all procedures more quickly regardless of camera type. Tower cystoscopy was significantly less difficult and more comfortable, and it was preferred by most participants. CONCLUSIONS: On objective and subjective measures the endogo HD portable cystoscopic camera received marks similar to those of other types of cystoscopy that are currently widely available. It required an average of a half minute longer to set up and overall participants preferred standard video tower cystoscopy. The endogo HD may be useful in the emergency department or office setting where no video tower is available. Further study of its usefulness as a teaching tool and the learning curve associated with its use will be performed in the future.
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OBJECTIVE: To evaluate the degree of urothelial exposure using 3 upper tract delivery techniques in an ex vivo porcine model, to determine the optimal modality to locally deliver topical anticarcinogenic agents in patients with upper tract urothelial carcinoma. MATERIALS AND METHODS: An indigo carmine solution was infused into en bloc porcine urinary tracts to test the 3 techniques: antegrade infusion via nephrostomy tube, reflux via indwelling double-pigtail stent, and retrograde administration via a 5F open-ended ureteral catheter. Nine renal units (3 per delivery method) were used. After a 1-hour dwell time, the urinary tracts were bivalved and photographed. Each renal unit was evaluated by 3 blinded reviewers who estimated the total percentage of stained urothelial surface area using a computer-based area approximation system. In addition, as a surrogate for exposure adequacy, a validated equation was used to calculate the staining intensity at 6 predetermined locations in the upper tract, with lower values representing more efficient staining. RESULTS: Mean percent of surface area stained for the nephrostomy tube, double-pigtail stent, and open-ended ureteral catheter groups was 65.2%, 66.2%, and 83.6%, respectively (P = .002). Mean staining intensities were 40.9, 33.4, and 20.4, respectively (P = .023). CONCLUSION: Our results suggest that retrograde infusion via open-ended ureteral catheter is the most efficient method of upper tract therapy delivery. Larger studies using in vivo models should be performed to further validate these findings and potentially confirm this method as optimal for delivery of topical anticarcinogenic agents in upper tract urothelial carcinoma.