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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]

Endoscopy and laparoscopy are used for the assessment of disorders of sex development (DSD) and therapeutic interventions. Endoscopy (urethra-cystoscopy, vaginoscopy) is especially useful when vaginal or urethral surgery is planned. It is also valuable for the assessment of complications. Laparoscopy is used to identify sex ducts and gonads and to perform minimally invasive abdominal and pelvic surgery. This article reviews clinical indications, limitations, findings, and their reporting. It further discusses the impact of these findings on care in typical clinical situations. [ABSTRACT FROM AUTHOR]

Objective:To assess the clinical significance of flexible endoscopic realignment in the treatment of posterior urethral disruption in comparison to the traditional open realignment method. Methods: A total of 58 patients suffering posterior urethral disruption were enrolled into the current study from January 2003 to May 2009. Of them, 23 patients (Group A) were treated with modified technique of urethral realignment under flexible urethroscopy and 35 patients (Group B) received conventional open realignment.Results:Either procedure was successfully performed in both groups. However, the operation time was significantly shorter in Group A (29.1 ± 9.5 min) than that in Group B (58.1 ± 11.2 min,p< 0.001). Also, patients in Group A had a significantly decreased incidence of stricture (4 of 23 cases in Group A versus 15 of 35 cases in Group B,p= 0.043) and formation of false urethra (0 of 23 cases in Group A versus 7 of 35 cases in Group B,p= 0.035). Prevalence of secondary urethroplasty was less in Group A (1/23) compared to Group B (8/35), but there was no statistical difference (p= 0.057). In addition, there was no significant difference in morbidity of urinary infection, incidence of incontinence, and impotence between the two groups (p> 0.05). Conclusion: Compared to the traditional open realignment, the new technique of urethral realignment under flexible endoscope has the advantage of short operation time, minimally invasive and less complications. [ABSTRACT FROM AUTHOR]

Background: Urinary tract tumours represent only 0.5-1% of neoplasms in dogs, and transitional cell carcinoma (TCC) is the most common. It is most common to find TCCs in the trigone region. Diagnosis can be made with image analysis, cytology or histology. With non-infiltrative lesions in the early stages, it is possible to obtain a biopsy by endoscopy. Surgical resection is the treatment option of choice for this tumour. Dogs with poor response to chemotherapy or at an advanced stage of the disease are candidates for palliative treatment. This paper reports an special case of TCC located in the distal urethra of a female dog, obtaining the diagnosis through endoscopy, cytology and immunohistochemistry. Case: A nine-year old, female, neutered Golden Retriever was referred for examination after suffering vaginal bleeding. Vaginal palpation revealed an apparent mass on the vaginal floor. Cytology by imprinting the mass revealed a carcinoma. A vaginoscopy was performed on the patient. An endoscopic examination showed normal vaginal mucosa, but, through the urethra, a mass was observed in the urethral lumen, with thickening and dilatation of the urinary meatus. A tissue biopsy was obtained. Episiotomy was performed to remove the tumour. Histopathological studies diagnosed the mass as transitional cell carcinoma with incomplete surgical margins. An immunohistochemistry analysis of the tumour was performed. Discussion: The location of the tumour in the distal urethra makes this case unusual, as this rarely occurs. There are few reports of this location in bitch dogs and they are usually diagnosed at necropsy. This shows the great advantages of endoscopy for the diagnosis of tumours in the urinary tract. There are few cases of this type of tumour being described at this site, and they are usually diagnosed at necropsy. This report shows the great advantages of urethroscopy for the diagnosis of neoplasias of the urinary tract. In this report, owing to the location of the tumour, cytologic diagnosis (carcinoma) could be made quickly by an impression smear. However, we were unable to determine the precise tumour type, because there were no cells with vacuolated basophilic cytoplasm or signet-ring-shaped cells. Distinguishing TCC from other malignant tumours by cytology is complicated, as they are caused by immaturity and there is a lack of differentiation; so, biopsy is suggested. Endoscopy is the most effective method to obtain biopsies of TCC in the urinary tract. An endoscopic examination can be performed with a rigid or flexible endoscope. In the present case, a videoendoscope with a diameter of 9.2 mm was used, owing to the large dilatation of the urinary meatus. The majority of vesical tumours are diagnosed by contrast and negative double-contrast cystography; however, in this case, they did not reveal the presence of a tumour in the bladder. Immunohistochemistry was positive for monoclonal antibodies for TAG-72 in the present case; this is a common finding in 53% of reported cases. Conventional surgery was performed to resect the tumour, because electrosurgical transurethral resection of TCCs in females can cause some surgical complications. This animal had a favourable response after administering NSAIDs (piroxicam). Treatment was still challenging, owing to the difficulties in surgical resection and the poor response to conventional chemotherapy. [ABSTRACT FROM AUTHOR]

The article focuses on the use of diagnostic flexible cysto-urethroscopy (FC) to investigate various symptoms including haematuria, lower urinary tract symptoms, (LUTS) and urinary tract infections in Great Britain. A study is conducted to examine if FC offers useful diagnostic information in young patients investigated for urological symptoms. It provides information regarding the results of the study.

Objective: To establish some guidelines for the definition, diagnosis, and treatment of failed posterior urethroplasty. Methods: We identified 20 successive patients who required a secondary endoscopic or surgical procedure after anastomotic repair of a postpelvic fracture urethral injury from 1979 to 2010. Of the 20 patients, 18 had undergone perineal repair and 2 a perineo-abdominal procedure. Their medical records were reviewed with a focus on 6 postoperative items: symptoms, onset of unsuccessful result, urethral calibration, urethrocystography, urethroscopy, and treatment. Follow-up ranged from 1 to 25 years (mean 14). Results: Of the 20 patients, 11 (55%) presented shortly after removal of the urethral stent with failure to void (n = 9) or incontinence (n = 2), and 9 (45%) presented 1 month to 12 years after surgery with a weak stream. Early failures resulted from obstruction at the site of repair in 5 patients, retraction of the bulbar urethra in 3, wrong anastomosis to a false tract in 1, and an open bladder neck in 2. Correction was accomplished by salvage urethroplasty in 8 patients and bladder neck repair in 2. Late failures resulted from narrowing of the anastomosis and were corrected by direct visual internal urethrotomy in 7 patients and surgery in 2. Conclusion: Unsuccessful outcomes can be encountered shortly after removal of the urethral stent or delayed for several months or years after surgery. Early cases present by an inability to void or incontinence and usually require salvage urethroplasty or bladder neck repair. Late cases present by a weak urinary stream, are due to narrowing of the anastomosis, and are usually corrected by direct visual internal urethrotomy. [Copyright &y& Elsevier]

Study Type – Therapy (RCT) Level of Evidence 1b OBJECTIVE To assess whether real-time cysto-urethroscopy (CUS) performance improves by simulator-based training (criterion or predictive validity), addressing the research question ‘Does practical skills training on the URO Mentor (UM, Simbionix USA Corp., Cleveland, OH, USA) virtual-reality simulator improve the performance of flexible CUS in patients’. SUBJECTS AND METHODS Participants (71 interns from Catharina Hospital Eindhoven, CHE, and 29 from University Medical Centre Groningen, UMCG) were randomized to carry out CUS in a patient after training on the UM (UM-trained, 50) or without training on UM (control, 50). The assessment of real-time performance consisted of scoring on a Global Rating Scale (GRS) by supervisors unaware of training status. Data were analysed using stepwise multiple linear regression. The effect size (ES) indication for correlations was used to interpret the magnitude of a standard regression coefficient (β); an ES of 0.10, 0.30 and 0.50 were considered small, moderate and large, respectively. The study was approved by the Medical Review Ethics Committees of the participating hospitals. RESULTS Overall, the group that received training performed significantly better than the controls ( P ≤ 0.003, β range 0.30–0.47). There was no effect of training for participants with a specific preference for a surgical speciality in two of five GRS scores. Participants from CHE obtained higher GRS 3 scores than those from UMCG. Significantly more UMCG trainees indicated having had stress than those from CHE ( P < 0.001). CONCLUSIONS The results showed that interns who had trained on UM outperformed controls for a CUS procedure in a patient. Training for CUS on the UM is to be recommended for learning to respect tissue, procedural knowledge, flow of procedure and forward planning. Use of the UM to train interns with a specific interest in a surgical speciality in handling instruments, and time and motion, seems to be of limited value. [ABSTRACT FROM AUTHOR]

Congenital obstruction of the male urethra is usually caused by posterior urethral valves. Anterior urethral valves (AUV) represent a rare anomaly with a wide spectrum of presentation varying from mild voiding difficulties to end-stage renal disease. Prompt diagnosis and appropriate treatment is essential to prevent renal impairment. We report the case of a 13 month-old boy who presented with deterioration of kidney function caused by unrecognized AUV disorder. Temporary cutaneous vesicostomy was necessary to protect the upper urinary tract from further damage and to stabilize renal function. Even though a voiding cystourethrogram (VCUG) demonstrated obstruction of distal urethra, AUV were initially overlooked but finally diagnosed on additional VCUG followed by urethroscopy. [ABSTRACT FROM AUTHOR]

Urethral stricture disease in men has traditionally been investigated with ascending and voiding cystourethrography as well as urethroscopy. The main emphasis during the preoperative assessment is on establishing the exact extent of the disease process in order to plan appropriate management. We describe a technique that represents a novel approach to the assessment of proximal urethral stricture and in selected cases would be of immense help in defining its precise nature and planning definitive treatment. [ABSTRACT FROM AUTHOR]

Background: Cysto-urethroscopy or cystoscopy is an important tool for the practicing urologist for both therapeutic and diagnostic purposes. The indications for cystoscopy vary widely from centre to centre. We describe our experience with this tool. Materials and Methods: We reviewed retrospectively the medical records of patients who had rigid cystoscopy at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Symbol specialist hospital, Nnewi and Borromeo specialist hospital Onitsha, all in Anambra State, Southeast,Nigeria in the period January 2004 to December 2009. All indications were as reported in the initial diagnosis for all the patients. Results: A total of one hundred and eleven patients had cystoscopy during the study period. Most of the patients who had cystoscopy were in the seventh48 (43.3%) and fifth26 (23.4%) decades of life. The male to female ratio was 2:1. The commonest indication for cystoscopy was for investigation of bladder tumors in 50(45.0%) of the patients. Other indications were for the investigation of hematuria in 31(28.0%) patients, hydronephrosis in 13(11.8%), urethral stricture 9(8.1%), cystitis 2(1.8%), bladder calculi 3(2.7%), prostatitis 1( 0.9%), bladder fistula 1(0.9%), and urinary incontinence 1(0.9%). Conclusion: The indications for Cystoscopy vary from centre to centre. In our experience, the most common indication is for bladder tumors. The procedure is well tolerated by patients with a low incidence of morbidity. Studies have shown that the flexible cystoscope offers more advantage in that it is less invasive and can be done under local anaesthesia. [ABSTRACT FROM AUTHOR]

We report a case of acute urinary retention in a 13-month-old boy, secondary to a perforate Cowper's syringocele. Diagnosis was established with voiding cystourethrogram, transperineal ultrasound and urethroscopy; definitive management involved endoscopic unroofing of the syringocele and resolution of the patient's obstructive signs and symptoms followed. Although novel diagnostic and therapeutic options have been reported, standard urethrographic imaging and endoscopic management is appropriate for the majority of symptomatic Cowper's syringoceles. [ABSTRACT FROM AUTHOR]

Introduction: Disorders of sex development (DSD), defined as congenital condition associated with atypical development of chromosomal, gonadal, and phenotypic sex abnormalities, is a social burden for the neonatal period, yet there's still limited data on the incidence, diagnostic and management of DSD. Materials and Methods: Data were collected from medical records of patients with DSD managed by urologist, pediatric endocrinologist, and reproductive gynaecologist at CiptoMangunkusumo Hospital from January 2005 to July 2014. The 2006 International Intersex Consensus Conference Participant (IICCP) classification was used as classification. The profile and management of DSD were evaluated. Results: Out of 182 DSD cases, type 46 XX DSD had the highest incidence (46%) with majority of CAH, followed by 46 XY DSD (33%) with majority of AIS. Most cases were diagnosed at = 1 year of age (41%) and = 11 years (31%). As many as 83% of 46 XY DSD cases were raised as male, and 83% of 46 XX DSD cases were raised as female. Genitography had been used in 11 cases, urethroscopy and colposcopy used in 7 case, and diagnostic laparoscopy in 13 case. thirty persent of 46XY cases raised as a female having cross gender assignment, while 3/14 of 46 XX cases raised as male having cross gender assignment. Medical treatment was the most common treatment for Turner syndrome and CAH, while AIS was mostly treated with orchidopexy, and a total of 73 surgeries were done in all case. Conclusion: Most cases of DSD in CiptoMangunkusumo Hospital were CAH and AIS. Genitography, urethroscopy and colposcopy, and diagnostic laparoscopy have been used in the diagnosis of DSD. Forty percentof all DSD cases were treated with surgical treatment. [ABSTRACT FROM AUTHOR]