Comparison of virtual endoscopy and transabdominal ultrasound with conventional endoscopy in patients with hematuria

Introducation: Patients with gross haematuria have higher incidence of (30 percent) urothelial cancer Currently recommended investigation of haematuria evaluation are CT scan, urine cytology Cystoscopy. Virtual endeoscopy (VE) is a 3D computer rendering technique with the possibility of interactive intraluminal navigation within the bladder simulating a conventional endoscopy. Aim and Objective: To Compare Virtual Endoscopy (VE) and Trans-abdominal ultrasound with Conventional Cystoscopy (CC), in the detection of bladder tumors in patients with haematuria. Materials and Methods: Study was conducted from November 2007 to January 2010 in our institute of urology. All patients with haematuria were evaluated and those having a bladder tumor included in the study. Initially few patients with tumors more than 6cm were included in the study, but later tumors less than 5cm only were studied.Observation and Results: Totally 106 patients were evaluatee. Of these 54 patients were included in the study as they had a bladder tumor detected by cystoscopy and/ or Ultrasonograph and / or Virtual cystoscopy or there were no tumor. Of the 54 patients in the study 38 (70.4%) were males and 16 (29.6 %) females. Most of the tumors were located in the anterior wall (18/51) and the posterior wall (13/51). Most of the tumors were papillary (82.4 %) type, probably as we included small sized tumors in the study. Virtual cystoscopy has a high sensitivity, 92.16 % and 100 % sensitivity to tumors more than 1 cm. But this is still inferior to conventional cystoscopy. Conclusion: Depite the obvious benefits of virtual cystoscopy in terms of less invasiveness and more comfort to the patient, it has several limitations. These include, 1. Low detection rate for lesions smaller than 1cm 2. Not able to detect CIS Inferior to conventional cystoscopy in detection bladder lesions. So Virtual cystoscopy cannot replace conventional cystoscopy. It may have a place in the evaluation of patients with haematuria in stricture disease and surgically poor rist patients.