Cystoscopy with TURP

For my third case, it is a case of cystoscopy with TURP. In this case I was specially asked for by the circulating nurse bascally because Im tall. In this case what I mostly did was help my circulating nurse by watching over the water infused to the scope continuously; every time the water level goes down, I immediately add another one. On my first time, I infused 8 bottles through out the operation; on the second time, I depleted 15 bottles; consequently, the mass that was scraped was heavier by 14grams and the first one weighed 10 grams.

Through out the procedure I was amazed by how advanced the doctors techniques were in removing the mass. Our technology today made it possible for the doctors to be less invasive in this procedure; there was no more need for incisions, although of course bleeding was still inevitable. In this case, what amazed me the most was the equipments the doctors were using. The doctors were using quite small instruments to visualize, cut, and coagulate but with the help of a monitor, it was magnified a hundred times making the whole procedure comfortable and more accurate for the doctors. And when the specimen came out, it smelled like burnt meat.

With the help of the monitor, I was able to see what the doctors were doing, that way it made me learn a lot about the process. I guess I was quite lucky that I had a monitor in the room; I noticed other cystoscopy procedures visualized it manually with out the monitor. Seeing the whole procedure made me learn a lot, I was even able to differentiate the normal growth from the abnormal one, I was even able to see how it was being cut and the bleedings, coagulated. The whole thing was quite an amazing experience for me.

On an article I have found, there was advancement in the field of medicine regarding the effect of the light incorporated to the scope. To reduce the recurrence and progression of abnormal growths, blue could be incorporated instead of the white one. Personally, knowing that Philippines arent economically stable as it used to be, I think we should soon practice the use of blue lights. If hospitals really do care about the people we should go through with this because people dont have the luxury of spending money for their health especially now that people could barely afford a check-up. Knowing that one procedure is quite expensive as it is now, what more if we pushed through for a second one if the abnormal growth grows back. So I think this blue light is quite a remarkable finding that has a great potential in being part of our standard procedure during cystoscopy. Im rooting for this promising work to actually materialize and push through.

Cystoscopy with TURP

Cystoscopy is a test that allows your doctor to look at the inside of the bladder and the urethra using a thin, lighted instrument called a cystoscope. The cystoscope is inserted into your urethra and slowly advanced into the bladder. Cystoscopy allows your doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be inserted through the cystoscope that allow your doctor to remove samples of tissue (biopsy) or samples of urine. Small bladder stones and some small growths can be removed during cystoscopy. This may eliminate the need for more extensive surgery. Cystoscopy may be done to: Find the cause of symptoms such as blood in the urine (hematuria), painful urination (dysuria), urinary incontinence, urinary frequency or hesitancy, an inability to pass urine (retention), or a sudden and overwhelming need to urinate (urgency). Find the cause of problems of the urinary tract, such as frequent, repeated urinary tract infections or urinary tract infections that do not respond to treatment. Look for problems in the urinary tract, such as blockage in the urethra caused by an enlarged prostate, kidney stones, or tumors. Evaluate problems that cannot be seen on X-ray or to further investigate problems detected by ultrasound or during intravenous pyelography, such as kidney stones or tumors. Remove tissue samples for biopsy. Remove foreign objects. Place ureteral catheters (stents) to help urine flow from the kidneys to the bladder. Treat urinary tract problems. For example, cystoscopy can be done to remove urinary tract stones or growths, treat bleeding in the bladder, relieve blockages in the urethra, or treat or remove tumors. Place a catheter in the ureter for an X-ray test called retrograde pyelography. A dye that shows up on an X-ray picture is injected through the catheter to fill and outline the ureter and the inside of the kidney.

Tell your doctor if you: Are allergic to any medicines, including anesthetics, have had
bleeding problems or take blood-thinning medicine, such as aspirin or warfarin (Coumadin). You will be asked to sign a consent form before the test. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. Cystoscopy can be performed with local, spinal, or general anesthesia. Discuss with your doctor which method is best for you and whether you should plan on staying overnight in the hospital. If you will not be staying in the hospital, arrange for someone to drive you home after the test. Follow the instructions exactly about when to stop eating and drinking, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water. You should empty your bladder just before the test. You may be given medicine to prevent a urinary tract infection that could be caused by the test.

Cystoscopy is performed by a urologist, with one or more assistants. The test is done in a special testing room in a hospital or the doctor's office. You will need to take off all or most of your clothes, and you will be given a cloth or paper covering to use during the test. About an hour before the test, you may be given a sedative to help you relax. An intravenous (IV) needle may be placed in a vein in your arm to give you other medicines and fluids. You will lie on your back on a special table with your knees bent, legs apart, and your feet or thighs may be supported by stirrups. Your genital area is cleaned with an antiseptic solution, and your abdomen and thighs are covered with sterile cloths. If a local anesthetic is used, the anesthetic solution or jelly is inserted in your urethra; and if a general anesthetic is used, you will be put to sleep either with a medicine given through an IV or by inhaling gases through a mask, or both methods may be used. If a spinal anesthetic is used, the area on the back where the needle will be inserted is first numbed with a local anesthetic, then the needle is guided into the spinal canal and the anesthetic is injected. A spinal anesthetic may prevent movement of the legs until the anesthetic wears off. After the anesthetic takes effect, a well-lubricated cystoscope is inserted into your urethra and slowly advanced into your bladder. If your urethra has a spot that is too narrow to allow the scope to pass, other smaller instruments are inserted first to gradually enlarge the opening. After the cystoscope is inside your bladder, either sterile water or saline is injected through the scope to help expand your bladder and to create a clear view. A medicine may also be injected through the scope to reduce chances of infection. Tiny instruments may be inserted through the scope to collect tissue samples for biopsy; the tissue samples then are sent to the laboratory for analysis. The cystoscope is usually in your bladder for only 2 to 10 minutes. But the entire test may take up to 45 minutes or longer if other X-ray tests are done at the same time. If a local anesthetic is used, you may be able to get up immediately after the test. If a general anesthetic is used, you will stay in the recovery room until you are awake and able to walk (usually an hour or less). You can eat and drink as soon as you are fully awake and can swallow without choking. If a spinal anesthetic was used, you will stay in the recovery room until sensation and movement below your chest returns (usually about an hour). Most people report that this test is not nearly as uncomfortable as they had expected. If a general anesthetic is used, you will feel nothing during the test, but after the anesthetic wears off your muscles may feel tired and achy. Some people experience nausea after receiving a general anesthetic. If a local anesthetic is used, you may feel a burning sensation or an urge to urinate when the instrument is inserted and removed. Also, when your bladder is irrigated with sterile water or saline, you may feel a cool sensation, an uncomfortable fullness, and an urgent need to urinate. Try to relax during the test by taking slow, deep breaths. Also, if the test is lengthy, lying on the table can become tiring and uncomfortable. If a spinal anesthetic is used, you may find it uncomfortable to lie curled up on your side while the anesthetic is injected. You will probably feel a brief stinging sensation when the anesthetic is injected. You may feel tired and have a slight backache the day after the test.

Cystoscopy generally is a very safe test. If a general anesthetic is used, there are some risks of general anesthesia. There is no risk of loss of sexual function. The most common side effect is a temporary swelling of the urethra, which may make it difficult to urinate. A catheter inserted in your bladder can help drain the urine until the swelling goes away. Bleeding sometimes occurs, but it usually stops on its own. You may have a mild infection in the urinary tract after cystoscopy. This can usually be prevented or treated by taking medicine before and after the test. In rare cases, the infection can spread through the body, and in very rare circumstances, usually with seriously ill people, the infection can be life-threatening. Another rare complication is a puncture of the urethra or bladder by one of the instruments, which requires surgery to repair. After the test, you may need to urinate frequently, with some burning during and after urination for a day or two. Drink lots of fluids to help minimize the burning and to prevent a urinary tract infection. A pinkish tinge to the urine is common for several days after cystoscopy, particularly if a biopsy was performed. But call your doctor immediately if: Your urine remains red or you see blood clots after you have urinated several times. You have not been able to urinate 8 hours after the test. You have a fever, chills, or severe pain in your flank or abdomen. These may be signs of a kidney infection. You have symptoms of a urinary tract infection. These symptoms include: o Pain or burning upon urination. o An urge to urinate frequently, but usually passing only small quantities of urine. o Dribbling or leakage of urine. o Urine that is reddish or pinkish, foul-smelling, or cloudy. o Pain or a feeling of heaviness in the lower abdomen. Cystoscopy is a test that allows the doctor to look at the inside of the bladder and the urethra. Your doctor may be able to talk to you about some of the results right after the cystoscopy. The results of a biopsy usually take several days to be available.

HAL Blue-Light Cystoscopy In High-risk Nonmuscle-Invasive Bladder Cancer-Re-TURBT Recurrence Rates In A Prospective, Randomized Study
Our study assesses three rather debatable subjects in bladder cancer: the high-risk patients, the photodynamic diagnostic, and the indications and results of Re-TURBT. Any trial attempting to analyze such matters of discussion must be performed in a prospective, randomized fashion, which we applied in the present study. According to the EAU Guidelines as well as to the most relevant data available in the literature, the high-risk category of bladder cancer patients is the most challenging as far as the diagnostic, treatment and follow-up are concerned [1]. Actually producing a significant impact in recurrence rates for such patients is a quite ambitious goal. In this regard, it may be relevant to mention that there are no published papers on the subject of photodynamic diagnostics in high-risk nonmuscle invasive bladder cancer patients in the literature so far. Consequently, we are confident in the novelty and potential impact of this trial. We performed a single center, prospective, randomized controlled study aiming to assess the impact of hexaminolevulinate (HAL) blue light cystoscopy (BLC) and transurethral resection of bladder tumors (BL-TURBT) upon the residual tumors rate in high-risk non-muscle invasive bladder cancer (HR-NMIBC) patients, through the looking glass of Re-TURBT. A total of 446 patients suspected of bladder cancer were enrolled and randomized under approved, written informed consent. The inclusion criteria consisted of positive urinary cytology and ultrasonographic suspicion of bladder tumors. In one arm, all patients underwent standard and fluorescence cystoscopy, conventional TURBT for all lesions visible in white light, blue light resection for tumors only visible in blue light, and fluorescence control assessing the margins of the resection areas. All patients in the second arm benefited from standard white light cystoscopy (WLC) and resection alone. In accordance with the EAU Guidelines [1] and based on the pathological analysis of the specimens, the high-risk series consisting of CIS, pTaG3 and pT1 cases were defined for both study arms. Standard Re-TURBT was performed 6 weeks after the initial intervention in all highrisk patients. In the blue light group of the trial, the overall NMIBC, CIS, pTa and pT1 patients' detection rates were superior for fluorescence cystoscopy by comparison to WLC. The advantages provided by blue light in terms of diagnostic accuracy emphasized statistical significance for all categories of cases. On the other hand, we also described during the blue light control, a significant proportion of pathologically confirmed fluorescent-positive margins of correctly diagnosed tumors in white light, left behind by the standard resection. The overall residual tumors rate at Re-TURBT was significantly reduced in the blue light group by comparison to the white light group, with an over 20% difference. The residual tumors rate in CIS and pT1 cases were significantly reduced in the HAL-BLC series. However, in spite of a resembling difference in pTaG3 cases, no statistical significant difference was achieved due to the small number of patients presenting this type of tumors.

Also, the short-term recurrence rate in cases of high-grade papillary tumors (pTaG3, pT1G3) was significantly higher in the WLC arm. In patients with initial cases of multiple tumors or tumors larger than 3 cm, fluorescence cystoscopy provided statistically significant advantages by comparison to the standard diagnostic approach. For initial single tumors under 3 cm, no such advantage was determined. So, we may conclude that HAL fluorescence cystoscopy emphasized improved diagnostic accuracy in NMIBC cases by comparison to standard cystoscopy, with superior detection rates and more complete endoscopic resections being achieved in blue light for all categories of tumor stage. Consequently, BLC diagnosed HR-NMIBC patients benefited from significantly reduced short-term residual tumors rates determined during the 6 weeks standard Re-TURBT by comparison to those in which only conventional cystoscopy and resection were initially performed. Future studies will be required in order to establish the long-term recurrence and progression rates as well as the general impact of BLC in HR-NMIBC cases. However, the ability to diagnose and resect with increased accuracy high-risk tumors, known to be associated with an increased potential of progression, seems to have a promisingly favorable impact upon the evolution of such cases.

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