Authors: Jiangcun Silang, Yalong Gu, Ciren Gazang...

Ureteral stent must be removed within a certain period, usually performed under the cystoscope. However, cystoscopic operations procedures carry risks such as urethral injury, hemorrhage, and infection. This study aimed to implement a cystoscope-free method for ureteral stent removal during the COVID-19 pandemic to mitigate the complications associated with cystoscopy, reduce the risk of cross-infection, and conserve medical resources and time. We retrospectively reviewed 33 patients who underwent ureteral stent removal at our institution between August and December 2022 during the COVID-19 pandemic. A simple device, consisting of an F6 or F8 gastric tube with the front end passing through a 3-0 Prolene line was utilized to extract the double-J stents without cystoscopic assistance. The gastric tube with the line was inserted into the urethra to drain urine from the bladder, saline was injected into the bladder, and the gastric tube was rotated with the line for 4-5 weeks, after which the stent tube was removed by gently pulling it outward. Perioperative characteristics assessed included operation time, pain score, stent removal success rate, postoperative complications, and reasons for stent removal failure. Among the 33 cases included in the study, 17 were males and 16 were females; 20 patients were older than 14 years while 13 were younger. Cystoscope-free stent removal was performed in all cases, with a success rate of 96.9% (32 patients), including 25 cases (78.1%) completed in one operation, four cases (12.5%) in two operations, and three cases (9.4%) in three operations. The mean extubation time was 4.3 ± 1.5 minutes, and the average pain score was 2.1 ± 0.7. No serious postoperative complications were noted. Cystoscope-free ureteral stent removal can be executed by a single physician, demonstrating simplicity, safety, effectiveness, and fewer complications. This method reduces the risk of cross-infection and conserves medical resources and time during the COVID-19 pandemic, making it suitable for both adults and children.

PubMed: 39839751
DOI: 10.62347/HSPG8492

Authors: P W Ross

Qualitative and quantitative tests have been carried out to assess the value of Cidex(1), a glutaraldehyde solution, as a disinfectant. Most of the tests were qualitative and were carried out in conditions as closely resembling those found in hospital practice as possible. Recently used anaesthetic equipment, catheters, and a cystoscope, which had been artificially contaminated with suspensions of Staph. aureus, Ps. pyocyanea, and Esch. coli, were used in the tests. The results show Cidex to be a useful disinfectant with a valuable potential in disinfecting hospital articles which, due to their perishable nature or the fragility of component parts, cannot be treated by physical means.

Topics: Aldehydes; Bacteria; Disinfectants; Equipment and Supplies, Hospital; Sterilization

PubMed: 5929332
DOI: 10.1136/jcp.19.4.318

Authors: C H Leong

PubMed: 38130158
DOI: 10.12809/hkmj-hkmms202312

Authors: J E Wickham, M J Kellet

A new method of removing calculi from the renal collecting system, in which the large and traumatic incision in the loin currently used is unnecessary, was attempted in 31 patients. Small dilators were introduced over a guide wire through a nephrostomy tube into the renal pelvis and a catheter inserted. The track was dilated in stages and two days later the nephrostomy tube was removed and a cystoscope introduced into the interior of the kidney. A stone basket was introduced down the operating channel of the cystoscope and maneuvered to secure the stone; the cystoscope, stone basket, and stone were then removed. The procedure failed in 11 of the 31 patients, in five because the needle could not be placed accurately initially and in six because the stone could not be removed despite the establishment of a nephrostomy track. In the remaining 20 patients the procedure was successful. This procedure is far less traumatic than the conventional operation. With the development of a flexible nephroscope and an ultrasonic stone disintegrator it will be possible also to remove larger stones and stones in the peripheral calices using this method.

Topics: Cystoscopy; Humans; Kidney Calculi; Kidney Pelvis; Kidney Tubules; Kidney Tubules, Collecting; Methods

PubMed: 6796170
DOI: 10.1136/bmj.283.6306.1571

Authors: Eoin MacCraith, Niall F Davis, James Forde...

A 23-year-old woman presented to the emergency department after manually inserting foreign bodies into the urinary bladder through her urethra. A plain abdominal film of the kidneys, ureters and bladder confirmed three radio-opaque densities in the urinary bladder. She was taken to the operating room where cystourethroscopy was performed. At cystoscopy 2 'corn-on-the-cob' skewers and 1 battery were identified but were too large to be retrieved safely with a grasper through the protective sheath. The objects were grasped with a 'sponge-holding forceps' (placed alongside the cystoscope) and extracted one at a time. A psychiatric consultation was sought and the patient was diagnosed and treated for borderline personality disorder. Unusual genitourinary activity (UGUA) has been described for several centuries and is characterised by the deposition of foreign objects in the genitalia. The most common incentive for UGUA is sexual stimulation, but psychiatric disorders and intoxication are also associated. Management involves retrieval of foreign bodies and evaluation of psychosocial factors.

Topics: Adult; Borderline Personality Disorder; Cystoscopy; Female; Foreign Bodies; Genitalia, Female; Humans; Radiography, Abdominal; Urethra; Urinary Bladder; Young Adult

PubMed: 28739565
DOI: 10.1136/bcr-2017-220297

Authors: Nayan Shah, Robert Medairos, Sumana Koduri...

INTRODUCTION

OB/GYN residents' preparedness to perform cystoscopy after residency may vary as the ACGME requires only 10 cystoscopic cases to be performed during training. Given residents' potentially limited exposure to cystoscopy, supplemental educational activities centered around increasing familiarity with the procedure may be useful. The objective of this workshop was to provide an opportunity for OB/GYN residents to become more comfortable with cystoscopic equipment and performing cystoscopy.

METHODS

We showed a video of common pathology seen on cystoscopy and then progressed through two hands-on stations. One station focused on equipment familiarity, with learners identifying equipment and then practicing assembling and disassembling the cystoscope. The other station allowed for simulated cystoscopy utilizing a pig bladder. We used a checklist assessment and pre- and postcourse surveys to evaluate familiarity with equipment and anxiety surrounding performing cystoscopy.

RESULTS

Twenty residents ranging from PGY 1s to PGY 4s who participated in this workshop over the past 2 years completed both pre- and postcourse evaluations. There was statistically significant improvement in ratings of familiarity with equipment and anxiety surrounding the procedure. All participants whom we assessed showed improvement in identifying and assembling equipment as well as in performing the steps of the procedure independently.

DISCUSSION

This workshop provided OB/GYN residents with an opportunity for hands-on cystoscopic experience. Through direct assessment and evaluation forms, the workshop was shown to be a beneficial activity for improving cystoscopic knowledge.

Topics: Animals; Cystoscopy; Gynecology; Humans; Internship and Residency; Obstetrics; Surveys and Questionnaires; Swine

PubMed: 35178470
DOI: 10.15766/mep_2374-8265.11220

Randomized Controlled Trial

Authors: M Alkhamees, A Alothman, M Alzughaibi...

OBJECTIVE

Two main types of cystoscopes, reusable cystoscope (RC) and disposable cystoscope, (DC) are used for the removal of ureteric stents. This study aimed to prospectively compare the effectiveness of disposable and reusable cystoscopes for the removal of ureteric stents.

PATIENTS AND METHODS

Patients who recently underwent double-J stent insertion were recruited and randomly assigned to the disposable and reusable cystoscope groups. Data were collected prospectively, which included pain scores (10-point visual analog scale), operation time, complications, and a 5-point Likert scale satisfaction assessment for surgeons, nurses, and patients. A cost analysis was also performed. The association between categorical data was assessed using the Chi-square/Fisher's exact test. The t-test was used to assess the mean difference in surgery time.

RESULTS

Overall, 128 patients (mean age, 46.8 years) were included in the study; 64 procedures were completed using each cystoscope type. Stent removal satisfaction among surgeons and patients was equivalent in both groups, while nurses favored the disposable cystoscope. A significant reduction of 23% in the procedural time and 27% in the total operative time was observed in the disposable cystoscope group. Pain score was the same for both groups. Two patients in the reusable cystoscope group had UTI. No complications were reported in the disposable cystoscope group.

CONCLUSIONS

Both disposable and reusable cystoscopes are comparable in terms of pain score and surgeons' and patients' satisfaction. Disposable cystoscope is more cost effective than reusable cystoscope.

Topics: Cost-Benefit Analysis; Cystoscopes; Humans; Middle Aged; Pain; Prospective Studies; Stents

PubMed: 35776026
DOI: 10.26355/eurrev_202206_29064

Review

Authors: Po-Yen Chen, Wei-Chia Lee, Hung-Jen Wang...

Cystoscopic onabotulinumtoxinA (onaBoNTA) intradetrusor injection is an efficient and durable modality for treating sensory bladder disorders. However, the inconvenience of using the cystoscopic technique and anesthesia, and the adverse effects of direct needle injection (e.g., haematuria, pain, and infections) have motivated researchers and clinicians to develop diverse injection-free procedures to improve accessibility and prevent adverse effects. However, determining suitable approaches to transfer onaBoNTA, a large molecular and hydrophilic protein, through the impermeable urothelium to reach therapeutic efficacy remains an unmet medical need. Researchers have provided potential solutions in three categories: To disrupt the barrier of the urothelium (e.g., protamine sulfate), to increase the permeability of the urothelium (e.g., electromotive drug delivery and low-energy shock wave), and to create a carrier for transportation (e.g., liposomes, thermosensitive hydrogel, and hyaluronan-phosphatidylethanolamine). Thus far, most of these novel administration techniques have not been well established in their long-term efficacy; therefore, additional clinical trials are warranted to validate the therapeutic efficacy and durability of these techniques. Finally, researchers may make progress with new combinations or biomaterials to change clinical practices in the future.

Topics: Animals; Botulinum Toxins, Type A; Drug Delivery Systems; Humans; Treatment Outcome; Urinary Bladder Diseases; Urothelium

PubMed: 31979383
DOI: 10.3390/toxins12020075

Authors: Uday Sankar Chatterjee, Indranil Chatterjee

AIMS

Incidence and recurrence of bladder stone in augmented exstrophy bladder rate is high. So, recurrent open cystolithotomy is not a preferred procedure; particularly through scarred tissues, consequence of previous surgeries. Percutaneous cystolithotomy (PCCL) is an old but standard procedure for retrieval of bladder stones in adults. We extrapolated PCCL for bladder stone in augmented bladders in children.

PATIENTS AND METHODS

In three patients, we made suprapubic (SP) needle track with initial puncture (IP) needle under cystoscopic guidance. Following that laparoscopic cannula was placed through dilated SP track that was crafted with Alken's dilators and bladder stones were removed with grasper.

RESULTS

On cystoscopy, we also observed the patches of skin tissues in native bladders. Continence and bladder capacity were not affected following PCCL.

CONCLUSION

PCCL in augmented bladder showed good outcome. High recurrence of bladder stone is possibly due to presence of keratin in dermal tissue; invaded mucosa in open bladder plate. It seems shaving or fulguration of those dermal elements during bladder reconstruction might decrease incidence of stone formation. However, we haven't attempted fulguration during PCCL.

PubMed: 34385769
DOI: 10.4103/jiaps.JIAPS_128_20