Can CT Virtual Cystoscopy Replace Conventional Cystoscopy in Early Detection of Bladder Cancer?

Aim. To correlate findings of conventional cystoscopy with CT virtual cystoscopy (CTVC) in detecting bladder tumors and to evaluate accuracy of virtual cystoscopy in early detection of bladder cancer. Material and Method. From June 2013 to June 2014, 50 patients (46 males, four females) with history and investigations suggestive of urothelial cancer, with mean age 62.76 ± 10.45 years, underwent CTVC by a radiologist as per protocol and subsequently underwent conventional cystoscopy (CPE) the same day or the next day. One urologist and one radiologist, blinded to the findings of conventional cystoscopy, independently interpreted the images, and any discrepant readings were resolved with consensus. Result. CTVC detected 23 out of 25 patients with bladder tumor(s) correctly. Two patients were falsely detected as negative while two were falsely labeled as positive in CTVC. Virtual and conventional cystoscopy were comparable in detection of tumor growth in urinary bladder. The sensitivity, specificity, positive predictive value, and negative predictive value of virtual cystoscopy were 92% each. Conclusion. CTVC correlates closely with the findings of conventional cystoscopy. Bladder should be adequately distended and devoid of urine at the time of procedure. However, more studies are required to define the role of virtual cystoscopy in routine clinical practice.

Current role of PCNL in pediatric urolithiasis.

The incidence of pediatric stone disease has been increasing. Though there are geographical variations, there remains a common theme in that this is a high-risk population with regard to stone formation and recurrence. Consequently, it is important to keep the number of procedures performed to a minimum and to save the developing kidney from the deleterious effects of intervention. Of the number of available treatment options, Percutaneous Nephrolithotomy (PCNL) offers a number of distinct advantages albeit with its own set of concerns. In the present article, the current literature on PCNL in pediatric urolithiasis was reviewed by a MEDLINE/PubMed search that was limited to literature in the English language, with emphasis on the current state of art in PCNL. Within the last few years, there have been improvements in radiological techniques, particularly computed tomography (CT), with dedicated reconstructions and development of scoring systems leading to better preoperative planning. Also, there has been miniaturization of instruments, particularly smaller nephroscopes, innovative sheaths and the potential to use lasers as well as smaller pneumatic and ultrasound probes. The combination of these has led to various modifications, such as miniperc, microperc and ultra-mini perc techniques. These modifications have been shown to be associated with a decrease in morbidity and high clearance rates. In this article, we analyze the current role of PCNL and its modifications, in terms of the indications, techniques, results, and complications in management of pediatric urolithiasis.