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MP06-20 THE FEASIBILITY AND SAFETY EVALUATION OF THE PRESSURE MONITORED AIR CYSTOSCOPY DURING ACTIVE HEMATURIA
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
following radical cystectomy (RC) for bladder cancer in the United States (US) and Japan. METHODS: We reviewed our retrospectively collected database of 2240 patients who underwent RC for bladder cancer at the University of Michigan (n¼1427) and in 21 Japanese institutions (n¼813) between 1997 and 2014. We performed a systematic comparison of clinical factors and perioperative factors and assessed predictors of perioperative morbidity and mortality. Death within 90 days of surgery was the primary outcome. RESULTS: There were a number of apparent differences in between the two study populations (Table 1). Notably, patients treated at the US institution had a significantly greater BMI and higher ASA score. The median postoperative hospital stay was significantly higher at the Japanese institutions (40 days vs. 7 days, p<0.001), and 90-day readmission rates were also significantly lower at the Japanese institutions (0.6% vs. 26.8%, p<0.001). There were a total of 1372/2240 patients (61.2%) with complications within 90 days and 66/2240 patients (2.9%) deaths. Significant predictors of 90-day mortality were older age (OR 1.04, CI 1.01-1.07), higher body mass index (OR 1.07, CI 1.02-1.12), node-positive disease (OR 3.14, CI 1.78-5.47), increased blood loss (OR 1.02, CI 1.01-1.03), and major (Clavien-grade 3 or greater) complication (OR 3.29, CI 1.885.71). Significant predictors of major complications were higher body mass index (OR 1.04, CI 1.02-1.07), higher ASA score (OR 1.35, CI 1.02-1.80), greater number of comorbidities (OR 1.33, CI 1.04-1.69), form of urinary diversion (p¼0.001), increased estimate blood loss (OR 1.02, CI 1.01-1.03) and treatment at the US institution (OR 0.47, CI 0.34-0.65). CONCLUSIONS: Despite major differences in baseline characteristics and care of cystectomy patients between the two study populations, peri-operative mortality rates proved to be comparable.
MP06-20 THE FEASIBILITY AND SAFETY EVALUATION OF THE PRESSURE MONITORED AIR CYSTOSCOPY DURING ACTIVE HEMATURIA Yu Fan*, Yu Wang, Lin Yao, Wei Yu, Qian Zhang, Jie Jin, Yu Fan, Beijing, China, People’s Republic of INTRODUCTION AND OBJECTIVES: Air cystoscopy is superior to water cystoscopy for the diagnosis during under some poor conditions, especially active hematuria. But a transient high intravescial pressure may raise the risk of air embolism into an open veinlet, especially during hematuria. This study added the pressure measurement to classical air cystoscopy and evaluated its feasibility and safety. METHODS: Two independent observers prospectively studied consecutive patients with active hematuria at Peking University First Hospital from January 2014 to September 2015. The patients underwent the conventional water cystoscopy by first observer and then switched to the pressure monitored air cystoscopy by second observer. The sequence of the observers was prospectively randomized. Two observers noted the visual definition and diagnostic findings independently. A Cuff Pressure Gauge was used to air irragation and measure the intravesical pressure during the air cystoscopy. The pressure was recorded by an urodynamic measurement at the same time. The mean and maxium intravescial pressure and examination duration was documented. When the examination finished, all patients were observed at least 60 min for possible complications. The results under two cystoscopic methods were tested using the Wilcoxon rank test. RESULTS: Total 82 patients with active hematuria were undertook the compared cystoscopy study. Sixty-two patients were indicated for bladder tumor post-operation fellow-up screening, others were for unknown originate hematuria. Air cystoscopy had the higher visual definition score than water cystoscopy during active hematuria (1.8 vs 0.2, p¼0.02). The cause of bleeding was clearly identified on water cystoscopy in 8 patients (9.7%), including tumors in 2 and prostate bleeding in 6, and by air cystoscopy in 71 (86.6%), including tumors in 57, prostate bleeding in 12 and radiocystitis in 2. The mean and maxium intravesical pressure were 7(0-12 cmH2O) and 12 cmH2O (10-22 cmH2O). The median air cystoscopy examination duration lasted 3.6min(2-9min). No complication specifically related to air cystoscopy was noted. CONCLUSIONS: Air cystoscopy is superior to water cystoscopy for the diagnosis of active hematuria. A pressure monitored air cystoscopy provided an additional safety guard of classical air cystoscopy. It is feasible and safety to alternate to a pressure monitored air cystoscopy when water cystoscopy encountered with a poor vision. Source of Funding: None
Source of Funding: None
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Vol. 195, No. 4S, Supplement, Friday, May 6, 2016
following radical cystectomy (RC) for bladder cancer in the United States (US) and Japan. METHODS: We reviewed our retrospectively collected database of 2240 patients who underwent RC for bladder cancer at the University of Michigan (n¼1427) and in 21 Japanese institutions (n¼813) between 1997 and 2014. We performed a systematic comparison of clinical factors and perioperative factors and assessed predictors of perioperative morbidity and mortality. Death within 90 days of surgery was the primary outcome. RESULTS: There were a number of apparent differences in between the two study populations (Table 1). Notably, patients treated at the US institution had a significantly greater BMI and higher ASA score. The median postoperative hospital stay was significantly higher at the Japanese institutions (40 days vs. 7 days, p<0.001), and 90-day readmission rates were also significantly lower at the Japanese institutions (0.6% vs. 26.8%, p<0.001). There were a total of 1372/2240 patients (61.2%) with complications within 90 days and 66/2240 patients (2.9%) deaths. Significant predictors of 90-day mortality were older age (OR 1.04, CI 1.01-1.07), higher body mass index (OR 1.07, CI 1.02-1.12), node-positive disease (OR 3.14, CI 1.78-5.47), increased blood loss (OR 1.02, CI 1.01-1.03), and major (Clavien-grade 3 or greater) complication (OR 3.29, CI 1.885.71). Significant predictors of major complications were higher body mass index (OR 1.04, CI 1.02-1.07), higher ASA score (OR 1.35, CI 1.02-1.80), greater number of comorbidities (OR 1.33, CI 1.04-1.69), form of urinary diversion (p¼0.001), increased estimate blood loss (OR 1.02, CI 1.01-1.03) and treatment at the US institution (OR 0.47, CI 0.34-0.65). CONCLUSIONS: Despite major differences in baseline characteristics and care of cystectomy patients between the two study populations, peri-operative mortality rates proved to be comparable.
MP06-20 THE FEASIBILITY AND SAFETY EVALUATION OF THE PRESSURE MONITORED AIR CYSTOSCOPY DURING ACTIVE HEMATURIA Yu Fan*, Yu Wang, Lin Yao, Wei Yu, Qian Zhang, Jie Jin, Yu Fan, Beijing, China, People’s Republic of INTRODUCTION AND OBJECTIVES: Air cystoscopy is superior to water cystoscopy for the diagnosis during under some poor conditions, especially active hematuria. But a transient high intravescial pressure may raise the risk of air embolism into an open veinlet, especially during hematuria. This study added the pressure measurement to classical air cystoscopy and evaluated its feasibility and safety. METHODS: Two independent observers prospectively studied consecutive patients with active hematuria at Peking University First Hospital from January 2014 to September 2015. The patients underwent the conventional water cystoscopy by first observer and then switched to the pressure monitored air cystoscopy by second observer. The sequence of the observers was prospectively randomized. Two observers noted the visual definition and diagnostic findings independently. A Cuff Pressure Gauge was used to air irragation and measure the intravesical pressure during the air cystoscopy. The pressure was recorded by an urodynamic measurement at the same time. The mean and maxium intravescial pressure and examination duration was documented. When the examination finished, all patients were observed at least 60 min for possible complications. The results under two cystoscopic methods were tested using the Wilcoxon rank test. RESULTS: Total 82 patients with active hematuria were undertook the compared cystoscopy study. Sixty-two patients were indicated for bladder tumor post-operation fellow-up screening, others were for unknown originate hematuria. Air cystoscopy had the higher visual definition score than water cystoscopy during active hematuria (1.8 vs 0.2, p¼0.02). The cause of bleeding was clearly identified on water cystoscopy in 8 patients (9.7%), including tumors in 2 and prostate bleeding in 6, and by air cystoscopy in 71 (86.6%), including tumors in 57, prostate bleeding in 12 and radiocystitis in 2. The mean and maxium intravesical pressure were 7(0-12 cmH2O) and 12 cmH2O (10-22 cmH2O). The median air cystoscopy examination duration lasted 3.6min(2-9min). No complication specifically related to air cystoscopy was noted. CONCLUSIONS: Air cystoscopy is superior to water cystoscopy for the diagnosis of active hematuria. A pressure monitored air cystoscopy provided an additional safety guard of classical air cystoscopy. It is feasible and safety to alternate to a pressure monitored air cystoscopy when water cystoscopy encountered with a poor vision. Source of Funding: None
Source of Funding: None
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