Objectives: To evaluate the feasibilty and detection rate of flexible PDD cystoscopy. Methods: In total 30 patients were included in this two-center study. A flexible endoscope and a rigid instrument were both used in the same patient. In preparation for PDD Hexylaminolevulinate was used. In every patient an experienced surgeon performed the examination of the bladder in white light and PDD using initially a rigid instrument first. Then another blinded surgeon performed a flexible cystoscopy using WL and PDD in the same patient again. In all patients a TUR-BT or bladder biopsy was performed during the same procedure. Results: In all 30 patients flexible cystoscopy could be performed without any technical problems. In the WL setting the overall sensitivity for flexible cystoscopy were 92% (22/24) vs 83% (20/24) using the rigid endoscope. The specificity was 50% for flexible WL vs 33% for rigid WL endoscopy. The accuracy of flexible WL was higher (83%) compared to rigid (73%) cystoscopy. There was an accordance of the two methods of 83% (25/30) with a Cohen´s kappa of k=0.44 (p=0.007). Respecting the data that were acquired in PDD mode only, there was no difference in sensitivity, specificity and accuracy between the two methods (p<0.001). In 24/30 cases there was observed no difference between flexible and rigid cystoscopy regarding fluorescence intensity. Conclusions: Flexible PDD using the chip on the tip technology was feasible with an excellent fluorescence quality. Sensitivity and specificity of flexible PDD was equivalent to the current gold standard - the rigid blue light endoscopy.

You have accessJournal of UrologyBladder Cancer: Detection & Screening1 Apr 2014MP22-09 FLEXIBLE PHOTODYNAMIC DIAGNOSIS OF THE BLADDER – READY FOR THE OUTPATIENT SETTING? Alexander Karl, Patrick Weidlich, Christoph Adam, Peter Stanislaus, Thomas Hoffmann, Stefan Tritschler, Christian Stief, and Dirk Zaak Alexander KarlAlexander Karl More articles by this author , Patrick WeidlichPatrick Weidlich More articles by this author , Christoph AdamChristoph Adam More articles by this author , Peter StanislausPeter Stanislaus More articles by this author , Thomas HoffmannThomas Hoffmann More articles by this author , Stefan TritschlerStefan Tritschler More articles by this author , Christian StiefChristian Stief More articles by this author , and Dirk ZaakDirk Zaak More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.857AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the feasibilty and detection rate of flexible HAL-cystoscopy using a new chip-on-the-tip technology in patients with the suspicion of bladder cancer. In this study the performance of photodynamic diagnosis (PDD) and white light (WL) endoscopy using flexible and rigid cystoscopes were compared. METHODS In total 30 patients were included in this two-center study. The flexible chip on the tip endoscope (Storz) and the rigid system (Storz) were both used for diagnostic cystoscopy in the same patient. In preparation for PDD Hexylaminolevulinate (HAL) was used. Two experienced surgeons in each participating institution were involved. In every patient one of these surgeons performed the examination in white light and PDD using a rigid instrument first. Then another blinded surgeon performed a flexible cystoscopy using WL and PDD in the same patient again. All blinded findings were captured on a specially designed documentation sheet. RESULTS In all 30 patients flexible cystoscopy could be performed without any technical problems. In the WL setting the overall sensivitiy for flexible cystoscopy was 92% (22/24) vs. 83% (20/24) with the rigid endoscope. The specificity was 50% for flexible WL vs. 33% for rigid WL. The accuracy of flexible WLwas higher (83%) compared to rigid (73 %). There was an accordance of the two methods of 83% (25/30) with a Cohen's kappa of k=0.44 (p=0.007). Respecting only the results that were acquired in PDD mode, there was no difference in sensitiviy, specificity and accuracy between the two methods (p <0.001). The quality of fluorescence was judged by every examiner for flexible and rigid PDD. For quality assessment four different subjective levels for fluorescence (no, low, medium, high) were used. In 24 of 30 cases there was the same level documented in flexible and rigid. This represents an accuracy of 80% (p<0.001). During the whole study there were observed no side effects caused by the PDD or the flexible approach. Tangential views of the bladder resulting in false positive fluorescence could be avoided using the flexible endoscope. CONCLUSIONS Flexible PDD using the chip on the tip technology was feasible with an excellent picture quality. Sensitivity of flexible PDD was equivalent to the current gold standard – the rigid endoscopy. There was no loss in fluorescence intensity or diagnostic information using the flexible cystoscope. Therefore the outpatient use of flexible PDD seems reasonable in the diagnosis and follow up of bladder cancer patients. However larger clinical studies need to further verify the efficiency of this new equipment. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e237-e238 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Alexander Karl More articles by this author Patrick Weidlich More articles by this author Christoph Adam More articles by this author Peter Stanislaus More articles by this author Thomas Hoffmann More articles by this author Stefan Tritschler More articles by this author Christian Stief More articles by this author Dirk Zaak More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

This study aims to evaluate whether optical coherence tomography (OCT) using both the surface and the endoluminal technique is feasible to investigate the locations and degree of encrustation process in clinically used ureteral stents. After removal from patients, 14 polyurethane JJ stents were investigated. A fresh JJ served as a control. The external surfaces were examined using an endoscopic surface OCT whereas the intraluminal surfaces were investigated by an endoluminal radial OCT device. The focus was on detection of encrustation or crystalline sedimentation. In 12 female and two male patients, the median indwelling time of the ureteral catheter was 100 days (range, 19-217). Using the endoluminal OCT, the size and grade of intraluminal encrustation could be expressed as a percentage relating to the open lumen of the reference stent. The maximum encrustation observed resulted in a remaining unrestricted lumen of 15-35 % compared to the reference. The luminal reduction caused by encrustation was significantly higher at the proximal end of the ureteral stent as compared to its distal part. The extraluminal OCT investigations facilitated the characterization of extraluminal encrustation. OCT techniques were feasible and facilitated the detection of encrustation of double pigtail catheters on both the extra and intra luminal surface. Quantitative expression of the degree of intraluminal encrustation could be achieved, with the most dense and thickened occurrence of intraluminal incrustation in the upper curl of the JJ stent.

Introduction: Ureteric stenting is a commonly used endourologic procedure for temporary and long-term drainage of an obstructed upper urinary tract. The indication for ureteric stenting is obstruction due to intrinsic (intraureteral stones, strictures, or tumors) or extrinsic (for example compressing pelvic or retroperitoneal mass) causes. Despite the fact that stents do certainly have proven benefits in all fields of urology, there are potential morbidities. The most common problem of indwelling ureteral stents is infection. As foreign body in the urinary system, stents act as a nidus for bacteria colonization, crystallization and encrustation. Bacteria induced biofilm formation predisposes for the crystallization of lithogenic salts, such as calcium-phosphate, calcium-oxalate, magnesium-phosphate on the surface initiating stent encrustation. It was the objective of this study to evaluate whether optical coherence tomography (OCT) using both the surface and the endoluminal technique is feasible to investigate the locations and degree of encrustation process in clinically used ureteral stents. Patients and methods: After removal from patients, fourteen polyurethane JJ stents were investigated. A fresh JJ served as a control. The external surfaces were examined using an endoscopic surface OCT whereas the intraluminal surfaces were investigated by an endoluminal radial OCT device. The focus was on detection of encrustation or crystalline sedimentation. Results: In 12 female and 2 male patients, the median indwelling time of the ureteral catheter was 100 days (range 19- 217). Using the endoluminal OCT, the size and grade of intraluminal encrustation could be expressed as a percentage relating to the open lumen of the reference stent. The maximum encrustation observed resulted in a remaining unrestricted lumen of 15-35% compared to the reference. The luminal reduction caused by encrustation was significantly higher at the proximal end of the ureteral stent as compared to its distal part. The extraluminal OCT-investigations facilitated the characterization of extraluminal encrustation. Conclusion: OCT techniques were feasible and facilitated the detection of encrustation of double pigtail catheters on both the extra and intra luminal surface. Quantitative expression of the degree of intraluminal encrustation could be achieved, with the most dense and thickened occurrence of intraluminal incrustation in the upper curl of the JJ stent.

A fundamental precondition of local radiotherapy by means of 32P-loaded urethral catheters is a precise position with respect to the target tissue. This feasibility study investigates optical coherence tomography (OCT)-assisted examination of the catheter position and its adherence to the tissue surface. OCT investigations were performed using an animal model (rabbit urethra, n=4). A radial scanning OCT probe located in the lumen of the catheter provided OCT images of the catheter structure as well as of the surrounding tissue. Descriptive evaluation of the OCT images gives information about the fitting, the structure of the catheter, as well as of the surrounding urethral tissue. The dimensions of catheter–tissue separation were determined. Radial OCT images provided clear cross-sections of the catheter. The layered structure of the surrounding urethral tissue could be identified and correlated to the histology. Distances between the catheter surface and the tissue could be evaluated indicating gaps of up to 0.4 mm and sector widths of up to 90°. Dosimetric calculations have shown that such changes may reduce the intended β-irradiation dose by 30% in the target tissue depth. Morphological changes (e.g. scar formation), related to wound healing processes after surgical incision, could be observed as well. OCT-mediated tissue differentiation through OCT-wavelength transparent catheters shows the potential for identifying morphological changes. The fitting of the catheter to the urethral wall could be verified. Therefore, OCT techniques may improve the control of the radioactive catheter position resulting in an upgrade of dosimetric calculation for local 32P-β-radiation low-dose brachytherapy. Voraussetzung für die lokale Behandlung der Harnröhre (Urethra) mit radioaktiv dotierten Kathetersegmenten ist deren exakte Positionierung im Bereich des Zielgewebes. Ziel dieser Machbarkeitstudie ist die OCT-gestützte Prüfung der Katheterposition und des Anschmiegeverhaltens urologischer Katheter an das umgebende Urethragewebe. Die Versuche erfolgten im Tiermodell (Kaninchen, n=4). Zur Untersuchung der Katheterposition wurde eine radial-scannende OCT-Sonde in das Lumen der Katheter eingeführt und OCT-Bildsequenzen vom Katheter und dem umliegenden Gewebe erstellt. Die Auswertung umfasste die Beschreibung des Anschmiegeverhaltens der Katheter an das Gewebe, die Identifizierung von Gewebestrukturen sowie die geometrische Bestimmung der Abstände zwischen Katheterwand und Harnröhre. Mittels radialer OCT-Technik war die Querschnittsstruktur der Katheter klar zuzuordnen. Die geschichtete Struktur und der Strukturwechsel im anliegenden Urethragewebe konnte identifiziert und zugeordnet werden. Die Abstände zwischen Katheterwand und Gewebe betrugen in radialer Richtung bis zu 0,4 mm in sektoriellen Bereichen von bis zu 90°. Diese Abstandsvariationen müssen bei der β-Bestrahlungsdosimetrie berücksichtigt werden, da sie eine Reduktion der effektiven β-Bestrahlungsdosis im Zielbereich um ein Drittel bewirken können. Auch morphologische Gewebeveränderungen (Narbenbildung), die auf dem Wundheilungsprozess basieren, konnten mittels radialer OCT durch die Katheterwand hindurch nachgewiesen werden. Mittels OCT ist eine Differenzierung zwischen morphologisch veränderten Gewebebereichen prinzipiell auch durch den urologischen Katheter hindurch gegeben. Der Kontaktbereich zwischen Katheter und Gewebe kann mit Hilfe der OCT verifiziert werden, was die Grundlage für eine solide Dosimetrie bei der lokalen Anwendung der 32P-β-Bestrahlung bildet.

Encrustation of pigtail catheters with crystalline deposit of urine components is a well-known problem and in addition to lower urinary tract infection, the most common complication of any material placed in the urinary tract. There is neither any data about the beginning of encrustation in literature, nor about location or progression. The aim of this study is to make an analysis of the level of encrustation and to document the longitudinal progression with OCT. Fourteen double-J (DJ) catheters (Neomedical Ch 7/28 cm) with different indwelling times were compared with a new DJ catheter as a reference, after removal. The external surfaces of the catheters were examined using endoscopic surface OCT (Imalux) and the intraluminal surfaces with endoluminal-radial OCT (LightLab Imaging) with regard to possible encrustation or crystalline sedimentation. The resolution of OCT was 20 μm. The pullback mode of the endoluminal radial OCT allowed the documentation in 6 μm sequences. The median indwelling time was 100 days (19–27 days; n=12 female and n=2 male patients). Firstly, the external encrustation was macroscopically rated in “low”, “medium” and “high”. The macroscopic and the extraluminal OCT results were correlated. With the help of endoluminal OCT, the dimension of intraluminal encrustation could be expressed as a percentage relating to the reference catheter. The luminal reduction caused by encrustation is significant higher at the proximal end of the pigtail. An encrustation at the distal end of the pigtail was only present when there was also an encrustation at the proximal end. Only 2 stents showed an encrustation in the middle part. OCT made it possible to detect the encrustation of DJ catheters and express the degree of encrustation quantitatively. The encrustation started at the proximal side and seemed to expand antegrade. Further studies have to be carried out in order to answer the question if an encrustation expands from intra- to extraluminal or vice versa. With the help of OCT, the effect of surface modification of the implanted material could be examined in order to reduce encrustation.

Context., Ureteroscopically guided laser techniques are commonly used in the treatment Of Upper urinary tract transitional cell carcinoma (UUTT); however, there is an ongoing debate with regard to indication and management.Objective: To review the indication, feasibility, and treatment outcome of laser application for definitive endoscopic treatment of UUTT, focusing on technical aspects of different laser devices and their impact on tissue.Evidence acquisition: PubMed and Medline were searched for reports on laser therapy in UUTT from 1980 to 2008, with particular focus on the technical background of various laser systems.Evidence synthesis: For decades, nephroureterectomy has been considered the gold standard for treating UUTT. With the intent to preserve functioning renal parenchyma, minimally invasive approaches, initially advocated for patients requiring a nephron-sparing approach (ie, single functioning kidney, renal insufficiency or significant comorbidities), have gained widespread acceptance due to advances in ureteroscopy, percutaneous renal Surgery, and laparoscopy. Ureteroscopically guided laser ablation has been used Successfully, resulting in recurrence rates ranging from 31% to 65% and disease-free rates of 35% to 86%, depending on stage and grade at diagnosis.Conclusions: To obtain the highest treatment success, the initial staging and grading of the turnout is crucial. Because low-grade tumours rarely if ever progress in stage or grade, the success rate of ureteroscopic therapy parallels that of endoscopic resection of identical bladder tumours. in the treatment of higher grade, advanced tumours, Ureteroscopic therapy is less likely to be curative, and thus, endoscopic manoeuvres can only be palliative. Due to the relatively low prevalence of this tumour and the lack of comparable randomised, multicentre trials, the indications for an endoscopic laser treatment option has to be defined based on the patient's individual situation. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.

You have accessJournal of Urology1 Apr 2008DOES THE TRAINING LEVEL OF THE FIRST ASSISTANT HAS AN IMPACT ON BLOOD LOSS IN RADICAL PROSTATECTOMIES? Alexander Karl, Derya Tilki, Peter Stanislaus, Alexander Buchner, Patrick Weidlich, Stefan Tritschler, Christian Gratzke, Frank Strittmatter, Dirk Zaak, and Christian G Stief Alexander KarlAlexander Karl , Derya TilkiDerya Tilki , Peter StanislausPeter Stanislaus , Alexander BuchnerAlexander Buchner , Patrick WeidlichPatrick Weidlich , Stefan TritschlerStefan Tritschler , Christian GratzkeChristian Gratzke , Frank StrittmatterFrank Strittmatter , Dirk ZaakDirk Zaak , and Christian G StiefChristian G Stief View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61790-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "DOES THE TRAINING LEVEL OF THE FIRST ASSISTANT HAS AN IMPACT ON BLOOD LOSS IN RADICAL PROSTATECTOMIES?." The Journal of Urology, 179(4S), pp. 611–612 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 611-612 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetrics Author Information Alexander Karl More articles by this author Derya Tilki More articles by this author Peter Stanislaus More articles by this author Alexander Buchner More articles by this author Patrick Weidlich More articles by this author Stefan Tritschler More articles by this author Christian Gratzke More articles by this author Frank Strittmatter More articles by this author Dirk Zaak More articles by this author Christian G Stief More articles by this author Expand All Advertisement PDF downloadLoading ...

Lower Urinary Tracts Symptoms (LUTS) due to Benign Prostatic Hyperplasia (BPH) represent an increasing prevalent condition in ageing men. Patients often seek primarily consultation at their general practitioner. Aetiology and natural history of LUTS due to BPH have not been completely clarified.The development of symptomatic LUTS is age-dependent and determined to varying degrees by the presence of Benign Prostatic Hyperplasia (BPH), Benign Prostatic Enlargement (BPE) as well as Bladder Outlet Obstruction (BOO). A causal relationship does not always exist. Basis for a specific medical or surgical treatment in the individual patient with LUTS due to BPH is an exact diagnosis by the practising urologist.

Ein Patient mit Coxarthrose steht vor der Entscheidung: künstliche Hüfte — ja oder nein? Klären Sie mit ihm folgende Punkte: Ist der Zeitpunkt für den Eingriff richtig gewählt? Nimmt der Patient Gerinnungshemmer ein und wenn ja, was hat das für Konsequenzen? Ist er mit oder ohne Zement besser beraten? Wählt er Keramik oder Metall? Wie schnell ist die neue Hüfte belastbar? Und was hat es mit den sogenannten minimierten Zugängen auf sich?