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Introduction: Cystoscopy is a basic urologic skill necessary for the endoscopic evaluation of the urethra and bladder. Presented is a step-by-step guide for flexible cystoscopy of the male and female patient. Materials/Methods: Routine flexible cystoscopy was performed on a male patient with a history of upper tract urothelial carcinoma and a female patient as part of a hematuria evaluation. The male patient was positioned supine, and the female patient frog-leg supine. Preoperative equipment included a flexible cystoscope (Storz 11272 VP; Karl Storz, Inc., Germany), irrigant, lubricating gel, sterile gloves, and towels/drapes. A typical cystoscopy room layout is shown. Results: This guide outlines the indications, preoperative preparation, and procedural steps for each gender, postoperative care, and troubleshooting recommendations. The video depicts the author's (R.V.C.) typical office cystoscopy procedure. In both cases, the cystoscopies were within normal limits. Conclusion: A simple, standardized manner for performing office-based flexible cystoscopy is essential to the practice of all urologists. By following the outlined steps, the urethra and the entire bladder, including the bladder neck area, can be thoroughly evaluated. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the long-term and flexible cystourethroscopy results of holmium laser enucleation of the prostate (HoLEP) and to compare them with those of plasmakinetic resection of the prostate (PKRP). Methods: In the long-term follow-up, variables, including the international prostatic symptomatic score, quality of life scores, maximum flow rate (Qmax), and international index of erectile function (IIEF), and the adverse events, including the need for retreatment, were specifically assessed. One hundred twenty-two HoLEP and 119 PKRP of the initial 280 patients included in this study were available, with 10 deceased and 29 lost to follow-up. Results: We found that none of the assessable patients required reoperation for recurrent benign prostatic enlargement (BPE) in the HoLEP group, whereas two required reoperation in the PKRP group. There were no significant differences in most variables between the two groups in the long-term results. But in terms of Qmax, transrectal ultrasound prostate volume, prostate specific antigen (PSA) level, IIEF-5 score, and long-term posttrial follow-up of flexible cystourethroscopy, the HoLEP group showed better results. Conclusion: The long-term follow-up data of this randomized trial confirm that HoLEP and PKRP are both effective and durable surgical interventions for the treatment of lower urinary tract symptoms due to BPE. Given the clinically relevant advantages associated with HoLEP, the alternation of PSA level, sexual function, and urination can be improved. [ABSTRACT FROM AUTHOR]

Purpose: To report the development of panurethral stricture disease and other lower urinary tract abnormalities as a complication of photovaporization of the prostate (PVP). Patients and Methods: We evaluated three patients who were referred for the treatment of urethral stricture disease after PVP. Evaluation included antegrade cystoscopy, urethroscopy, retrograde urethrography, and cystourethrography. Results: All three patients had panurethral stricture disease, and a low capacity bladder with bilateral vesicoureteral reflux had developed in one patient as a complication of PVP. Conclusions: Although not previously reported, a potential complication of PVP is devastating panurethral stricture disease. [ABSTRACT FROM AUTHOR]

An ideal biomaterial for urethral reconstruction has not been developed. To create a urethral graft biomaterial with optimal biodegradability and biocompatibility, a copoly(L-lactide/-caprolactone) P(LA/CL) fabric tube was combined with a type I collagen sponge. The P(LA/CL) fibers were knitted into a vascular stent style (Type 1) or weaved into a mesh style (Type 2) to prepare P(LA/CL) tubes. The tubes were dipped in aqueous collagen solution and lyophilyzed to prepare the P(LA/CL)–collagen sponge graft. The grafts were applied to a 1.5-cm rabbit urethral defect (n 14 for each condition), and tissue repair was evaluated using urethrographical, urethroscopical, and histological examination 1, 3, and 6 months after surgery. Although epithelialization was observed after 1 month in all Type 1 grafts, stenoses, fistulae, or stone formation was seen in 7 of the rabbits. In some cases, P(LA/CL) fibers prolapsed into the urethral lumen, causing stone formation. Only 3 rabbits survived for 6 months, and 2 of these had stenoses. For the Type 2 graft, all urethras were patent, without fistulae or stenoses, over the entire observation period. Histologically, urethral structure was disorganized for the Type 1 graft, whereas the urethral tissue on the Type 2 graft was slightly fibrotic but completely epithelialized and supported by a regenerated smooth muscle layer at 6 months. These findings suggest that creation of a scaffold suitable for urethral tissue regeneration will depend not only on the biomaterial composition, but also on the fabrication technique. [ABSTRACT FROM AUTHOR]

AbstractBackground and Purpose:Flexible ureteroscopes are fragile devices, and the costs associated with their repair and replacement can be considerable. Although surgical use can degrade ureteroscope function, the cleaning and sterilization process can also cause great damage. We performed a study to define the effect of having the urology nursing staff process and sterilize all ureteroscopes, rather than the central processing core; the total repair cost and cost per use were analyzed.Materials and Methods:From April 2007 to March 2008, all ureteroscopes were processed by the urology nursing staff. We analyzed the average cost per use as a measure of the effectiveness of this strategy. For all endoscopic stone removal cases, a flexible ureteroscope is opened onto the operative field; therefore, after every endoscopic procedure, the flexible ureteroscope needs processing and sterilizing. The number of times each ureteroscope was processed and the type and cost of repairs were recorded.Results:From April 2007 to March 2008, 11 ureteroscopes were processed 478 times; average uses before repair was 28.1. Seven ureteroscopes were returned for repair because of: loss of deflection (2); loss of fiberoptic bundles (2); failed leak test (3). No ureteroscope damage was because of processing. The total repair cost in this 12-month period was $57,664.50. Amortizing repair costs over use gives a value of $120.63 cost per use.Conclusions:Training the urology nursing staff to clean and sterilize ureteroscopes is a reasonable means to reduce processing-related damages. [ABSTRACT FROM AUTHOR]