The Role of Photodocumentation in Surveillance Cystoscopy for Bladder Cancer

Abstract

PURPOSE:To determine if the combination of photodocumentation and electronic medical record keeping led to changes in the management of suspicious lesions in patients with bladder cancer undergoing surveillance cystoscopy. METHODS:We reviewed the charts of all patients undergoing surveillance cystoscopy for bladder cancer during a 15-month period. We evaluated patients who had photodocumentation of bladder lesions in our electronic medical record (EPIC). Baseline demographics, surveillance data, and biopsy results were collected, and the outcome of photodocumentation was analyzed. A cost base analysis was performed using figures obtained from the billing department. RESULTS:During the study period, 50 patients underwent flexible cystoscopy for bladder cancer surveillance at our institution. Fifteen were identified who met the study criteria. Using photodocumentation in EPIC, nine patients had well-documented lesions that had no change during the surveillance period with negative urine cytology and therefore did not undergo biopsy. Six patients, however, did undergo biopsy based on a change in the appearance of the lesion. Biopsies demonstrated 3 benign lesions, 2 low-grade transitional cell carcinomas, and 1 muscle-invasive lesion. An economic base analysis demonstrated a cost reduction of 27% and 55% compared with office-based biopsy and transurethral resection of bladder tumor, respectively, by using photodocumentation. CONCLUSIONS: Photodocumentation of lesions during flexible cystoscopy is a useful tool in bladder cancersurveillance. It provides support for clinical decisions and is a cost-effective way to monitor patients undergoing frequent interventions.

Current Standards in the Endoscopic Management of Bladder Cancer: A Survey Evaluation among Urologists in German-Speaking Countries

“…Similarly, written surgical reports are the main method (77%) used to communicate endoscopic findings between urologists for further surveillance referral -significantly more in the inpatient setting. Numerous studies, however, have described written reports and the bladder diagram as suboptimal and suggest they are not only a major limitation for patient follow-up and treatment but may also play a role in the high recurrence rates [5,6,[21][22][23]. The current documentation approach lacks anatomical accuracy due to the inter-and intra-urologist variability related to the diagram and interpretation of macroscopic findings [5].…”

“…The current documentation approach lacks anatomical accuracy due to the inter-and intra-urologist variability related to the diagram and interpretation of macroscopic findings [5]. To overcome these challenges, a registration/navigation system [5], photo documentation [23], and 3D reconstruction of cystoscopic videos have been proposed Urol Int 2020;104:410-416 DOI: 10.1159/000506653 [6,21]. Such strategies would facilitate clinical history reconstruction, as an increase in time from the initial presentation makes it progressively more difficult and time consuming.…”