Abstract
Whilst we agree that coughing may lower the patient's subjective perception of pain, we are unsure whether this technique would improve the diagnostic yield of muscle invasive bladder carcinoma identified by biopsy. Flexible cystoscopy is good in diagnosis and biopsy of superficial dieases of the bladder in trained hands1 but is not reliable in identifying muscle invasive bladder carcinoma as this requires resection of the tumour together with the underlying lamina propria (i.e. for diagnosis of T1b tumours) or detrusor muscle to stage the tumour accurately. It has also been long known that the main risk associated with bladder biopsy is that of bladder perforation.2 The incidence of asymptomatic bladder perforation following routine bladder operation for investigation of bladder tumour can be as high as 58.3%.3 We feel that with the technique described by De'ath and Kayes, one may lose the preciseness of controlling the depth of biopsy which may result in inadvertent perforation of the bladder. A formal rigid cystoscopy and resection of tumour (TURBT) should, therefore, be organised if suspicion of muscle invasion arises during flexible cystoscopy.
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