Evaluation of outpatient cystoscopy in urogynaecology

Abstract

The benefits of outpatient cystoscopy include high levels of tolerability and patient satisfaction, shorter waiting time, quicker implementation of treatment strategies, avoidance of the risks of general anaesthesia and lower procedural cost.

The Importance of Urethrocystoscopy and Bladder Biopsy in Gynecologic Patients

“…Flores-Carreras et al (2010) evaluated 331 women with LUTS of which 62.8% had symptoms of overactive bladder and 31.4% had hematuria. Bladder cancer was diagnosed in two cases (0.6%), similar percentage than that reported by others authors, (0.2% to 3.9%) (Lee et al 2009;Borden et al 2003;Sokol et al 2005). None of the cancer cases had hematuria.…”

“…There are those who recommend the procedure (Lee et al 2009;Goldberg et al 2008;Cundiff & Bent 1996) and others who restrict it to patients with irritability symptoms together with macro or micro hematuria. In any event, the general consensus is to consider urethral cystoscopy the "gold standard" method to diagnose bladder cancer (Abel 1988;VanDer Meijde et al 1999).…”

“…In these cases the criteria for performing biopsy include suspicious lesions or areas of red urothelium (Lee et al 2009), but some authors advocate biopsy even in the absence of epithelial disruption. This approach is controversial and it is not in accordance with international guidelines (Matsuchima et al 2010).…”

“…About the different points of view Lee et al (2009) expressed the following concepts: "There are many different points of view related to the practice of cystoscopy between urologists and urogynecologists. For the first one, hematuria is the single most common indication; in contrast, urogynecologists not only perform cystoscopy but also urethroscopy and they visualize the lower urinary tract more thoroughly for a broad range of indications, most commonly for exclusion of intravesical lesions in women with LUTS or recurrent urinary tract infection (RUTI), suspected foreign body and diagnosis of urethral diverticulum".…”

Low incidence of bacteriuria with outpatient flexible cystoscopy

“…Improvements in antiseptic solutions and research studies produced guidelines to efficiently clean and disinfect the cystoscopes . These developments made outpatient cystoscopy possible, with the advantages of shorter procedure and waiting times, earlier implementation of treatment, avoidance of risks of anaesthesia, higher patient satisfaction and lower procedural costs . Compared with the rigid cystoscope, the flexible cystoscope with its smaller calibre this procedure improves patient comfort and tolerability.…”