RSS-Feed abonnieren
DOI: 10.1055/a-1867-0560
Zystoskopien in der urologischen Praxis – was muss ich beachten?
Cystoscopy in the outpatient clinical routine: things to keep in mind
Zusammenfassung
Die Urethrozystoskopie ist ein wichtiges diagnostisches Werkzeug zur Abklärung des unteren Harntraktes. Die Standardzystoskopie (Weißlicht) wird fortwährend weiterentwickelt, moderne Endoskope und Videosysteme stehen zur Verfügung. Unterstützende Verfahren wie die photodynamische Diagnostik (PDD), narrow band imaging (NBI) oder digitale Kontrastverstärkungen verbessern die Detektionsrate von Blasentumoren. Besondere Bedeutung im Praxisalltag haben eine korrekte Indikationsstellung, die sorgfältige Vorbereitung und Aufklärung der Patienten und eine fachliche Expertise bei der Durchführung der Untersuchung, um Beschwerden und Komplikationen zu minimieren und zielführende Befunde zu erheben. Die Hygieneanforderung an Aufbereitung und Infrastruktur werden derzeit im Vergütungssystem nicht adäquat abgebildet. Technische Bildverarbeitung und Systeme mit künstlicher Intelligenz (KI) haben das Potential den Urologen bereits während der Untersuchung zu unterstützen.
Abstract
Cystoscopy is an important procedure in the diagnostic evaluation of the lower urinary tract. Standard cystoscopy (white light) undergoes permanent improvement. High-end instruments and video systems are available, supported by PDD (photodynamic diagnostic), NBI (narrow band imaging) and digital contrast enhancement to improve the detection rate of bladder cancer. A correct indication, careful patient education and high expertise are core competencies of our daily business needed to minimise discomfort, keep the complication rate as low as possible and find the correct diagnosis. A severe mismatch is seen between the hygiene requirements in instrument preparation and infrastructure on the one hand and payment on the other. Digital image processing and artificial intelligence will raise the procedure to the next level in the future.
Publikationsverlauf
Eingereicht: 31. Mai 2022
Angenommen nach Revision: 26. September 2022
Artikel online veröffentlicht:
09. November 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Kremling H. Die Zystoskopie – Historische Betrachtungen. Würzburger medizinhistorische Mitteilungen 1993; 11: 5-8
- 2 Cina SJ, Epstein JI, Endrizzi JM. et al. Correlation of cystoscopic impression with histologic diagnosis of biopsy specimens of the bladder. Hum Pathol 2001; 32: 630-637 DOI: 10.1053/hupa.2001.24999. (PMID: 11431718)
- 3 Borin JF, Abdelshehid CS, Clayman RV. Comparison of resolution, contrast, and color differentiation among fiberoptic and digital flexible cystoscopes. J Endourol 2006; 20: 54-58 DOI: 10.1089/end.2006.20.54. (PMID: 16426134)
- 4 Burger M, Grossman HB, Droller M. et al. Photodynamic diagnosis of non-muscle-invasive bladder cancer with hexaminolevulinate cystoscopy: a meta-analysis of detection and recurrence based on raw data. Eur Urol 2013; 64: 846-854 DOI: 10.1016/j.eururo.2013.03.059. (PMID: 23602406)
- 5 Rink M, Babjuk M, Catto JW. et al. Hexyl aminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: a critical review of the current literature. Eur Urol 2013; 64: 624-638 DOI: 10.1016/j.eururo.2013.07.007. (PMID: 23906669)
- 6 Zheng C, Lv Y, Zhong Q. et al. Narrow band imaging diagnosis of bladder cancer: systematic review and meta-analysis. BJU Int 2012; 110: 680-687 DOI: 10.1111/j.1464-410X.2012.11500.x. (PMID: 22985502)
- 7 Naito S, Algaba F, Babjuk M. et al. The clinical research office of the Endourological society (CROES) multicentre randomised trial of narrow band imaging-assisted transurethral resection of bladder tumour (TURBT) versus conventional white light imaging-assisted TURBT in primary non-muscle-invasive bladder cancer patients: trial protocol and 1year results. Eur Urol 2016; 70: 506-515
- 8 Drejer D, Beji S, Oezeke R. et al. Comparison of white light, photodynamic diagnosis, and narrow-band imaging in detection of carcinoma in situ or flat dysplasia at transurethral resection of the bladder: the DaBlaca8 study. Urology 2017; 102: 138-142 DOI: 10.1016/j.urology.2016.11.032. (PMID: 27894979)
- 9 Kranz J, Schmidt S, Lebert C. et al. The 2017 update of the German clinical guideline on epidemiology, diagnostics, therapy, prevention, and management of uncomplicated urinary tract infections in adult patients: part 1. Urol Int 2018; 100: 263-270 DOI: 10.1159/000486138.
- 10 Kranz J, Schmidt S, Lebert C. et al. The 2017 update of the German clinical guideline on epidemiology, diagnostics, therapy, prevention, and management of uncomplicated urinary tract infections in adult patients. Part II: therapy and prevention. Urol Int 2018; 100: 271-278 DOI: 10.1159/000487645. (PMID: 29539622)
- 11 Flannigan GM, Gelister JSK, Nobel JG. et al. Rigid versus Flexible Cystoscopy A Controlled Trial of Patient Tolerance. Br J Urol 1988; 62: 537-540 (PMID: 23311016)
- 12 Aaronson DS, Walsh TJ, Smith JF. et al. Meta-analysis: does lidocaine gel before flexible cystoscopy provide pain relief?. BJU Int 2009; 104: 506-509 DOI: 10.1111/j.1464-410X.2009.08417.x. (PMID: 19239453)
- 13 Rappaport YH, Beberashvili I, Zismanet A. et al. Is meatal analgesia necessary for pain reduction during cystoscopy in females? A prospective randomised study. Urology 2020; 146: 79-82 DOI: 10.1016/j.urology.2020.08.052..
- 14 Calleary JG, Masood J, Van-Mallaerts R. et al. Nitrous oxide inhalation to improve patient acceptance and reduce procedure related pain of flexible cystoscopy for men younger than 55 years. J Urol 2007; 178: 184-188 DOI: 10.1016/j.juro.2007.03.036. (PMID: 17499771)
- 15 Soomro KQ, Nasir AR, Ather MH. Impact of patient's self-viewing of flexible cystoscopy on pain using a visual analog scale in a randomized controlled trial. Urology 2011; 77: 21-23 (PMID: 32468766)
- 16 Cornel EB, Oosterwijk E, Kiemeney LA. The effect on pain experienced by male patients of watching their office-based flexible cystoscopy. BJU Int 2008; 102: 1445-1446 DOI: 10.1111/j.1464-410X.2008.07777.x. (PMID: 18540935)
- 17 Zhang Z, Tang L, Wang X. et al. Seeing is believing: a randomized controlled study from China of real-time visualization of flexible cystoscopy to improve male patient comfort. J Endourol 2011; 25: 1343-1346 DOI: 10.1089/end.2011.0084. (PMID: 21745113)
- 18 Gunendran T, Briggs RH, Wemyss-Holden GD. et al. Does increasing hydrostatic pressure ("bag squeeze") during flexible cystoscopy improve patient comfort: a randomized, controlled study. Urology 2008; 72: 255-258 DOI: 10.1016/j.urology.2008.02.072. (PMID: 18554699)
- 19 Hetou K. et al. A Randomized Controlled Trial of a Modified Cystoscopy Technique using the Peak-End Rule in order to Improve Pain and Anxiety. Urology 2021; DOI: 10.1016/j.urology.2021.02.033. (PMID: 33716036)
- 20 Burke DM, Shackley DC, O’Reilly PH. The community-based morbidity of flexible cystoscopy. BJU Int 2002; 89: 347-349 DOI: 10.1046/j.1464-4096.2001.01899.x. (PMID: 11872022)
- 21 Johnson MI, Merrilees D, Robson WA. et al. Oral ciprofloxacin or trimethoprim reduces bacteriuria after flexible cystoscopy. BJU Int 2007; 100: 826-829 DOI: 10.1111/j.1464-410X.2007.07093.x. (PMID: 17822463)
- 22 Wilson L, Ryan J, Thelning C. et al. Is antibiotic prophylaxis required for flexible cystoscopy? A truncated randomized double-blind controlled trial. J Endourol 2005; 19: 1006-1008 DOI: 10.1089/end.2005.19.1006. (PMID: 16253070)
- 23 Anforderungen an die Hygiene bei der Aufbereitung von Medizinprodukten Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI) und des Bundesinstitutes für Arzneimittel und Medizinprodukte (BfArM). Bundesgesundheitsbl 2012; 55: 1244-1310 DOI: 10.1007/s00103-012-1548-6.
- 24 Kollenbach P, Kühne P, Rulf W. et al. Zystoskopieaufbereitung in der Praxis niedergelassener Urologen. Handreichung des Berufsverbandes der Deutschen Urologen. 2. aktualisierte Auflage. Stand Juni 2019.
- 25 Kassenärztliche Bundesvereinigung: EBM-Ziffern. Zugriff am 28. August 2022 unter: https://www.kbv.de/tools/ebm/html/26310_2901472495658532524736.html
- 26 Kriegmair MC, Hein S, Schoeb DS. et al. Erweiterte Bildgebung in der urologischen Endoskopie. Urologe A 2021; 60: 8-18 DOI: 10.1007/s00120-020-01400-9.. (PMID: 33301070)