الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Bladder cancer is the 9th most common cancer in the world,
with 430,000 new cases diagnosed in 2012. It is three times more
common in men compared with women. While smoking is a
major cause of bladder cancer, also Infestations with schistosomes
(particularly Schistosoma haematobium) is a cause of this cancer
especially in middle- and low-income countries like Egypt which
is the 10th highest country in the incidence of bladder cancer with
13.1 cases per 100.000
Bladder cancer has the highest lifetime treatment costs per
patient of all cancers, Although most patients present with
NMIBC, the high rate of recurrence and disease progression
necessitates cautious long-term monitoring for BC patients. The
economic burden of BC underscores the importance of optimizing
diagnosis and treatment protocols.
Conventional cystoscopy is the gold standard for the
detection and surveillance of NMIBC however, this procedure is
costly and invasive for the patient.
Due to the above mentioned drawbacks there would be
considerable benefit in examining the bladder internally without
using cystoscopy as the first screening step. With recent advances
in imaging the virtual computer based 3D volume rendering
technique allows systematic visualization of the bladder wall and
its layers. Simulating conventional cystoscopy.
The main goal of VC was to develop a non-invasive
diagnostic tool that would be easily tolerated by the majority of
patients, producing images similar to those acquired by the
conventional endoscopy. Urinary bladder is an appropriate organ
for virtual endoscopy because of its simple luminal morphology,
its relatively small volume and the absence of involuntary
peristalsis.
In our study, we tried to investigate the utility of the 3D
virtual sonographic cystoscopy in the detection of the bladder
lesions, and the possibility of its usage in the follow up of patients
with non muscle invasive bladder cancer and compared the
findings to 2D Ultrasonography and the gold standard
conventional cystoscopy.
3D US of the bladder was done using a freehand technique.
The examiner moved the transducer with a steady, smooth motion
and only the angle of the transducer was changed. After scanning,
the software automatically created 3D volume data sets. To
examine the bladder surface, multiplanar reconstruction (MPR)
with different planes was performed manually and reviewed.
Our study included 50 Patients either presented with
hematuria or have suspicious lesions or inconclusive readings by
2D ultrasonography, and those scheduled for follow up
cystoscopy after previous superficial bladder tumor resection. All
underwent 2D ultrasound examination, 3D virtual cystoscopy and
conventional cystoscopy which was considered the standard
investigation and used as a reference.
An excellent overview of the bladder masses was obtained
in all cases and 3D virtual cystoscopy proved to be superior to 2D
Ultrasonography in tumor detection. The high sensitivity rates
were comparable to those obtained by other virtual techniques
(CT and MRI) and by conventional cystoscopy.
3D virtual cystoscopy had sensitivity of (96.5%); while its
specificity in identifying lesions was (85.7%), positive predictive
values: (96.5%), negative predictive value: (85.7%).The
sensitivity of the 2D ultrasound was (77.2%); while its specificity
in identifying lesions was (57.1%), positive predictive values:
(88%), negative predictive value: (38.1%).
As a minimally invasive procedure, virtual cystoscopy
provides many advantages. It is less time consuming than
conventional cystoscopy and allows accurate localization of a
lesion due to its wide field of view.
Patients with a severe urethral stricture or marked prostatic
hypertrophy, who may be poor candidates for conventional
cystoscopy, can safely undergo virtual cystoscopy.
Virtual cystoscopy has some limitations, the most important
being its inability to show flat or intramural lesions (carcinoma in
situ), which appear as subtle mucosal color changes on
conventional cystoscopy. Also it does not allow biopsy for
histologic evaluation.