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OBJECTIVETo evaluate the possible benefit of fluorescence cystoscopy (FC) in detecting cytologically ‘confirmed’ lesions when assessing urothelial carcinoma of the bladder, as negative white‐light cystoscopy in cases of a positive cytological finding represents a diagnostic dilemma.PATIENTS AND METHODSFrom January 1996 to December 2006, 348 patients, who had cystoscopy for surveillance or due to suspicion of urothelial carcinoma, presented with an entirely negative white‐light cystoscopy at our hospital. However, 77 of the 348 patients (22.2%) were diagnosed with a positive cytological finding. All patients had white‐light cystoscopy first and a bladder‐wash cytological specimen was obtained, then FC, followed by cold‐cup biopsies and/or transurethral resection of the bladder tumour.RESULTSIn the 77 patients with a positive cytological specimen FC enabled the detection of the precise site of malignancy within the bladder in 63 (82%). As malignant or premalignant lesions, there were 18 moderate dysplasias, 27 carcinoma in situ (CIS), and 18 pTa‐1/G1‐3 tumours. Moreover using FC, malignant or premalignant lesions were detected in 43 of 271 patients (15.9%) who had a negative cytological specimen (15 moderate dysplasias, six CIS, 22 pTa‐1/G1‐3).CONCLUSIONThis study shows that FC is beneficial in the detection of malignant and premalignant lesions, if there is negative white‐light cystoscopy but positive urine cytology. The immediate identification of the exact site of a malignant lesion during FC enables the physician to diagnose and treat these patients more accurately and with no delay.

Study Type – Therapy (case series)
Level of Evidence 4 OBJECTIVES To determine the impact of previous inguinal mesh hernia repair (IMHR) on the performance of subsequent open radical retropubic prostatectomy (ORRP). PATIENTS AND METHODS A total of 1466 patients underwent ORRP for clinically localized prostate cancer from 2004 to 2008; 51 patients (3.5%) presented with a history of IMHR. Body‐mass index (BMI), perioperative blood loss (PBL), operating time (OT), performance of pelvic lymph node dissection (PLD), positive resection‐margins (R1), continence and potency between the groups were analysed using Mann–Whitney U and χ2 tests. RESULTS Fifty‐one patients with previous IMHR were compared with 1466 patients without previous mesh implantation (nMI) who underwent ORRP. Mean age was 66.8 years and mean BMI 25.7. No statistically difference in the mean OT (68 vs 72 min, P= 0.112), mean PBL (167 vs 156 ml, P= 0.089) or R1 was observed in the pT2‐stage tumors (3% vs 9.7%, P= 0.197), or in the pT3‐stage tumors (16% vs 21%, P= 0.386). After 3 months 85% showed full continence in the nMI group vs 83.9% MI group (P= 0.864) and after 12 months 94.5% of the nMI patients vs 97.6% with mesh (P= 0.610). The IIEF‐5 score after 3 months showed a median of 9.0 in the MI group and 4.5 in the nMI group (P= 0.116) and after 12 months 12.0 in the MI group and 9.0 in the nMI group (P= 0.511). PLD was significantly more feasible in patients that underwent only unilateral IMHR compared with bilateral IMHR (96% vs 40%, P= 0.001) and significantly less feasible if previous IMHR was operated laparoscopically than with an open access (47% vs 88%, P= 0.014). CONCLUSION No impairment of perioperative variables or functional outcome during ORRP was observed in patients with IMHR. PLD could be performed in a significantly fewer patients who underwent bilateral IMHR or laparoscopic IMHR.

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