The profile of patients undergoing urethrocystoscopy, urethrocystoscopic findings, and early complicatioms of cytoscopy at Muhimbili National Hospital 2008, Dar es salaam

Abstract

Back ground

Urethrocystoscopy is said to be one of the most precise diagnostic test in evaluation of lower urinary tract, and it is considered as the reference in diagnosis of the bladder tumors. At Muhimbili National Hospital, it is believed to be one of the most common procedures in the Urology Unit with various indications. The pattern of such indications is not well documented. On the other hand the literature on the common urethrocystoscopic findings and its. complications is equally scarce. Title The profile of patients undergoing urethrocystoscopy, urethrocystoscopic findings, and early complications of urethrocystoscopy at Muhimbili National Hospital Dar es Salam Tanzania 2008. Objective To determine the profile of patients undergoing urethrocystoscopy, urethrocystoscopic findings and early complications of urethrocystoscopy at Muhimbili National Hospital Dar es Salam Tanzania 2008. Material and Methods

All patients scheduled for urethrocystoscopy were recruited into the study, clinical indications' from the patients' case notes, were recorded directly into the questionnaire. Urethrocystoscopy with or without biopsy and Bimanual examination were done accordingly, and after consultation with the Specialist the findings were recorded. The patients were followed for early post operative complications (duration ofhemorrhage, pain intensity and fever). Results

One hundred and ten patients were recruited during the study period. There were seventy male patients, giving male to female ratio of 2.3: 1. The commonest age group was 41-60 years (37.3%). The most common clinical indication overall was hematuria in 37.3% of all patients. In males, Bladder outlet obstruction due to stricture was the commonest indication (31.2%). Majority of the patients who presented with hematuria (65.9%) had bladder tumor at. cystoscopy, and most of them were anemic (73.1 %). In this, 59.1 %, 54.5% and 63.6% of

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patients had urinalysis, renal function test and abdominal ultrasound done. In patients with bladder tumor, the ultrasound had sensitivity of 82.8% and specificity of 92.9%.The commonest urethral pathology was stricture (23.9%) and urethral hyperemia (7.3%). Bladder tumor was the most predominant pathology at cystoscopy (31.7%), the common locations were bladder neck, lateral and anterior wall in 74% of cases. Majority of these tumors were. advanced (58.8%), and the common histologies were squamous cell carcinoma (48.2%) and transitional cell carcinoma (24.3%). About 18.5% of the tumors were non neoplastic (chronic non specific inflammation).

Complications included; pain 91.8%, urethral bleeding up to the first day 42.7%,' transient fever 25.5% and urethral injury necessitating suprapubic cystostomy 1.8%. Conclusion Hematuria and bladder outlet obstruction due to stricture are the commonest indications. Urethral stricture and bladder tumor are the commonest urethrocystoscopic findings. Most patients who presented with hematuria had bladder tumor at cystoscopy, and hence the role of urethrocystoscopy in evaluation of these patients can not be over emphasized. Bimanual examination is valuable in staging bladder tumors. The commonest early complications" includes; pain, fever and urethral bleeding. Pain management appears to be serious problem in post cystoscopy period despite the prescription of analgesics. It was also demonstrated that the ultrasound had an important role in the diagnosis of bladder tumors.