Zien is geloven - videodatabase met NBI-ingrepen

Op de volgende pagina krijgt u toegang tot een grote database met video-opnamen uit de klinische praktijk, opgenomen door prof. Traxer en prof. Bjerggaard. Aangezien NBI een geavanceerde beeldvormingstechniek betreft, is het duidelijk dat korte video's van ingrepen het beste kunnen uitleggen hoe de technologie kan bijdragen aan een nauwkeuriger diagnose van kanker.

NBI bij flexibele cystoscopie

Op de volgende pagina's vindt u zorgvuldig geselecteerde video's die de klinische voordelen laten zien die HD-NBI kan bieden bij flexibele cystoscopie-ingrepen. Het maakt niet uit of het gaat om de initiële diagnose of follow-up-cystoscopieën; door met één druk op de knop NBI in te schakelen, krijgt u extra relevante informative waarvan u eerder niet op de hoogte was.

De video-atlas is bedoeld om de gepubliceerde klinische onderzoeken die de voordelen van verbeterde detectie en een kleiner risico op herhaling aantonen, praktisch te ondersteunen. Het is de bedoeling urologen die HD-NBI in hun praktijk willen integreren, te helpen. De vraag die deze video-atlas specifiek wil beantwoorden is: "Wat zie ik nu echt met NBI?".

Om deze te beantwoorden, heeft professor Jörgen Bjerggaard Jensen van het Skejby universitaire centrum in Aarhus, Denemarken verschillende flexibele cystoscopieën in zijn dagelijkse polikliniek opgenomen. Deze video's zijn gegroepeerd volgens de blaaskankerclassificatie zodat u begrijpt hoe verschillende tumoren en verdachte gebieden eruit zien in NBI-licht in vergelijking met conventioneel wit licht.

Voor deze opnamen is gebruik gemaakt van flexibele cystoscopen van type CYF-VH en CYF-VH2 van Olympus in combinatie met de nieuwste systemen voor beeldvorming. Hieronder vindt u meer informatie.

HG Ta Visualized by NBI in Follow-Up Cystoscopy

HG Ta Visualized by NBI in Follow-Up Cystoscopy

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Conclusion

First, a small papilloma is seen in white light. Afterwards, the same papilloma is seen in NBI and the typical frog egg configuration stands out clearly.

Patient Background:

Male, age: 77

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

HG, Ta, no CIS

Treatment:

Biopsy of a papilloma

TimeChapter
00:03Papilloma seen in white light
00:16Switch between white light and NBI
00:39Biopsy

NBI Highlighting Two Satellite Lesions

NBI Highlighting Two Satellite Lesions

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Conclusion

The area with the papillomatosis appears wider with a clearer demarcation in NBI. Furthermore using NBI, two additional small tumors are identified in the top of the bladder close to the larger papilloma seen in both white light and NBI.

Patient Background:

Female, age: 62

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

HG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

HG, Ta, no CIS

Treatment:

The patient was referred to TUR-B

TimeChapter
00:03Two papillomas and a red elevated area seen in white light
00:36Same areas seen in NBI, note the additional findings
00:40White light procedure
00:49NBI procedure, note the additional findings

Extremely Clear Visualization of LG Ta Lesion

Extremely Clear Visualization of LG Ta Lesion

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Conclusion:

The papillomatosis is identified first in white light. NBI enhanced the contrast between normal mucosa and the area with papillomatosis.

Patient Background:

Female, age: 74

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

HG, Ta, no CIS

Treatment:

Biopsy and coagulation

TimeChapter
00:07White light cystoscopy
00:36Switch between NBI and white light

NBI Helps Confirm Non-Malignancy

NBI Helps Confirm Non-Malignancy

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Conclusion

Several red spots are seen in white light. Note the absence of additional capillary density and frog eggs configuration. Overall, the red spots did not appear malignant in NBI.

Patient Background:

Male, age: 73

Reason for Cystoscopy:

Hematuria

Previous history of BC:

No previous tumor. No previous CIS. No previous BCG.

Cytology:

No tumor cells.

Path outcome:

No tumor

Treatment:

No malignancy was found in the biopsy.

TimeChapter
00:03White light procedure
00:31NBI procedure
00:34White light procedure
00:39NBI procedure
00:53White light procedure

Suspicious Area in White Light Identified as Non-Suspicious Using NBI

Suspicious Area in White Light Identified as Non-Suspicious Using NBI

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Conclusion

Red elevated areas are seen up-close in white light and afterwards in NBI. The switching between the two modalities can be helpful in making a clinical decision.

Patient Background:

Male, age: 78

Reason for Cystoscopy:

Follow-up of NMIBC

Previous History of BC:

Previous CIS. Last recurrence 18 months ago. Previous BCG treatment.

Cytology:

No tumor cells

Treatment:

No malignancy was found in the biopsy.

TimeChapter
00:22Red area seen in NBI, inflammation?
00:26NBI procedure
00:31White light procedure

Cystitis Confirmed by NBI

Cystitis Confirmed by NBI

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Conclusion

Using NBI confirms that the red areas are not considered malignant, but most likely due to recent cystitis. There are no frog egg configurations or angiogenesis.

Patient Background:

Male, age: 72

Reason for Cystoscopy:

Follow-up of NMIBC

Previous History of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells.

Path outcome:

No tumor.

Treatment:

No biopsy. The patient had a cystitis and was treated with relevant antibiotics.

TimeChapter
00:12NBI procedure
00:15White light procedure
00:21NBI procedure

Chronic Inflammation

Chronic Inflammation

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Conclusion

The trigonum of the bladder is shown in both white light and NBI. Note the absence of frog eggs configuration. The confirmatory biopsy shows no malignancy.

Patient Background

Female, age: 68

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, previous CIS. Last recurrence 24 months ago. Previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

No tumor

Treatment:

No treatment initiated

Time Chapter00:05
00:05Trigonum in NBI and white light. Inflammation or papilloma?
00:30Biopsy

Superior NBI Result with Empty Bladder

Superior NBI Result with Empty Bladder

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Conclusion:

Please note the improved quality of NBI after emptying the bladder. When the bladder is filled with saline instead of urine, the contrast between the small vessels and mucosa is enhanced.

Patient Background:

Male, age: 69

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG. Ta. No previous CIS. Last recurrence 12 months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

No tumor

Treatment:

Conventional cystoscopy

TimeChapter
00:07White light procedure
00:10NBI procedure

Air Bubble Effect during Cystoscopy

Air Bubble Effect during Cystoscopy

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Conclusion:

Several papillomas visible in white light. Accidental multiple air bubbles through the cystoscopy when emptying and filling the bladder with saline to get a better view in NBI. Surprisingly, the papillomas appeared even clearer through the air bubble and revealed an additional tiny papilloma. Of course, intentional large amounts of air inside the bladder is not recommended.

Patient Background:

Male, age: 74

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

HG. Ta. No previous CIS. Last recurrence 4 months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, LG.

Treatment:

Referred to TURBT

TimeChapter
00:35NBI procedure, papillomas seen through air bubbles
00:38NBI procedure
00:50White light procedure
00:59NBI procedure
01:20White light procedure

NBI-Guided Coagulation

NBI-Guided Coagulation

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Conclusion:

NBI improves the visualization and distinction between normal and pathological tissue. This video shows NBI-guided electrocoagulation.

Patient Background:

Female, age: 72

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG. Ta. No previous CIS. Last recurrence four months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, LG.

Treatment:

Biopsy and NBI-guided coagulation

TimeChapter
00:03NBI procedure, biopsy
00:13First NBI-guided coagulation

NBI Highlighting Several Recurrences Unseen in White Light

NBI Highlighting Several Recurrences Unseen in White Light

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Conclusion:

The white light cystoscopy first appears to be normal. But small recurrences were identified using NBI in the second-look cystoscopy.

Patient Background:

Female, age: 72

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence 24 months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

LG, Ta, no CIS

Treatment:

Biopsy and coagulation

TimeChapter
00:06White light procedure
00:31NBI procedure
00:41Switch between NBI and white light

Frog Eggs Effect Visualized by NBI

Frog Eggs Effect Visualized by NBI

Sluit

Conclusion:

Multiple red areas in white light become darker and more enhanced in NBI. Note the optical enhancement of the vessels, the papillomas, and normal mucosa.

Patient Background:

Male, age: 83

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

LG, Ta, no CIS

Treatment:

Referred to TUR-B

TimeChapter
00:03White light cystoscopy, multiple red spots
00:07White light procedure
00:21NBI cystoscopy, multiple papillomas
00:24NBI procedure
00:39Switch between NBI and white light

Frog Eggs Configuration in CIS

Frog Eggs Configuration in CIS

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Conclusion:

White light cystoscopy finds the mucosa reddish and elevated on the left side bladder wall. Only in NBI does the papillomatosis appear with the typical frog eggs configuration.

Patient Background:

Male, age: 67

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Previous CIS. Last recurrence four months ago. Previous BCG.

Cytology:

No tumor cells

Path outcome:

CIS

Treatment:

Referred to TUR-BT

TimeChapter
00:03White light cystoscopy, red area on the left bladder wall
00:06White light procedure
00:35Same area in NBI, note the frog eggs
00:39NBI procedure

Flat Lesion at the Posterior Wall

Flat Lesion at the Posterior Wall

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Conclusion:

The video is the same as shown before with the two satellite tumors in the top of the bladder next to the larger papilloma. The thickened reddish area in the posterior bladder wall is a non-invasive high-grade papillary urothelial carcinoma.

Patient Background:

Female, age: 62

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, HG, dysplasia

Treatment:

Biopsy and coagulation of lesion

TimeChapter
00:03White light procedure, flat lesion on the posterior bladder wall
00:06White light procedure
00:14NBI procedure
00:17White light procedure
00:38NBI procedure

NBI Highlighting Hypervascularization of Papillomas

NBI Highlighting Hypervascularization of Papillomas

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Conclusion:

The visualization of two small red areas on the left side of the bladder is enhanced using the NBI technique. The larger papilloma on the right side is visible in both modalities.

Patient Background:

Female, age: 76

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Previous CIS. Last recurrence four months ago. Previous BCG.

Cytology:

No tumor cells

Path outcome:

Dysplasia

Treatment:

Referred to TURBT

TimeChapter
00:03 White light cystoscopy, papilloma on the right bladder wall
00:07White light procedure
00:31NBI procedure
00:55White light procedure

Tis – Visualization of Elevated Areas

Tis – Visualization of Elevated Areas

Sluit

Conclusion:

The video shows an area with small papillomas. The switching between white light and NBI helps the clinical decision.

Patient Background:

Male, age: 79

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG. Ta. No previous CIS. Last recurrence 12 months ago. No previous BCG.

Cytology:

Atypical – not graded

Path outcome:

Ta. LG. Dysplasia.

Treatment:

Biopsy and coagulation

TimeChapter
00:07White light procedure
00:24NBI procedure
00:31Red elevated area in NBI and white light
00:34NBI procedure
00:45White light procedure
00:59NBI procedure

NBI Confirms Non-Malignancy of Cystitis-Related Lesion

NBI Confirms Non-Malignancy of Cystitis-Related Lesion

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Conclusion

Using the NBI confirms that the red areas are not considered suspicious for malignancy, but are most likely caused by recent cystitis. Please note the absence of frog eggs configuration and angiogenesis.

Patient Background:

Male, age: 61

Reason for cystoscopy:

Two incidents of severe macroscopic hematuria

Previous history of BC:

No previous history of BC

Cytology:

Inflammation

Path outcome:

No biopsy

Treatment:

Follow-up cystoscopy in two months

TimeChapter
00:03White light procedure
00:28Focus on a selected red area; switch between NBI and white light

NBI Helps Discount the Suspicion of Malignancy Raised during White Light Cystoscopy

NBI Helps Discount the Suspicion of Malignancy Raised during White Light Cystoscopy

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Conclusion

In white light cystoscopy an area in the trigonum to the left is considered suspicious for malignancy, however the NBI discounts this suspicion. Note the absence of frog eggs configuration and the normal capillary density, suggesting acute inflammation rather than malignancy causing angiogenesis.

Patient Background:

Male, age: 71

Reason for cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Ta, LG. No previous CIS. Last recurrence 25 months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

No biopsy

Treatment:

Next appointment for cystoscopy in eight months

TimeChapter
00:03White light procedure
01:08NBI procedure
01:41Suspicious area in white light
01:53Suspicious area in NBI

Higher Visibility in NBI Mode during Bleeding

Higher Visibility in NBI Mode during Bleeding

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Conclusion

A small papilloma is visualized in both white light and NBI. Biopsy is performed and the bleeding makes the visibility poor in white light. In NBI the bleeding is concentrated just at the localization of the removed parts of the papilloma, and therefore it has a marginal impact on the overview. Thus, in cases with diffuse bleeding NBI can be helpful in giving a better overview of the bladder compared to white light. Note also that the mucosa surrounding the papilloma is completely normal. Coagulation in the outpatient clinic is therefore considered a safe procedure.

Patient Background:

Male, age: 77

Reason for cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Ta, HG. No previous CIS. Last recurrence four months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

-

Treatment:

Biopsy and coagulation

Time Chapter
00:03Identifying the papilloma in white light
00:10Identifying the papilloma in NBI
00:22Biopsy of the papilloma in NBI
00:38Note the bleeding in white light
00:49Note the bleeding in NBI

NBI Confirms Papillomatosis

NBI Confirms Papillomatosis

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Conclusion

In white light cystoscopy the area close to the bladder neck is suspicious but could also be interpreted as cystitis cystica. By using the NBI, the area is considered highly suspicious for papillomatosis. Note the string of frog eggs configuration.

Patient Background:

Male, age: 79

Reason for cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Ta, LG. No previous CIS. Last recurrence six months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, LG

Treatment:

Biopsy and coagulation

TimeChapter
00:03Identification of the subject area in the bladder neck in white light
00:12Identification of the subject area close to the bladder neck with NBI

NBI Showing Highly Suspicious Dark Area and Frog Eggs

NBI Showing Highly Suspicious Dark Area and Frog Eggs

Sluit

Conclusion

In white light cystoscopy a suspect area on the posterior bladder wall is identified, but not considered pathognomonic for malignancy. In the NBI cystoscopy the same area appears suspicious for papillomatosis. Note how the area seems slightly darker and gray regarding the mucosa, and a small area of frog egg configuration is visualized within the area.

Patient Background:

Female, age: 73

Reason for cystoscopy:

Follow-up of NMIBC

Previous history of BC:

T1, LG. No previous CIS. Last recurrence nine months ago. Previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, LG

Treatment:

Biopsy and coagulation

TimeChapter
00:03White light procedure with finding of slightly suspect mucosa
00:40NBI procedure
00:56Identification of the suspect area in NBI
01:19Still picture of the frog egg configurations
01:28Identification of the same area in white light

HG Ta Visualized by NBI in Follow-Up Cystoscopy

HG Ta Visualized by NBI in Follow-Up Cystoscopy

Sluit

Conclusion

First, a small papilloma is seen in white light. Afterwards, the same papilloma is seen in NBI and the typical frog egg configuration stands out clearly.

Patient Background:

Male, age: 77

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

HG, Ta, no CIS

Treatment:

Biopsy of a papilloma

TimeChapter
00:03Papilloma seen in white light
00:16Switch between white light and NBI
00:39Biopsy

NBI Highlighting Two Satellite Lesions

NBI Highlighting Two Satellite Lesions

Sluit

Conclusion

The area with the papillomatosis appears wider with a clearer demarcation in NBI. Furthermore using NBI, two additional small tumors are identified in the top of the bladder close to the larger papilloma seen in both white light and NBI.

Patient Background:

Female, age: 62

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

HG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

HG, Ta, no CIS

Treatment:

The patient was referred to TUR-B

TimeChapter
00:03Two papillomas and a red elevated area seen in white light
00:36Same areas seen in NBI, note the additional findings
00:40White light procedure
00:49NBI procedure, note the additional findings

Extremely Clear Visualization of LG Ta Lesion

Extremely Clear Visualization of LG Ta Lesion

Sluit

Conclusion:

The papillomatosis is identified first in white light. NBI enhanced the contrast between normal mucosa and the area with papillomatosis.

Patient Background:

Female, age: 74

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

HG, Ta, no CIS

Treatment:

Biopsy and coagulation

TimeChapter
00:07White light cystoscopy
00:36Switch between NBI and white light

NBI Highlighting Several Recurrences Unseen in White Light

NBI Highlighting Several Recurrences Unseen in White Light

Sluit

Conclusion:

The white light cystoscopy first appears to be normal. But small recurrences were identified using NBI in the second-look cystoscopy.

Patient Background:

Female, age: 72

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence 24 months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

LG, Ta, no CIS

Treatment:

Biopsy and coagulation

TimeChapter
00:06White light procedure
00:31NBI procedure
00:41Switch between NBI and white light

Frog Eggs Effect Visualized by NBI

Frog Eggs Effect Visualized by NBI

Sluit

Conclusion:

Multiple red areas in white light become darker and more enhanced in NBI. Note the optical enhancement of the vessels, the papillomas, and normal mucosa.

Patient Background:

Male, age: 83

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

LG, Ta, no CIS

Treatment:

Referred to TUR-B

TimeChapter
00:03White light cystoscopy, multiple red spots
00:07White light procedure
00:21NBI cystoscopy, multiple papillomas
00:24NBI procedure
00:39Switch between NBI and white light

NBI Confirms Papillomatosis

NBI Confirms Papillomatosis

Sluit

Conclusion

In white light cystoscopy the area close to the bladder neck is suspicious but could also be interpreted as cystitis cystica. By using the NBI, the area is considered highly suspicious for papillomatosis. Note the string of frog eggs configuration.

Patient Background:

Male, age: 79

Reason for cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Ta, LG. No previous CIS. Last recurrence six months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, LG

Treatment:

Biopsy and coagulation

TimeChapter
00:03Identification of the subject area in the bladder neck in white light
00:12Identification of the subject area close to the bladder neck with NBI

NBI Showing Highly Suspicious Dark Area and Frog Eggs

NBI Showing Highly Suspicious Dark Area and Frog Eggs

Sluit

Conclusion

In white light cystoscopy a suspect area on the posterior bladder wall is identified, but not considered pathognomonic for malignancy. In the NBI cystoscopy the same area appears suspicious for papillomatosis. Note how the area seems slightly darker and gray regarding the mucosa, and a small area of frog egg configuration is visualized within the area.

Patient Background:

Female, age: 73

Reason for cystoscopy:

Follow-up of NMIBC

Previous history of BC:

T1, LG. No previous CIS. Last recurrence nine months ago. Previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, LG

Treatment:

Biopsy and coagulation

TimeChapter
00:03White light procedure with finding of slightly suspect mucosa
00:40NBI procedure
00:56Identification of the suspect area in NBI
01:19Still picture of the frog egg configurations
01:28Identification of the same area in white light

Tis – Visualization of Elevated Areas

Tis – Visualization of Elevated Areas

Sluit

Conclusion:

The video shows an area with small papillomas. The switching between white light and NBI helps the clinical decision.

Patient Background:

Male, age: 79

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG. Ta. No previous CIS. Last recurrence 12 months ago. No previous BCG.

Cytology:

Atypical – not graded

Path outcome:

Ta. LG. Dysplasia.

Treatment:

Biopsy and coagulation

TimeChapter
00:07White light procedure
00:24NBI procedure
00:31Red elevated area in NBI and white light
00:34NBI procedure
00:45White light procedure
00:59NBI procedure

NBI Highlighting Hypervascularization of Papillomas

NBI Highlighting Hypervascularization of Papillomas

Sluit

Conclusion:

The visualization of two small red areas on the left side of the bladder is enhanced using the NBI technique. The larger papilloma on the right side is visible in both modalities.

Patient Background:

Female, age: 76

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Previous CIS. Last recurrence four months ago. Previous BCG.

Cytology:

No tumor cells

Path outcome:

Dysplasia

Treatment:

Referred to TURBT

TimeChapter
00:03 White light cystoscopy, papilloma on the right bladder wall
00:07White light procedure
00:31NBI procedure
00:55White light procedure

Frog Eggs Configuration in CIS

Frog Eggs Configuration in CIS

Sluit

Conclusion:

White light cystoscopy finds the mucosa reddish and elevated on the left side bladder wall. Only in NBI does the papillomatosis appear with the typical frog eggs configuration.

Patient Background:

Male, age: 67

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Previous CIS. Last recurrence four months ago. Previous BCG.

Cytology:

No tumor cells

Path outcome:

CIS

Treatment:

Referred to TUR-BT

TimeChapter
00:03White light cystoscopy, red area on the left bladder wall
00:06White light procedure
00:35Same area in NBI, note the frog eggs
00:39NBI procedure

Flat Lesion at the Posterior Wall

Flat Lesion at the Posterior Wall

Sluit

Conclusion:

The video is the same as shown before with the two satellite tumors in the top of the bladder next to the larger papilloma. The thickened reddish area in the posterior bladder wall is a non-invasive high-grade papillary urothelial carcinoma.

Patient Background:

Female, age: 62

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, HG, dysplasia

Treatment:

Biopsy and coagulation of lesion

TimeChapter
00:03White light procedure, flat lesion on the posterior bladder wall
00:06White light procedure
00:14NBI procedure
00:17White light procedure
00:38NBI procedure

NBI Confirms Non-Malignancy of Cystitis-Related Lesion

NBI Confirms Non-Malignancy of Cystitis-Related Lesion

Sluit

Conclusion

Using the NBI confirms that the red areas are not considered suspicious for malignancy, but are most likely caused by recent cystitis. Please note the absence of frog eggs configuration and angiogenesis.

Patient Background:

Male, age: 61

Reason for cystoscopy:

Two incidents of severe macroscopic hematuria

Previous history of BC:

No previous history of BC

Cytology:

Inflammation

Path outcome:

No biopsy

Treatment:

Follow-up cystoscopy in two months

TimeChapter
00:03White light procedure
00:28Focus on a selected red area; switch between NBI and white light

Suspicious Area in White Light Identified as Non-Suspicious Using NBI

Suspicious Area in White Light Identified as Non-Suspicious Using NBI

Sluit

Conclusion

Red elevated areas are seen up-close in white light and afterwards in NBI. The switching between the two modalities can be helpful in making a clinical decision.

Patient Background:

Male, age: 78

Reason for Cystoscopy:

Follow-up of NMIBC

Previous History of BC:

Previous CIS. Last recurrence 18 months ago. Previous BCG treatment.

Cytology:

No tumor cells

Treatment:

No malignancy was found in the biopsy.

TimeChapter
00:22Red area seen in NBI, inflammation?
00:26NBI procedure
00:31White light procedure

Cystitis Confirmed by NBI

Cystitis Confirmed by NBI

Sluit

Conclusion

Using NBI confirms that the red areas are not considered malignant, but most likely due to recent cystitis. There are no frog egg configurations or angiogenesis.

Patient Background:

Male, age: 72

Reason for Cystoscopy:

Follow-up of NMIBC

Previous History of BC:

LG, Ta, no previous CIS. Last recurrence four months ago. No previous BCG treatment.

Cytology:

No tumor cells.

Path outcome:

No tumor.

Treatment:

No biopsy. The patient had a cystitis and was treated with relevant antibiotics.

TimeChapter
00:12NBI procedure
00:15White light procedure
00:21NBI procedure

Chronic Inflammation

Chronic Inflammation

Sluit

Conclusion

The trigonum of the bladder is shown in both white light and NBI. Note the absence of frog eggs configuration. The confirmatory biopsy shows no malignancy.

Patient Background

Female, age: 68

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG, Ta, previous CIS. Last recurrence 24 months ago. Previous BCG treatment.

Cytology:

No tumor cells

Path outcome:

No tumor

Treatment:

No treatment initiated

Time Chapter00:05
00:05Trigonum in NBI and white light. Inflammation or papilloma?
00:30Biopsy

NBI Helps Confirm Non-Malignancy

NBI Helps Confirm Non-Malignancy

Sluit

Conclusion

Several red spots are seen in white light. Note the absence of additional capillary density and frog eggs configuration. Overall, the red spots did not appear malignant in NBI.

Patient Background:

Male, age: 73

Reason for Cystoscopy:

Hematuria

Previous history of BC:

No previous tumor. No previous CIS. No previous BCG.

Cytology:

No tumor cells.

Path outcome:

No tumor

Treatment:

No malignancy was found in the biopsy.

TimeChapter
00:03White light procedure
00:31NBI procedure
00:34White light procedure
00:39NBI procedure
00:53White light procedure

Superior NBI Result with Empty Bladder

Superior NBI Result with Empty Bladder

Sluit

Conclusion:

Please note the improved quality of NBI after emptying the bladder. When the bladder is filled with saline instead of urine, the contrast between the small vessels and mucosa is enhanced.

Patient Background:

Male, age: 69

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG. Ta. No previous CIS. Last recurrence 12 months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

No tumor

Treatment:

Conventional cystoscopy

TimeChapter
00:07White light procedure
00:10NBI procedure

Air Bubble Effect during Cystoscopy

Air Bubble Effect during Cystoscopy

Sluit

Conclusion:

Several papillomas visible in white light. Accidental multiple air bubbles through the cystoscopy when emptying and filling the bladder with saline to get a better view in NBI. Surprisingly, the papillomas appeared even clearer through the air bubble and revealed an additional tiny papilloma. Of course, intentional large amounts of air inside the bladder is not recommended.

Patient Background:

Male, age: 74

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

HG. Ta. No previous CIS. Last recurrence 4 months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, LG.

Treatment:

Referred to TURBT

TimeChapter
00:35NBI procedure, papillomas seen through air bubbles
00:38NBI procedure
00:50White light procedure
00:59NBI procedure
01:20White light procedure

NBI-Guided Coagulation

NBI-Guided Coagulation

Sluit

Conclusion:

NBI improves the visualization and distinction between normal and pathological tissue. This video shows NBI-guided electrocoagulation.

Patient Background:

Female, age: 72

Reason for Cystoscopy:

Follow-up of NMIBC

Previous history of BC:

LG. Ta. No previous CIS. Last recurrence four months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

Ta, LG.

Treatment:

Biopsy and NBI-guided coagulation

TimeChapter
00:03NBI procedure, biopsy
00:13First NBI-guided coagulation

NBI Helps Discount the Suspicion of Malignancy Raised during White Light Cystoscopy

NBI Helps Discount the Suspicion of Malignancy Raised during White Light Cystoscopy

Sluit

Conclusion

In white light cystoscopy an area in the trigonum to the left is considered suspicious for malignancy, however the NBI discounts this suspicion. Note the absence of frog eggs configuration and the normal capillary density, suggesting acute inflammation rather than malignancy causing angiogenesis.

Patient Background:

Male, age: 71

Reason for cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Ta, LG. No previous CIS. Last recurrence 25 months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

No biopsy

Treatment:

Next appointment for cystoscopy in eight months

TimeChapter
00:03White light procedure
01:08NBI procedure
01:41Suspicious area in white light
01:53Suspicious area in NBI

Higher Visibility in NBI Mode during Bleeding

Higher Visibility in NBI Mode during Bleeding

Sluit

Conclusion

A small papilloma is visualized in both white light and NBI. Biopsy is performed and the bleeding makes the visibility poor in white light. In NBI the bleeding is concentrated just at the localization of the removed parts of the papilloma, and therefore it has a marginal impact on the overview. Thus, in cases with diffuse bleeding NBI can be helpful in giving a better overview of the bladder compared to white light. Note also that the mucosa surrounding the papilloma is completely normal. Coagulation in the outpatient clinic is therefore considered a safe procedure.

Patient Background:

Male, age: 77

Reason for cystoscopy:

Follow-up of NMIBC

Previous history of BC:

Ta, HG. No previous CIS. Last recurrence four months ago. No previous BCG.

Cytology:

No tumor cells

Path outcome:

-

Treatment:

Biopsy and coagulation

Time Chapter
00:03Identifying the papilloma in white light
00:10Identifying the papilloma in NBI
00:22Biopsy of the papilloma in NBI
00:38Note the bleeding in white light
00:49Note the bleeding in NBI

NBI bij flexibele ureteroscopie

Ontdek met Narrow Band Imaging, nieuwe informative en verkrijg beter inzicht in conservatief tumorbeheer van de bovenste urinewegen. Met een simpele druk op de knop heeft u superieure visualisatie van laesies die zo klein zijn dat ze voorheen bijna niet konden worden waargenomen.

Met de volgende videocollectie willen we de vraag: "Wat zie ik nu echt wanneer ik de NBI-modus activeer?" beantwoorden, om het onderwijs te ondersteunen voor urologen die willen beginnen met NBI in ureteroscopie. Het idee is om praktische voorbeelden te geven van hoe NBI kan helpen nauwkeurige tumordetectie te faciliteren.

Professor Olivier Traxer van het Hôpital Tenon in Parijs, Frankrijk heeft verschillende flexibele ureteroscopieën uit zijn dagelijkse klinische praktijk opgenomen. Deze clips zijn gegroepeerd volgens het classificatiesysteem voor kanker van de bovenste urinewegen zodat u begrijpt hoe verschillende tumoren en verdachte gebieden eruit zien in NBI-licht in vergelijking met conventioneel wit licht.

Voor deze opnamen is gebruik gemaakt van een flexibele video-ureteroscopen van de typen URF-V2 en URF-V van Olympus in combinatie met de nieuwste systemen voor beeldvorming.

Meer informatie vindt u hieronder in het overzicht van het hoofdstuk.

Solid Tumor of the Renal Pelvis

Solid Tumor of the Renal Pelvis

Sluit

Conclusion

NBI highlights the hypervascularization of the solid lesion of the renal pelvis.

Patient Background:

Male, age: 67

Reason for Ureteroscopy:

Hematuria, CT scan: filling defect of the renal pelvis in patient with solitary kidney

Previous history of Urinary Tract Tumors:

No

Path outcome:

HG, Ta

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:04Switch between WL and NBI
00:06NBI procedure
00:11NBI procedure – hypervascularization of the solid lesion

UTUC Bridge

UTUC Bridge

Sluit

Conclusion

NBI helps to improve the visualization of UTUC bridge, which covers three renal papillae, even though it was also identified by WL. Note the typical frog eggs configuration of the tumor obtained with the NBI procedure.

Patient Background:

Male, age: 76

Reason for Ureteroscopy:

UTUC follow-up in patient with solitary kidney

Previous history of Urinary Tract Tumors:

Last recurrence 12 months ago, LG

Path outcome:

LG, Ta

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:22Switch between White light procedure and NBI
00:24NBI procedure

Tumor of the Renal Pelvis

Tumor of the Renal Pelvis

Sluit

Conclusion

NBI highlights the frog eggs configuration of the tumor of the renal pelvis. The lesion is seen in both WL and NBI.

Patient Background:

Male, age: 63

Reason for Ureteroscopy:

Hematuria. CT scan: filling defect of the renal pelvis

Previous history of Urinary Tract Tumors:

No

Path outcome:

LG, Ta

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:07NBI procedure

Microscopic UTUC Recurrence

Microscopic UTUC Recurrence

Sluit

Conclusion

NBI identifies a microscopic lesion of the upper urinary tract, because of higher contrast to the normal mucosa. This recurrence is not visible in white light even when the lesion is known. In addition NBI addresses the laser treatment of the tumor.

Patient Background:

Male, age: 55

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

LG, Ta. Last recurrence 12 months ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:08NBI procedure

UTUC Covering the Whole Surface of the Calyx

UTUC Covering the Whole Surface of the Calyx

Sluit

Conclusion

NBI made the tumor, covering the whole surface of the calyx, more obvious.

Patient Background:

Male, age: 74

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence four months ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:10Switch between White light procedure and NBI
00:12NBI procedure

Small Neoplasm Close to the Renal Papilla

Small Neoplasm Close to the Renal Papilla

Sluit

Conclusion

NBI shows the small lesion close to the renal papilla with more definition than with white light.

Patient Background:

Male, age: 62

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence 12 months ago

Path outcome:

Insufficient sample for diagnosis

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:09NBI procedure

Small Lesion of the Upper Urinary Tract

Small Lesion of the Upper Urinary Tract

Sluit

Conclusion

NBI may improve the detection of small UTUCs scarcely visible with white light.

Patient Background:

Male, age: 79

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence one year ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:08NBI procedure – the small UTUC of the renal pelvis is clearly detectable

UTUC Carpet in the Whole Ureter

UTUC Carpet in the Whole Ureter

Sluit

Conclusion

NBI highlights the hypervascularization of the tumor involving the whole ureter; the presence of the frog eggs effect allows the neoplasm to be differentiated from the inflammation.

Patient Background:

Male, age: 71

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG. Last recurrence six months ago

Path outcome:

No biopsy

Treatment:

Nephroureterectomy one week after

TimeChapter
00:00White light procedure
00:09NBI procedure – frog eggs effect in UTUC carpet

Small UTUC of the Lower Calyx

Small UTUC of the Lower Calyx

Sluit

Conclusion

NBI helps to improve the visualization of the small lesion of the lower calyx. The lesion was identified by both white light and NBI.

Patient Background:

Male, age: 83

Reason for Ureteroscopy:

Follow-up UTUC

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence 18 months ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:05NBI procedure

Precise Demarcation of Upper Urinary Tract Tumor Margins

Precise Demarcation of Upper Urinary Tract Tumor Margins

Sluit

Conclusion

NBI better defines the UTUC margins in order to correctly perform the laser coagulation and prevent recurrence.

Patient Background:

Male, age: 65

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence six months ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:10NBI procedure – better definition of UTUC margins

UTUC of the Minor Calyx and Papilla

UTUC of the Minor Calyx and Papilla

Sluit

Conclusion

White light shows some small and superficial lesions on the walls of the minor calyx and papilla. NBI identifies and highlights the impressive extension of the tumor, not clearly visible with WL.

Patient Background:

Male, age: 75

Reason for Ureteroscopy:

UTUC follow-up. Solitary kidney

Previous history of Urinary Tract Tumors:

LG, Ta. Last recurrence six months ago

Path outcome:

LG, Ta

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:08NBI procedure

Several Small UTUCs Covering the Renal Papilla

Several Small UTUCs Covering the Renal Papilla

Sluit

Conclusion

The papilla is covered by several small tumors. The lesion on the left of the papilla appears wider and with a clearer demarcation in NBI, because of higher contrast to the normal papilla.

Patient Background:

Male, age: 81

Reason for Ureteroscopy:

UTUC follow-up in patient with chronic kidney disease

Previous history of Urinary Tract Tumors:

Last recurrence four months ago, LG

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:12NBI procedure

Ureteral Fibro-Epithelial Polyp

Ureteral Fibro-Epithelial Polyp

Sluit

Conclusion

NBI highlights the smooth surface of the ureteral lesion, without showing any frog eggs effect on it.

Patient Background:

Female, age: 54

Reason for Ureteroscopy:

Mild hydroureteronephrosis.

CT scan: elongated ureteral lesion of the proximal ureter

Previous History of Urinary Tract Tumors:

No. Previous history of urolithiasis

Path Outcome:

Fibroepithelial polyp

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:06NBI procedure – smooth surface of polyp without frog eggs effect

Hemangioma of the Upper Urinary Tract

Hemangioma of the Upper Urinary Tract

Sluit

Conclusion

NBI highlights the sinusoidal vessels of the hemangioma; note the absence of frog eggs configuration on the lesion.

Patient Background:

Female, age: 38

Reason for Ureteroscopy:

Recurrent episodes of hematuria

Previous history of Urinary Tract Tumors:

No

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:08NBI procedure

Pyeloureteritis Cystica

Pyeloureteritis Cystica

Sluit

Conclusion

The walls of the small submucosal cysts are transparent. The cysts are more clearly defined from the rest of the mucosa by NBI than by white light.

Patient Background:

Female, age: 65

Reason for Ureteroscopy:

Kidney stone in patient with recurrent UTIs

Previous history of Urinary Tract Tumors:

No

Path outcome:

No biopsy

Treatment:

None

TimeChapter
00:00White light procedure
00:07NBI procedure

Massive Ureteral Inflammation after Ureteral Stenting

Massive Ureteral Inflammation after Ureteral Stenting

Sluit

Conclusion

Ureteral inflammation can be confirmed by NBI. Note the absence of frog eggs configuration and the normal capillary density, suggesting acute inflammation rather than malignancy, causing angiogenesis.

Patient Background:

Female, age: 33

Reason for Ureteroscopy:

Urolithiasis

Previous history of Urinary Tract Tumors:

No

Path outcome:

Acute inflammation

Treatment:

Biopsy, lithotripsy, and ureteral stenting

TimeChapter
00:00White light procedure
00:08NBI procedure

Small Petechiae of the Urothelium

Small Petechiae of the Urothelium

Sluit

Conclusion

NBI highlights, more than WL, the petechiae of the urothelium. The small submucosal spots of bleeding due to the guidewire and endoscope manipulation are shown very well by NBI.

Patient Background:

Female, age: 47

Reason for Ureteroscopy:

Urolithiasis

Previous History of Urinary Tract Tumors:

No

Path outcome:

No biopsy

Treatment:

Nothing for the petechiae

TimeChapter
00:00White light procedure
00:08NBI procedure

Ureteral Edema in Patient with DJ Stent

Ureteral Edema in Patient with DJ Stent

Sluit

Conclusion

NBI may allow the differentiation of the ureteral edema, due to DJ stent, from tumors during UTUC follow-up. Note the absence of vessels and consequently of frog eggs configuration inside the edema.

Patient Background:

Male, age: 71

Reason for Ureteroscopy:

UTUC follow-up in patient with ureteral stent

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence three months ago

Path outcome:

Ureteral edema

Treatment:

None

TimeChapter
00:00Right video: White light procedure
00:00Left video: NBI procedure

Inflammation around Impacted Stone

Inflammation around Impacted Stone

Sluit

Conclusion

The inflammation around an impacted stone can be detected with NBI. Note the absence of increased capillary density and consequently the absence of the frog eggs configuration inside the mucosa.

Patient Background:

Female, age: 50

Reason for Ureteroscopy:

Stone

Previous history of Urinary Tract Tumors:

No

Path outcome:

Urolithiasis

Treatment:

Lithotripsy

TimeChapter
00:00White light procedure
00:09NBI procedure – absence of frog eggs configuration inside the mucosa

Solid Tumor of the Renal Pelvis

Solid Tumor of the Renal Pelvis

Sluit

Conclusion

NBI highlights the hypervascularization of the solid lesion of the renal pelvis.

Patient Background:

Male, age: 67

Reason for Ureteroscopy:

Hematuria, CT scan: filling defect of the renal pelvis in patient with solitary kidney

Previous history of Urinary Tract Tumors:

No

Path outcome:

HG, Ta

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:04Switch between WL and NBI
00:06NBI procedure
00:11NBI procedure – hypervascularization of the solid lesion

UTUC Bridge

UTUC Bridge

Sluit

Conclusion

NBI helps to improve the visualization of UTUC bridge, which covers three renal papillae, even though it was also identified by WL. Note the typical frog eggs configuration of the tumor obtained with the NBI procedure.

Patient Background:

Male, age: 76

Reason for Ureteroscopy:

UTUC follow-up in patient with solitary kidney

Previous history of Urinary Tract Tumors:

Last recurrence 12 months ago, LG

Path outcome:

LG, Ta

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:22Switch between White light procedure and NBI
00:24NBI procedure

Tumor of the Renal Pelvis

Tumor of the Renal Pelvis

Sluit

Conclusion

NBI highlights the frog eggs configuration of the tumor of the renal pelvis. The lesion is seen in both WL and NBI.

Patient Background:

Male, age: 63

Reason for Ureteroscopy:

Hematuria. CT scan: filling defect of the renal pelvis

Previous history of Urinary Tract Tumors:

No

Path outcome:

LG, Ta

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:07NBI procedure

Microscopic UTUC Recurrence

Microscopic UTUC Recurrence

Sluit

Conclusion

NBI identifies a microscopic lesion of the upper urinary tract, because of higher contrast to the normal mucosa. This recurrence is not visible in white light even when the lesion is known. In addition NBI addresses the laser treatment of the tumor.

Patient Background:

Male, age: 55

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

LG, Ta. Last recurrence 12 months ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:08NBI procedure

UTUC Covering the Whole Surface of the Calyx

UTUC Covering the Whole Surface of the Calyx

Sluit

Conclusion

NBI made the tumor, covering the whole surface of the calyx, more obvious.

Patient Background:

Male, age: 74

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence four months ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:10Switch between White light procedure and NBI
00:12NBI procedure

Small Neoplasm Close to the Renal Papilla

Small Neoplasm Close to the Renal Papilla

Sluit

Conclusion

NBI shows the small lesion close to the renal papilla with more definition than with white light.

Patient Background:

Male, age: 62

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence 12 months ago

Path outcome:

Insufficient sample for diagnosis

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:09NBI procedure

Small Lesion of the Upper Urinary Tract

Small Lesion of the Upper Urinary Tract

Sluit

Conclusion

NBI may improve the detection of small UTUCs scarcely visible with white light.

Patient Background:

Male, age: 79

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence one year ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:08NBI procedure – the small UTUC of the renal pelvis is clearly detectable

UTUC Carpet in the Whole Ureter

UTUC Carpet in the Whole Ureter

Sluit

Conclusion

NBI highlights the hypervascularization of the tumor involving the whole ureter; the presence of the frog eggs effect allows the neoplasm to be differentiated from the inflammation.

Patient Background:

Male, age: 71

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG. Last recurrence six months ago

Path outcome:

No biopsy

Treatment:

Nephroureterectomy one week after

TimeChapter
00:00White light procedure
00:09NBI procedure – frog eggs effect in UTUC carpet

Small UTUC of the Lower Calyx

Small UTUC of the Lower Calyx

Sluit

Conclusion

NBI helps to improve the visualization of the small lesion of the lower calyx. The lesion was identified by both white light and NBI.

Patient Background:

Male, age: 83

Reason for Ureteroscopy:

Follow-up UTUC

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence 18 months ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:05NBI procedure

Precise Demarcation of Upper Urinary Tract Tumor Margins

Precise Demarcation of Upper Urinary Tract Tumor Margins

Sluit

Conclusion

NBI better defines the UTUC margins in order to correctly perform the laser coagulation and prevent recurrence.

Patient Background:

Male, age: 65

Reason for Ureteroscopy:

UTUC follow-up

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence six months ago

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:10NBI procedure – better definition of UTUC margins

UTUC of the Minor Calyx and Papilla

UTUC of the Minor Calyx and Papilla

Sluit

Conclusion

White light shows some small and superficial lesions on the walls of the minor calyx and papilla. NBI identifies and highlights the impressive extension of the tumor, not clearly visible with WL.

Patient Background:

Male, age: 75

Reason for Ureteroscopy:

UTUC follow-up. Solitary kidney

Previous history of Urinary Tract Tumors:

LG, Ta. Last recurrence six months ago

Path outcome:

LG, Ta

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:08NBI procedure

Several Small UTUCs Covering the Renal Papilla

Several Small UTUCs Covering the Renal Papilla

Sluit

Conclusion

The papilla is covered by several small tumors. The lesion on the left of the papilla appears wider and with a clearer demarcation in NBI, because of higher contrast to the normal papilla.

Patient Background:

Male, age: 81

Reason for Ureteroscopy:

UTUC follow-up in patient with chronic kidney disease

Previous history of Urinary Tract Tumors:

Last recurrence four months ago, LG

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:12NBI procedure

Ureteral Fibro-Epithelial Polyp

Ureteral Fibro-Epithelial Polyp

Sluit

Conclusion

NBI highlights the smooth surface of the ureteral lesion, without showing any frog eggs effect on it.

Patient Background:

Female, age: 54

Reason for Ureteroscopy:

Mild hydroureteronephrosis.

CT scan: elongated ureteral lesion of the proximal ureter

Previous History of Urinary Tract Tumors:

No. Previous history of urolithiasis

Path Outcome:

Fibroepithelial polyp

Treatment:

Biopsy and laser coagulation

TimeChapter
00:00White light procedure
00:06NBI procedure – smooth surface of polyp without frog eggs effect

Hemangioma of the Upper Urinary Tract

Hemangioma of the Upper Urinary Tract

Sluit

Conclusion

NBI highlights the sinusoidal vessels of the hemangioma; note the absence of frog eggs configuration on the lesion.

Patient Background:

Female, age: 38

Reason for Ureteroscopy:

Recurrent episodes of hematuria

Previous history of Urinary Tract Tumors:

No

Path outcome:

No biopsy

Treatment:

Laser coagulation

TimeChapter
00:00White light procedure
00:08NBI procedure

Pyeloureteritis Cystica

Pyeloureteritis Cystica

Sluit

Conclusion

The walls of the small submucosal cysts are transparent. The cysts are more clearly defined from the rest of the mucosa by NBI than by white light.

Patient Background:

Female, age: 65

Reason for Ureteroscopy:

Kidney stone in patient with recurrent UTIs

Previous history of Urinary Tract Tumors:

No

Path outcome:

No biopsy

Treatment:

None

TimeChapter
00:00White light procedure
00:07NBI procedure

Massive Ureteral Inflammation after Ureteral Stenting

Massive Ureteral Inflammation after Ureteral Stenting

Sluit

Conclusion

Ureteral inflammation can be confirmed by NBI. Note the absence of frog eggs configuration and the normal capillary density, suggesting acute inflammation rather than malignancy, causing angiogenesis.

Patient Background:

Female, age: 33

Reason for Ureteroscopy:

Urolithiasis

Previous history of Urinary Tract Tumors:

No

Path outcome:

Acute inflammation

Treatment:

Biopsy, lithotripsy, and ureteral stenting

TimeChapter
00:00White light procedure
00:08NBI procedure

Small Petechiae of the Urothelium

Small Petechiae of the Urothelium

Sluit

Conclusion

NBI highlights, more than WL, the petechiae of the urothelium. The small submucosal spots of bleeding due to the guidewire and endoscope manipulation are shown very well by NBI.

Patient Background:

Female, age: 47

Reason for Ureteroscopy:

Urolithiasis

Previous History of Urinary Tract Tumors:

No

Path outcome:

No biopsy

Treatment:

Nothing for the petechiae

TimeChapter
00:00White light procedure
00:08NBI procedure

Ureteral Edema in Patient with DJ Stent

Ureteral Edema in Patient with DJ Stent

Sluit

Conclusion

NBI may allow the differentiation of the ureteral edema, due to DJ stent, from tumors during UTUC follow-up. Note the absence of vessels and consequently of frog eggs configuration inside the edema.

Patient Background:

Male, age: 71

Reason for Ureteroscopy:

UTUC follow-up in patient with ureteral stent

Previous history of Urinary Tract Tumors:

Ta, LG, last recurrence three months ago

Path outcome:

Ureteral edema

Treatment:

None

TimeChapter
00:00Right video: White light procedure
00:00Left video: NBI procedure

Inflammation around Impacted Stone

Inflammation around Impacted Stone

Sluit

Conclusion

The inflammation around an impacted stone can be detected with NBI. Note the absence of increased capillary density and consequently the absence of the frog eggs configuration inside the mucosa.

Patient Background:

Female, age: 50

Reason for Ureteroscopy:

Stone

Previous history of Urinary Tract Tumors:

No

Path outcome:

Urolithiasis

Treatment:

Lithotripsy

TimeChapter
00:00White light procedure
00:09NBI procedure – absence of frog eggs configuration inside the mucosa