Reliability of the patient's history in the diagnosis of urinary incontinence

The reliability of a patient's history has been challenged in the preoperative evaluation of stress urinary incontinence. In this study, 122 consecutive patients referred to our Gynecology/Urology clinic were evaluated and an additional 32 control patients (continent women with no urinary symptoms) were evaluated. All patients answered a detailed 64-item questionnaire, and all patients received a complete urodynamic evaluation. Our detailed questionnaire provided a mean positive predictive value of 80% for genuine stress incontinence and 25% for detrusor instability. The conditions leading to a false positive history suggestive of genuine stress incontinence were detrusor instability and urethral diverticulum. The conditions leading to a false positive history suggestive of detrusor instability were urethritis, unstable urethra, vaginitis and polyuria. History alone can be misleading in diagnosing urinary incontinence.

Strategies for asymptomatic microscopic hematuria: a prospective study of 1,034 patients

To establish strategies for treatment of asymptomatic microscopic hematuria we conducted a prospective study of 1,034 patients with this disease. The patients were examined by cystoscopy, urine cytology, abdominal ultrasound and excretory urography. On initial examination 30 highly significant lesions, including 24 cases of urological malignancies, 195 moderately significant lesions and 246 insignificant lesions were detected. In the remaining 563 patients no underlying lesion could be found. Of the 246 patients with insignificant lesions and 563 with unexplained asymptomatic microscopic hematuria followup was done in 421 at 6-month intervals for more than 1 year. A diagnosis became clear within 3 years in 22 patients, including 3 cases of bladder carcinoma and 1 of prostatic carcinoma.

Endourologic procedures for ureteropelvic junction stenosis: techniques and results

Twenty-two cases of stenosis of the ureteropelvic junction were treated by endourologic procedures; 13 were associated with renal stones. Three techniques were used, depending on the type and degree of obstruction: (1) anterograde or retrograde dilation with a double-lumen balloon dilator catheter; (2) incision of the stricture with a cold knife after a percutaneous approach to the kidney; and (3) incision of the stenosis with a new flexible knife through a nephrostomy tract. Balloon dilation was always performed after the incision. No immediate complications were observed following the procedure. The average follow-up was eight months. A routine excretory urogram was done three months after treatment. There were four reobstructions, and in 1 patient the ureteropelvic junction could not be identified. Success rate was 77.3 percent.

Infected urachal cysts

Infected urachal cysts present with protean clinical manifestations. Diagnosis is frequently difficult in spite of the use of modern genitourinary radiologic imaging techniques. Patients with intra-abdominal or pelvic symptoms are frequently misdiagnosed. Surgical excision is the treatment of choice for infected urachal cysts.

Management of intrameatal warts in men

The case notes of 1080 men with genital warts were analysed retrospectively over a 30-month period. One hundred and forty patients were identified with intrameatal warts and an audit of their treatment is discussed. When electrocautery and cryotherapy were compared the former produced a more rapid resolution of the lesions. Cystourethroscopy was performed on 16 patients with intrameatal warts. No patient had involvement beyond the distal 3 cm of the urethra. Data on concurrent sexually transmitted diseases, population characteristics and pattern of referral are presented and compared to previously reported studies.

The role of midazolam and flumazenil in urology

The effects of midazolam (3-10 mg i.m.) and their reversal by flumazenil were studied in transurethral endoscopic procedures performed using topical analgesia. In one randomised study, patients (n = 84) received either no medication or flumazenil (0.5 mg i.v.) on completion of endoscopy. Recovery was assessed subjectively. Within 15 min, 83% of those receiving flumazenil were considered ready for discharge compared with only 24% of the control group (P less than 0.001). In a second randomised, double-blind, placebo-controlled trial of 44 patients, post-operative recovery was assessed using five objective psychomotor tests. Whereas the placebo group took up to 2 h to recover, those receiving flumazenil recovered fully or returned to near control values within 15 min. Sedoanalgesia--a technique combining adequate local anaesthesia with sedation (using midazolam)--has wide application in urology, and the introduction of flumazenil has major implications for the practice of day-case surgery.

Endoscopic correction of vesicoureteric reflux in children with spina bifida

Twenty patients with vesicoureteric reflux (VUR) secondary to a neuropathic bladder and associated spina bifida were treated with the endoscopic injection of subureteric polytetrafluoroethylene (Teflon) paste. Of the 19 patients (29 ureters) followed up, 13 have persistent reflux, although only 3 of these ureters have needed a second injection. Twelve of the 16, where reflux resolved, required only 1 injection.

Cystometry, urethrocystometry, and videocystourethrography

A number of techniques are available to detect detrusor overactivity. The test best suited to an individual investigator is a function of expertise, frequency of use, cost, availability, and ability to interpret the testing method. Even the simplest methods may be used effectively when the examiner understands the test and its limitations. Many investigators will find it useful to use more than one of these techniques. It is in the patient's best interest for her physician to maintain a reasonable index of suspicion and continue testing rather than submit her to inappropriate therapy based on an inadequate evaluation.

[Leiomyoma of urinary bladder: report of a case]

A case of leiomyoma of the urinary bladder in a 46-year-old woman is reported. The patient was referred to us because of incidental finding of a mass in the bladder. Cystoscopy revealed a protruding tumor covered with normal-appearing urothelium on the right posterior wall of the bladder. The tumor was well-demarcated from adjacent organs on echography and computed tomographic scan. Transurethral biopsy revealed a bladder leiomyoma. Partial cystectomy was performed. The patient is now apparently free of disease 7 months after the operation.

Transurethral resection of the prostate in the outpatient setting

Transurethral resection of the bladder neck (8 patients) or prostate (142) was performed in the outpatient setting. Of the patients 5 required hospitalization for post-prostatectomy hemorrhage. This method has proved to be safe and cost-effective in the treatment of patients with outlet obstruction.

[A case of primary localized amyloidosis of the urinary bladder]

A case of primary localized amyloidosis is reported. The patient was a 73-year-old female who suffered from miction pain and consulted our department. There was a 1.5 x 1.5 cm slightly red, nonpapillary tumor around the right ureteral orifice in cystoscopy. The diagnosis was amyloidosis with cystitis hemorrhagica histopathologically. After the treatment with antibiotics for about one month there were no symptoms and no tumors in the urinary bladder cystoscopically. The clinical course was relatively good. The treatment varies from transurethral resection to total cystectomy with urinary diversion. This case was cured by non-operative treatment, but close follow-up of the patient is necessary because of the frequency of multiple recurrence.

Immunohistochemical study of the ras oncogene expression in human bladder endoscopy specimens

We have used the monoclonal antibody Y13 259 to the ras oncogene p21 protein product in 42 endoscopy specimens from the bladder of 37 patients, in order to determine the ras oncogene expression in different conditions of the urothelium. The examined material included: 27 normal and hyperplastic or dysplastic mucosae and 13 papillomas and transitional cell carcinomas, graded according to Mostofi's classification. Our results showed the following: the normal urothelium sections tended to be negative, while the umbrella cells from the superficial layer always expressed a higher degree of positivity. The majority of the hyperplastic lesions and the papillomas were weakly positive or negative. In contrast, all the dysplastic lesions and the carcinomas of different grades were strongly positive. Our results suggest that elevated expression of ras oncogene may serve as an early marker in the pathogenesis of bladder lesions.

[An intravesical foreign body--the cause of chronic pyelonephritis in a child]

The paper reports on a case of chronic pyelonephritis with bacillus Proteus, generated by an intravesical foreign body (sewing needle). The needle was extracted with surgical cystoscope. After removing the foreign body, nalidixic acid was administered. The immediate evolution of the case was good.

An outlet obstruction caused by V-shaped bar at the bladder neck in a woman

A case of outlet obstruction caused by a V-shaped bar at the bladder neck in a woman was treated successfully by transurethral resection of the bar. The poor urinary flow in our patient was believed to be due to impedance during voiding caused by retraction of the bladder neck in the anteroposterior direction by the bar. Our case is different from previously reported cases.

[Incidence of vesico-ureteral reflux after endoscopic surgery of superficial tumors of the bladder. A prospective study]

The present retrospective study was undertaken to determine the true incidence of vesicoureteric reflux after transurethral resection (TUR) of superficial bladder tumors. The possible role of tumor size, number, site, etc., relative to the appearance of reflux were analyzed, and the principal pathogenic factors involved in iatrogenic vesicoureteric reflux were determined. The incidence of reflux was studied using pre and postoperative ureterocystograms. The study revealed the presence of vesicoureteric reflux long after TUR in 20.6% of the patients.

[Valves of the anterior urethra]

Despite the cases reported in the literature, anterior urethral valves continue to be an uncommon condition. The foregoing has to be considered when evaluating children with urinary obstruction or recurrent infections. A case of anterior urethral valves associated with segmental saccular dilatation of the urethra is described and the diagnostic methods are highlighted.

[Clinical importance of microhematuria as an initial sign of bladder tumor]

To investigate the role of microhematuria for the diagnosis of bladder tumor, the retrospective study of 156 patients with bladder tumor was done. Among the 156 cases, asymptomatic microhematuria was observed in 15 cases (9.6%) as an initial sign of the disease. According to the process to the final diagnosis, these 15 cases were classified into 4 groups; the Group 1 comprised 4 patients who consulted the urologist just after health examination; the Group 2 comprised 6 patients who consulted the urologist by the introduction of the general practitioner; the Group 3 comprised 2 patients who disregarded the sign and consulted the urologist after the appearance of symptoms; the Group 4 comprised 3 patients whose general practitioner overlooked the sign and who consulted the urologist after the appearance of the symptoms. The mean duration between the initial sign and the final diagnosis of each group was 2, 2, 8 and 62 months, respectively. Three of the 5 patients (60%) in groups 3 and 4 were treated by total cystectomy, while only 2 of the 10 patients (20%) in groups 1 and 2 totally cystectomized. High grade tumor was observed more frequently in groups 3 and 4 than in groups 1 and 2. Since the negative rate of urinary cytologic examinations of these 15 cases was 33.3%, cystoscopic examination was necessary for screening of bladder tumor.

[A case of cystitis glandularis suspected of malignant tumor of urinary bladder]

A case of cystitis glandularis is reported. A 70-year-old male was admitted to our hospital with the complaint of urinary frequency and gross hematuria. A bladder tumor was suspected by ultrasonography. Cystoscopy revealed multiple cystic lesions arising from the bladder neck and trigone. Transurethral biopsy of the bladder wall lesion revealed cystitis glandularis. Transurethral resection was performed. His postoperative course was uneventful.

[The treatment of superficial bladder carcinoma with intravesical HPC-adriamycin and verapamil]

A new form of hydroxypropylcellulose-adriamycin (HPC-ADM), which was supplemented with verapamil, a known calcium antagonist, in order to potentiate the antineoplastic effect of HPC-ADM, was synthesized and used for the treatment of superficial bladder carcinoma for clinical evaluation. The results are reported in this paper. A total of 23 patients who were treated for bladder carcinoma during a 2-year period (1987-1988) were subjected in this study. All patients were diagnosed cases of superficial bladder carcinoma as follows; Ta, 3 cases, T1, 18 cases and Tis, 2 cases. For the injection protocol, firstly HPC-ADM solution supplemented with verapamil was introduced into the urinary bladder via the urethra. After 2-3 weeks, the efficacy of the drug against the tumor was evaluated by cystoscope. Patients in whom the drug were found to be effective received increased administration of drug. In cases in whom the drug was found to be ineffective, different drugs for further treatment were adopted. The average frequency and amount of drug was 2.3 times and 45.2 mg, respectively. Complete responses achieved in 9 of 23 cases (39.1%). Of the 23 cases, 4 cases was with PR and 10 with NC. No cases were found to be with PD. Side effects were observed in 4 of the 23 cases (17.4%), however, severe side effects were not recognized. The important aspect in applying the method of intravesical therapy is that it makes enhanced antineoplastic potency possible with concomitant reduction of side effects and prevents the invasion of tumor.

[Modification of Stamey's endoscopic cervicopexy for stress urinary incontinence]

The modifications made by the authors to Stamey's endoscopic suspension of the vesical neck are described. These are analyzed, explained, and their advantages are highlighted. The modified technique has been utilized in 51 female patients with stress urinary incontinence with a success rate of 92.1% and furthermore, without detriment to the benefits afforded by the Stamey procedure.

[Errors and dangers of various valve resection technics]

Complications are frequently seen in patients with urethral valves, especially in the youngest age bracket. Some of the complications are due to valve obstruction and others due to the primary therapy. Valve resection can be transvesical, with or without symphysic incision, in direct view, via perineostomy or transurethral. These different methods represent a historical development. The mandatory prerequisite consists of the availability of update cystoscopic equipment for babies and infants. The main problems involved in "open" surgery concern incontinence. Transurethral approach can result in strictures; incontinence due to sphincter lesion can also occur. In recent years antegrade resection is being performed via percutaneous transvesical approach. It may be expected that this reduces the complications, but there is still insufficient experience to permit final assessment.