Is Diagnostic Cystoscopy Painful? Analysis of 1,320 Consecutive Procedures

Objective To prospectively evaluate self-reported pain levels associated with diagnostic cystoscopy. Materials and Methods Patients who underwent diagnostic cystoscopy and subsequently graded their pain level during the procedure were enrolled. Pain was graded on a Likert visual analog scale (VAS) of 1-10 where 0 = no pain and 10 = excruciating unbearable pain. Local lidocaine gel 2% was used as intraurethral lubricant. Results Data from 1320 consecutive cystoscopies (929 males, 391 females, age range 15-93 years) between 6/2009-1/2010 were analyzed. This was the first cystoscopy for 814 patients. The overall mean VAS was 2.74 ± 1.51 (range 0-9) for rigid cystoscopy and 2.48 ± 1.53 (range 0-10) for flexible cystoscopy (P = 0.004). The reported mean pain level for first-time cystoscopy was significantly higher than that for repeat cystoscopy (2.8 ± 1.6 vs. 2.2 ± 1.4, P < 0.001), regardless of gender or type of cystoscope. Men reported significantly higher pain levels than women 2.6 ± 1.5 vs. 2.4 ± 1.4 (P < 0.04). The highest mean pain level was reported by men (3.4 ± 1.6) and women (2.5 ± 1.6) for rigid cystoscopy compared to flexible cystoscopy (2.5 ± 1.4 and 1.1 ± 1.9, respectively, P < 0.001). Pain levels > 5 were reported in 75 (5.7%) cystoscopies. Conclusions Cystoscopy was not associated with distressing levels of pain. Pain levels during first cystoscopies were higher than those for repeated ones. Using a flexible cystoscope is associated with a lower pain level in both men and women and it should be used for both genders. .

Ureteroscopic versus cystoscopic introduction of ureteric guide wire

To evaluate the feasibility of the ureteroscope versus the use of cystoscope to introduce the ureteric guide wire. This study was conducted on 50 patients [100 units]. They were divided into two groups, group A [50 units] with normal ureters in one side as seen in IVU and group B [50 units] with pathology either stricture or stone ureter in the other side. After initial cystoscopic evaluation and identification of both ureteric orifices, the cystoscope and/or ureteroscope were used to introduce the guide wire in group A ureteroscopy was successful in 100% of the cases [25 units] as initial tool, while with the use of the cystoscope it is only 76% [18 out of 25] which increased to 96% after the use of ureteroscope to introduce the guide wire. In group B with the use of ureteroscope in 25 pathological ureters, it is successful in 92% of the cases [23/ 25] while with the use of cystoscope it is only 60% [15/ 25]. With the aid of the ureterpscope in the remaining failed cases the success rate was increased to 80% [20/25] and complete failure in 5 cases due to massive trauma to the ureter from multiple trials of blind introduction of the guide wire through the cystoscope. Introduction of the ureteric guide wire is essential step in ureteroscopy as with its failure all the procedure will fail. So, simple and easy introduction of the guide wire through the cystoscope was tried first, if failed, multiple trials is not recommended and it is better to use the ureteroscope to introduce it under vision better than blind trials avoiding trauma to the ureter

Alternating mitomycin C and Bacillus calmette-guerin instillations versus MMC or BCG monotherapy in treatment of superficial bladder cancer

To evaluate whether, in patients with superficial bladder cancer, alternating instillation therapy with mitomycin C [MMC] and bacillus Calmette-Guerin [BCG] was effective and less toxic than conventional BCG or MMC monotherapy. This study was conducted on 90 patients, their age ranged from 38-72 years [73 male and 17 female]. They were clinically evaluated and investigated by routine laboratory investigation, plain x-ray, IVU and US. Cystoscopic biopsy was done, and after confirmation of the pathology as superficial bladder cancer [Cis, Ta or T1] they were classified into three groups A,B and C each of them 30 patients in a random fashion. Transurethral resection was done for the pathological lesion. All the patients received the treatment in the first postoperative day, after the urine becomes clear. Group A received a full dose of BCG [120 mg] weekly for 6 weeks, group B received a full dose of MMC [40mg] weekly for 6 weeks and group C received weekly alternatively a reduced dose from BCG [75mg] and MMC [30 mg] for 12 weeks. All the patients were followed by cystoscopic biopsy every 3 months during a period of 18 months for recurrence or progression of the tumor and local toxicity of the drug. Comparing the results in group [C] with the other two groups [A and B] we found lower recurrence rate [6.7% versus 23.3% and 16.7% respectively] and progression rate [3.3% versus 16.7% and 13.3% respectively]. Also the regimen is well tolerated with less toxicity as compared with the two other groups [6.7% versus 23.3% and 13.3% in group C versus A and B respectively]. Alternating bacillus Calmette Guerin and mitomycin C instillations for treatment of superficial bladder cancer in low doses after transurethral resection in the early postoperative day is an effective regimen for prophylaxis against tumor recurrence and progression like monotherapy and even more effective with less toxicity and well tolerated by the patients. These results must be evaluated on a more large scale

Uretrotomia interna en el tratamiento de la estenosis de uretra bulbar (EUB) / Internal urethrotomy as a treatment of the bulbar urethral stricture

Objetivo: Determinar el porcentaje de reestenosis posterior al tratamiento de la EUB con uretrotomía interna. Material y Métodos: Fueron tratados un total de 31 pacientes portadores de EUB cuya longitud fuera igual o menor de 0,5 cm, en los cuales el seguimiento promedio fue de 25,3 meses. Se excluyeron aquellos con áreas de espongiofibrosis, tratamiento previo por su estenosis o en tratamiento por carcinoma transicional de vejiga. En al 90 por ciento de los casos el procedimiento se realizó en forma ambulatoria bajo anestesia local. Resultados: El 58 por ciento de los pacientes presentaromn estenosis postoperatorias en un tiempo promedio de 5,4 meses. La distribución del tiempo de estenosis mostró una curva bimodal en el primer y cuarto trimestre, detectándose el 83 por ciento de las recurrencias dentro del primer año. El 100 por ciento de los pacientes que fueron tratados nuevamnete con uretrotomía interna (n:10) sufrieron reestenosis en el primer trimestre del postoperatorio. Conclusión: Aun en popblaciones altamente seleccionadas como la presente, el porcentaje de reestenosis es cvonsiderable, debiendo extenderse el seguimiento de los pacientes a largo plazo. El empleo reiterado de la uretrotomía interna en el tratamiento de la EUB res uina opción desaconsejable como tratamiento definitivo en poblaciones similares a las estudiadas. El empleo de anestesia local y manejo ambulatorio de estos pacientes debe ser considerado