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

Introduction: Patients with gross haematuria have higher incidence of (30 percent) urothelial cancer. Currently recommended investigations for haematuria evaluation are CT scan, urine cytology, Cystoscopy. Virtual endoscopy (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 6 cm were included in the study, but later tumors less than 5 cm only were studied. Observation and Results: Totally 106 patients were evaluated. Of these 54 patients were included in the study as they had a bladder tumor detected by cystoscopy and/or Ultrasonography 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: Despite 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 1 cm 2. Not able to detect CIS. Inferior to conventional cystoscopy in detecting 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 risk patients.