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European Urology Focus Jan 2024Haematuria can be macroscopic (visible haematuria [VH]) or microscopic (nonvisible haematuria [NVH]), and may be caused by a number of underlying aetiologies. Currently,... (Review)
Review
The Diagnostic Accuracy of Cystoscopy for Detecting Bladder Cancer in Adults Presenting with Haematuria: A Systematic Review from the European Association of Urology Guidelines Office.
CONTEXT
Haematuria can be macroscopic (visible haematuria [VH]) or microscopic (nonvisible haematuria [NVH]), and may be caused by a number of underlying aetiologies. Currently, in case of haematuria, cystoscopy is the standard diagnostic tool to screen the entire bladder for malignancy.
OBJECTIVE
The objective of this systematic review is to determine the diagnostic test accuracy of cystoscopy (compared with other tests, eg, computed tomography, urine biomarkers, and urine cytology) for detecting bladder cancer in adults.
EVIDENCE ACQUISITION
A systematic review of the literature was performed according to the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for diagnostic test accuracy studies' checklist. The MEDLINE, Embase, Cochrane CENTRAL, and Cochrane CDSR databases (via Ovid) were searched up to July 13, 2022. The population comprises patients presenting with either VH or NVH, without previous urological cancers. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).
EVIDENCE SYNTHESIS
Overall, nine studies were included in the qualitative analysis. Seven out of nine included trials covered the use of cystoscopy in comparison with radiological imaging. Overall, sensitivity of cystoscopy ranged from 87% to 100%, specificity from 64% to 100%, positive predictive value from 79% to 98%, and negative predictive values between 98% and 100%. Two trials compared enhanced or air cystoscopy versus conventional cystoscopy. Overall sensitivity of conventional white light cystoscopy ranged from 47% to 100% and specificity from 93.4% to 100%.
CONCLUSIONS
The true accuracy of cystoscopy for the detection of bladder cancer within the context of haematuria has not been studied extensively, resulting in inconsistent data regarding its performance for patients with haematuria. In comparison with imaging modalities, a few trials have prospectively assessed the diagnostic performance of cystoscopy, confirming very high accuracy for cystoscopy, exceeding the diagnostic value of any other imaging test.
PATIENT SUMMARY
Evidence of tests for detecting bladder cancer in adults presenting with haematuria (blood in urine) was reviewed. The most common test used was cystoscopy, which remains the current standard for diagnosing bladder cancer.
Topics: Adult; Humans; Hematuria; Cystoscopy; Urology; Urinary Bladder Neoplasms; Urinary Bladder
PubMed: 37633791
DOI: 10.1016/j.euf.2023.08.002 -
Journal of Pediatric Urology Oct 2023Urinary drainage is usually left in place after laparoscopic pyeloplasty to limit the risk of complications, such as urinary leakage. The procedure is sometimes...
INTRODUCTION
Urinary drainage is usually left in place after laparoscopic pyeloplasty to limit the risk of complications, such as urinary leakage. The procedure is sometimes laborious and complications may occur.
PURPOSE
Prospective evaluation of the Kirschner technique for urinary drainage during pediatric laparoscopic pyeloplasty.
STUDY DESIGN
This technique (Upasani et al., J Pediatr Urol 2018) involves introducing a nephrostomy tube (Blue Stent) with a Kirschner wire during laparoscopic transperitoneal pyeloplasty. We evaluated this technique by analyzing 14 consecutive pyeloplasties (53% on female patients, median age 10 years (6-16 years), on the right side in 40%) performed by a single operator between 2018 and 2021. The drain and urinary catheter were clamped and the perirenal drain removed on day 2. The stent was removed during consultation between days 7 and 15.
RESULTS
The median duration of surgery was 155 ± 7 min. Urinary drainage was installed within 5 min, without the need for radiological control and with no complications. All drains were correctly placed, with no drain migration or urinoma. Median hospital stay was 2 ± 1 days. One patient developed pyelonephritis (D8). The stent was removed without difficulty or complications. One patient presented an 8-mm lower calyx urinary stone at two months, revealed by macroscopic hematuria, necessitating extracorporeal shock wave lithotripsy.
DISCUSSION
The study design was based on a homogeneous series of patients, without comparison with another drainage technique or procedures performed by another operator. A comparison with other techniques might have been informative. Before this study, we tested various types of urinary drainage, to optimize performance. This technique was considered the simplest and least invasive.
CONCLUSION
External drain placement with this technique was rapid, safe, and reproducible in children. It also made it possible to test the tightness of the anastomosis and to avoid the need for anesthesia for drain removal.
Topics: Child; Female; Humans; Bone Wires; Drainage; Kidney Pelvis; Laparoscopy; Retrospective Studies; Stents; Ureteral Obstruction; Urologic Surgical Procedures; Adolescent
PubMed: 37419833
DOI: 10.1016/j.jpurol.2023.06.008 -
Medicine May 2024Hematuria is the most common symptom of bladder cancer (BCa). It is well-known that the frequency of hematuria increases with the use of antithrombotic drugs (ATDs). We... (Observational Study)
Observational Study
Hematuria is the most common symptom of bladder cancer (BCa). It is well-known that the frequency of hematuria increases with the use of antithrombotic drugs (ATDs). We designed our study with the hypothesis that patients using antithrombotic drugs who present with the complaint of hematuria and are subsequently diagnosed with BCa may receive an earlier diagnosis, leading to lower tumor grades and stages. Data of 441 consecutive patients who presented to our urology outpatient clinic with macroscopic hematuria between 2020 and 2023 were retrospectively evaluated. A total of 88 patients (21.4%) with a primary diagnosis of BCa were included in our study. Patients were divided into 2 groups: those using ATDs during the episode of macroscopic hematuria (group 1) and those not using ATDs (group 2). Univariate and multivariate binary logistic regression analysis was performed to identify risk factors that could predict tumor grade. The incidence of multiple tumors (>1) was significantly lower in patients using ATDs (P = .033). The number of patients with tumor size larger than 3 cm was significantly higher in the group not using ATDs (P = .005). The rates of pathological T1 stage in the group using ATDs were significantly lower than those in the nonuser group (P = .038). According to the results of the multivariate model, the effect of pathology stage and ATD use on predicting tumor grade was significant (P = .002 and P < .001, respectively). The probability of having a high-grade tumor in patients with pathology stage T1 was 5.32 times higher than in patients with pathology stage TA. The probability of having a high-grade tumor in patients not using ATDs was 7.73 times higher than in those using ATDs. The effect of pathology stage and ATD use on predicting tumor grade was found to be significant. The probability of having a high-grade tumor was higher in patients not using ATDs compared to those using ATDs. In light of these results, we can state that the use of ATDs is a positive predictive factor in the early diagnosis of BCa, bringing along the chance of early diagnosis and treatment.
Topics: Humans; Urinary Bladder Neoplasms; Male; Female; Retrospective Studies; Aged; Middle Aged; Early Detection of Cancer; Hematuria; Fibrinolytic Agents; Risk Factors; Neoplasm Staging; Neoplasm Grading
PubMed: 38758868
DOI: 10.1097/MD.0000000000038228 -
International Urogynecology Journal Oct 2023We aimed to examine the risk of bleeding in female patients undergoing intravesical onabotulinumtoxinA (BTX-A) treatments and provide clinical recommendations for the...
INTRODUCTION AND HYPOTHESIS
We aimed to examine the risk of bleeding in female patients undergoing intravesical onabotulinumtoxinA (BTX-A) treatments and provide clinical recommendations for the perioperative management of patients on antithrombotic therapy prior to BTX-A treatments.
METHODS
This was a retrospective cohort of Danish female patients, who had their first BTX-A treatment because of an overactive bladder at the Department of Gynecology and Obstetrics, Herlev and Gentofte University Hospital, between January 2015 and December 2020. Data extraction was from an electronic medical journal system. BTX-A, Botox® Allergan was injected in the detrusor at 10-20 sites. Significant bleeding during or after a BTX-A treatment was defined as persistent macroscopic hematuria. Bleeding reporting was based on information obtained from journal notes.
RESULTS
We included 400 female patients, who had a total of 1,059 BTX-A treatments. Median age at first BTX-A treatment was 70 years (IQR 21), and median number of BTX-A treatments was 2 (range 1-11). In total, 27.8% (n=111) received antithrombotic therapy. Within this group, 30.6% and 69.4% were on anticoagulant and antiplatelet therapy. No cases of hematuria were reported in our cohort. We found that no patients stopped their antithrombotic therapy, were bridged, or monitored by International Normalized Ration (INR) levels.
CONCLUSIONS
We suggest that BTX-A treatments might be classified as low-risk procedures. Discontinuation of antithrombotic therapy is not required in the perioperative management of this patient group.
PubMed: 37329356
DOI: 10.1007/s00192-023-05579-1 -
World Journal of Clinical Cases Feb 2024A man experienced multiple episodes of macroscopic hematuria following nocturnal exercise. Urinary stones and tumors were considered the two most likely causes. The...
BACKGROUND
A man experienced multiple episodes of macroscopic hematuria following nocturnal exercise. Urinary stones and tumors were considered the two most likely causes. The patient had two hobbies: Consuming health care products in large quantities and engaging in late-night running.
CASE SUMMARY
Health care products contain a large amount of calcium phosphate, and we hypothesize that this could induce the formation of small phosphate stones. After exercise, the urinary system is abraded, resulting in bleeding. The patient was advised to stop using the health care products. Consequently, the aforementioned symptoms disappeared immediately. However, the patient resumed the above two habits one year later; correspondingly, the macroscopic hematuria reappeared.
CONCLUSION
This finding further confirmed the above inference and allowed for a new avenue to determine the cause of the patient's hematuria.
PubMed: 38414602
DOI: 10.12998/wjcc.v12.i5.1025 -
BJUI Compass Mar 2024To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography...
OBJECTIVES
To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography urography (CTU) and cystoscopy negative for urinary bladder cancer (UBC) and upper tract urothelial cancer (UTUC) and to identify potential factors associated with occurrence of recurrent macroscopic haematuria.
METHODS
All patients older than 50 years who underwent urological investigation for macroscopic haematuria with both cystoscopy and CTU 2015-2017 were retrospectively reviewed. A descriptive analysis of the primary and later investigations for recurrent macroscopic haematuria was performed. To investigate the association between explanatory variables and the occurrence of recurrent macroscopic haematuria, a Poisson regression analysis was performed.
RESULTS
A total of 1395 eligible individuals with primary standard investigation negative for UBC and UTUC were included. During a median follow-up of 6.2 (IQR 5.3-7) years, 248 (18%) patients had recurrent macroscopic haematuria, of whom six patients were diagnosed with UBC, two with prostate cancer, one with renal cell carcinoma and one had a suspected UTUC at the repeated investigation. Within 3 years, 148 patients (11%) experienced recurrent macroscopic haematuria, of whom two patients were diagnosed with low-grade UBC (TaG1-2), one with T2G3 UBC and one with low-risk prostate cancer. The presence of an indwelling catheter, use of antithrombotic medication, pathological findings at CTU or cystoscopy or history of pelvic radiotherapy were all statistically significant independent predictors for increased risk for recurrent macroscopic haematuria.
CONCLUSION
In the case of recurrent macroscopic haematuria within 3 years of primary standard evaluation for urinary tract cancer, there was a low risk of later urological malignancies in patients initially negative for UBC and UTUC. Therefore, waiting 3 years before conducting another complete investigation in cases of recurrent macroscopic haematuria might be appropriate.
PubMed: 38371208
DOI: 10.1002/bco2.300 -
Mediterranean Journal of Rheumatology Mar 2024Eosinophilic granulomatosis with polyangiitis (eGPA) is a necrotising vasculitis of small and medium calibre vessels, which affects mostly patients in their fourth to...
INTRODUCTION
Eosinophilic granulomatosis with polyangiitis (eGPA) is a necrotising vasculitis of small and medium calibre vessels, which affects mostly patients in their fourth to sixth decade of life, and it is a very uncommon aetiology for pulmonary fibrosis.
CLINICAL CASE
A Hispanic 72-year-old female patient presents with a history of lower extremities pain, paraesthesia, oedema, and occasional macroscopic haematuria. During her hospitalisation, the patient presents, and images showed findings compatible with pulmonary fibrosis and alveolar haemorrhage, which require a biopsy, establishing the diagnosis of an eGPA.
DISCUSSION
eGPA is a low-incidence autoimmune vasculitis, with a high number of phenotypes which explain the broad clinical spectrum, but recent advances has helped to understand the physiopathology and its link with other conditions like pulmonary fibrosis.
CONCLUSION
Early diagnosis and management of this condition is mandatory because it is the only factor that change the outcome of the patients.
PubMed: 38736966
DOI: 10.31138/mjr.161023.lpe -
Journal of Medical Case Reports Jul 2023Primary carcinosarcoma of the bladder is a rare and highly aggressive tumor, representing less than 1% of all bladder neoplasms. There is no specific treatment guideline...
BACKGROUND
Primary carcinosarcoma of the bladder is a rare and highly aggressive tumor, representing less than 1% of all bladder neoplasms. There is no specific treatment guideline has for carcinosarcoma of the bladder, and majority of published patients was treated exclusively by surgery.
CASE PRESENTATION
We report a case of 65-year-old Moroccan man, presented with macroscopic hematuria, pollakiuria and painful urination. Histological analysis showed a biphasic epithelial and mesenchymal proliferation, with invasion of lamina propria and muscularis, compatible with diagnosis of bladder carcinosarcoma. The patient was treated with cystectomy and adjuvant chemotherapy based on gemcitabin-cisplatin, 18 months after treatment, patient still free of recurrence.
CONCLUSION
Carcinosarcoma of the urinary bladder is a rare and aggressive tumor regardless treatment. A multidisciplinary management based on radical cystectomy and combined adjuvant treatments can improve prognosis. In this work, we suggest to propose adjuvant chemotherapy whenever possible.
Topics: Male; Humans; Aged; Cystectomy; Urinary Bladder; Urinary Bladder Neoplasms; Carcinoma, Transitional Cell; Pelvic Neoplasms; Chemotherapy, Adjuvant; Carcinosarcoma; Soft Tissue Neoplasms
PubMed: 37464254
DOI: 10.1186/s13256-023-04028-3 -
Pediatrics and Neonatology Apr 2024Post streptococcal acute glomerulonephritis (PSAGN) patients have favorable prognosis, in which most patients showed full recovery in terms of kidney function. However,...
BACKGROUND
Post streptococcal acute glomerulonephritis (PSAGN) patients have favorable prognosis, in which most patients showed full recovery in terms of kidney function. However, there is a slight chance ranging from 3 to 6% that PSAGN patients develop chronic kidney diseasewhich may progress into end-stage kidney disease in later life. It is important to identify the factors that can predict the development of chronic glomerulonephritis following PSAGN. Therefore, early intervention can be performed to halt the progression of chronic kidney disease. This study aimed to determine the predictive factors of chronic glomerulonephritis in pediatric patients with PSAGN.
METHODS
This study was an analytical observational study with retrospective cohort design. The accessible population was children within the age of 2-18 years old who were admitted with PSAGN between January 2015 and December 2020 in Dr. Sardjito General Hospital Yogyakarta. All anonymized patient data were evaluated for demographic variables, clinical features, laboratory profiles and outcome. Multivariate analysis was performed with multivariate logistic regression method.
RESULTS
A total of 124 patients with PSAGN were obtained from medical record data. There were 65 patients (52.4%) with chronic glomerulonephritis. Bivariate analysis was performed on assumed predictive factors with the results indicating massive proteinuria with hypoalbuminemia (OR 1.670, 95%CI 1.199-2.326; p = 0.003), oliguria (OR 1.517, 95%CI 1.101-2.089; p = 0.028) and macroscopic hematuria (OR 1.647, 95%CI:1.061-2.555; p = 0.013) were significantly higher in the PSAGN group with chronic glomerulonephritis compared to those without. Results of the multivariate logistic regression analysis showed massive proteinuria with hypoalbuminemia (OR 2.896, 95%CI 1.177-7.123, p = 0.021) and macroscopic hematuria (OR 2.457, 95%CI ,1.018-5.933, p = 0.046) would highly predict chronic glomerulonephritis in subjects with PSAGN.
CONCLUSION
We concluded that massive proteinuria with hypoalbuminemia and macroscopic hematuria are the predictive factors which highly predict chronic glomerulonephritis in PSAGN.
PubMed: 38649317
DOI: 10.1016/j.pedneo.2023.11.005 -
World Journal of Urology May 2024To perform a comprehensive narrative review that will examine the risk factors and treatment outcomes of arterial pseudoaneurysm following laser flexible ureteroscopy... (Review)
Review
OBJECTIVE
To perform a comprehensive narrative review that will examine the risk factors and treatment outcomes of arterial pseudoaneurysm following laser flexible ureteroscopy (F-URS).
METHODS
A retrospective case series and a review of literature was performed. Clinical records from three patients treated for postoperative arterial pseudoaneurysm from January of 2021 to November 2023 were identified. A comprehensive literature review was also performed. The MEDLINE and Scopus databases were searched. The analysis was made by a narrative synthesis.
RESULTS
Three cases of postoperative arterial pseudoaneurysm were included, one from our center, one from Dubai, UAE, and one from Barcelona. The literature review identified six case reports, two after endocorporeal laser lithotripsy with thulium fiber laser (TFL) and four with Ho:YAG laser. All cases, from our series and literature review, presented with macroscopic hematuria and used high-power laser settings. All cases were treated by selective embolization.
CONCLUSION
Ho:YAG or TFL lasers are both capable of causing arterial pseudoaneurysms following F-URS if high-power settings are used. Selective artery embolization continues to be the treatment of choice with good outcomes.
Topics: Aged; Female; Humans; Male; Middle Aged; Aneurysm, False; Lithotripsy, Laser; Postoperative Complications; Retrospective Studies; Ureteroscopy; Adult
PubMed: 38693433
DOI: 10.1007/s00345-024-04980-9