Pannek Jürgen, Rademacher Franziska, Wöllner Jens
Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.
Res Rep Urol. 2017 Dec 1;9:219-223. doi: 10.2147/RRU.S148429. eCollection 2017.
Screening for bladder cancer in patients with neurogenic lower urinary tract dysfunction is a challenge. Cystoscopy alone is not sufficient to detect bladder tumors in this patient group. We investigated the usefulness of combined cystoscopy and urine cytology.
By a systematic chart review, we identified all patients with neurogenic lower urinary tract dysfunction who underwent combined cystoscopy and urine cytology testing. In patients with suspicious findings either in cytology or cystoscopy, transurethral resection was performed.
Seventy-nine patients (age 54.8±14.3 years, 38 female, 41 male) were identified; 44 of these used indwelling catheters. Cystoscopy was suspicious in 25 patients and cytology was suspicious in 17 patients. Histologically, no tumor was found in 15 patients and bladder cancer was found in 6 patients. Sensitivity for both cytology and cystoscopy was 83.3%; specificity was 43.7% for cytology and 31.2% for cystoscopy. One bladder tumor was missed by cytology and three tumors were missed by cystoscopy. If a biopsy was taken only if both findings were suspicious, four patients would have been spared the procedure, and one tumor would not have been diagnosed.
A combination of cystoscopy and urine cytology can improve bladder tumor detection rates and lower the number of unnecessary biopsies.
对神经源性下尿路功能障碍患者进行膀胱癌筛查是一项挑战。仅靠膀胱镜检查不足以在该患者群体中检测出膀胱肿瘤。我们研究了膀胱镜检查与尿液细胞学检查联合应用的有效性。
通过系统的病历回顾，我们确定了所有接受膀胱镜检查与尿液细胞学检查联合检测的神经源性下尿路功能障碍患者。对于细胞学检查或膀胱镜检查有可疑发现的患者，进行经尿道切除术。
共确定了79例患者（年龄54.8±14.3岁，女性38例，男性41例）；其中44例使用留置导尿管。膀胱镜检查有可疑发现的患者有25例，细胞学检查有可疑发现的患者有17例。组织学检查发现，15例患者未发现肿瘤，6例患者发现膀胱癌。细胞学检查和膀胱镜检查的敏感性均为83.3%；细胞学检查的特异性为43.7%，膀胱镜检查的特异性为31.2%。细胞学检查漏诊了1例膀胱肿瘤，膀胱镜检查漏诊了3例肿瘤。如果仅在两项检查结果均可疑时才进行活检，4例患者可避免该手术，1例肿瘤将无法被诊断。
膀胱镜检查与尿液细胞学检查联合应用可提高膀胱肿瘤的检出率，并减少不必要的活检数量。
