Flexible Cystoscopies Research Articles

726 Are Disposable Flexible Cystoscopies Beneficial for Patients and Financially Feasible?

726 Are Disposable Flexible Cystoscopies Beneficial for Patients and Financially Feasible?

The Impact of Single-Use Cystoscopes on Clinical Time Workflow in an Outpatient Setting

ObjectiveTo evaluate the change in overall clinical encounter time and clinical capacity after transitioning to single-use cystoscopes (Ambu A/S, Ballerup, Denmark) in an outpatient urology setting. MethodsA single-institution prospective study in an outpatient urology procedure clinic was performed. Discrete categories for each portion of nursing care responsibilities were defined, and time spent during each category was recorded. Two separate clinic days were observed and analyzed: one where the clinic exclusively used reusable cystoscopes and the other after the transition to single-use cystoscopes occurred. Additionally, clinic schedules were reviewed from all procedure clinics in the 3-month periods before and after the transition to single-use cystoscopes. Outcomes included overall clinical encounter time and the number of procedures per clinic day. ResultsThere were 12 flexible cystoscopies performed during each of the observed clinic days. Preliminary cystoscope cleaning and transportation tasks by nursing staff were eliminated when utilizing single-use cystoscopes. Average total encounter time decreased from 66 to 44 minutes, resulting in a 34% reduction in clinical encounter time. The median number of flexible cystoscopy procedures increased after the transition from 9 (IQR 7-12) to 16 (IQR 11-17), representing a 78% increase (p=0.003). ConclusionsTransition to a completely single-use cystoscopy outpatient procedure clinic improved clinical efficiency and facilitated an increased number of procedures per clinic day.

Surveillance of Low-Grade Non-Muscle Invasive Bladder Tumors Using Uromonitor: SOLUSION Trial

The surveillance of non-muscle invasive bladder cancer (NMIBC) requires frequent cystoscopies, which are costly and uncomfortable for patients. Uromonitor is a validated non-invasive urinary test for detecting NMIBC recurrence. However, data on its clinical benefit in an NMIBC surveillance program is limited. To assess the diagnostic accuracy of Uromonitor in NMIBC surveillance and its potential to limit the number of cystoscopies. The study included 202 patients with previous low-grade (LG) NMIBC tumors. Newly diagnosed patients were scheduled for flexible cystoscopy and Uromonitor test at 4, 12, and 24 months from the time of diagnosis. Patients with tumors diagnosed before entering the study underwent cystoscopy and Uromonitor test at the start of the study and 12 and 24 months from inclusion in the study. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Between February 2020 and October 2022, 202 patients were enrolled in the study. Of these patients, 171 met the eligibility criteria to perform the analysis, with a median age of 69 years, IQR (62-74), and 380 flexible cystoscopies with simultaneous Uromonitor tests. Overall, 39/171 (22.8%) patients had recurrences. Uromonitor showed a sensitivity of 89.7%, specificity of 96.2%, PPV of 72.9%, and NPV of 98.8%. In 28 cases, flexible cystoscopy was falsely positive, leading to surgery, where Uromonitor showed negative results. There were 13 cases of possible false positives for Uromonitor where flexible cystoscopy was negative. Uromonitor displays high diagnostic accuracy in detecting NMIBC recurrence with the potential for reducing the number of flexible cystoscopies in the follow-up of low- and intermediate-risk NMIBC. We followed up on newly and previously diagnosed patients with LG NMIBC. We concluded that Uromonitor could potentially reduce the number of cystoscopies in NMIBC surveillance programs.

Fremantle protocol: Multicenter clinical outcomes for a pragmatic protocol for intravesical bacillus Calmette-Guerin.

To examine the utility and efficacy of a multifaceted protocol for the administration of intravesical bacillus Calmette-Guerin (BCG) for non-muscle-invasive bladder cancer (NMIBC). A multicenter retrospective review was conducted among 83 patients undergoing Fremantle protocol intravesical BCG for NMIBC within 4 major hospitals in Western Australia between January 2016 and December 2018. The Fremantle protocol consists of weekly BCG instillations for 6 weeks during the induction phase, followed by monthly BCG instillations for 10 months during the maintenance phase with integrated clearance-to-proceed algorithms for urine MSU checks, flexible cystoscopies performed at 3 monthly intervals during maintenance BCG, and repeat GA cystoscopies with four quadrant bladder biopsies routinely obtained following the completion of induction and maintenance treatment. For patients undergoing Fremantle protocol BCG, 98.8% (82/83) and 75.9% (63/83) of patients completed their induction and maintenance courses of BCG, respectively. Induction BCG was delivered over a median duration of 35 days (range 34-84 days), and maintenance BCG was delivered over a median duration of 266 days (range 1-682 days). The tumor recurrence rate was 10.8% (9/83) at the time of post-induction biopsies, 2.4% (2/83) during maintenance treatment, 0% (0/60) at the time of post-maintenance biopsies, and 8.8% (5/57) after a median further follow-up of 16 months (range 0-51 months). The Fremantle protocol appears to be a safe and effective BCG regimen with several advantages over other BCG protocols, including high completion rates, low recurrence rates, and being highly pragmatic.

Cost and Environmental Impact of Disposable Flexible Cystoscopes Compared to Reusable Devices.

Objectives: To quantify the environmental impact and costs associated with flexible cystoscopy procedures from an institutional perspective, with particular attention for the comparison between disposable and reusable cystoscopes. Materials and Methods: This is a single-center retrospective study, including all flexible cystoscopies performed between 2020 and 2021 using reusable or single-use devices. The Ambu aS4C single-use cystoscope (Ballerup, Denmark) gradually replaced the reusable device in our center, with exclusive use from October 2021. Reprocessing costs for reusable cystoscopes were evaluated using a micro-costing approach. The environmental impact of reusable and disposable cystoscopes was assessed by the amount of waste and water consumed for each procedure. Results: A total of 1578 flexible cystoscopies using reusable cystoscopes were performed in 2020, and 550 cystoscopies were performed using the Ambu aS4C cystoscope from October 2021 to February 2022. The cost of flexible cystoscopy with a reusable and a disposable endoscope was €196 and €192, respectively. The amount of waste generated by reprocessing reusable and disposable cystoscopes was 800 and 200 g per procedure, respectively. Water consumption for sterilization of the reusable cystoscope was 60 L per procedure, whereas no water consumption was required with the Ambu aS4C cystoscope. A 100% Ambu aS4C cystoscope use would reduce waste generation and water consumption by 946.8 kg and 94.68 m3 per year. Conclusion: In this study, implementing a strategy of using 100% disposable cystoscopes was associated with similar costs and reduced waste generation and water consumption compared to reusable devices. Future studies are needed to compare the carbon footprint of these devices, through a comprehensive and rigorous life cycle assessment from manufacturing to recycling.

The Carbon Footprint of Single-Use Flexible Cystoscopes Compared with Reusable Cystoscopes.

Introduction: Single-use devices for endourologic procedures are becoming more popular. The environmental impact of single-use instruments is relatively unknown. This study aimed to compare the carbon footprint of single-use vs reusable flexible cystoscopes based on waste production and estimated carbon emissions. Methods: An analysis of the solid waste produced when using the aScope™ 4 Cysto (Ambu®) single-use flexible cystoscope compared with the reusable Cysto-Nephro Videoscope CYF-VA2 (Olympus®) was performed. The solid waste generated was measured (grams) and recorded as either recyclable, landfill, or contaminated, and carbon dioxide (CO2) produced by disposal, manufacture, and cleaning was calculated. Results: A total of 40 flexible cystoscopies (20 single-use and 20 reusable) were analyzed. Median total weight of waste produced was 622 g (interquartile range [IQR] 621-651) for the single-use cystoscope compared with 671.5 g (IQR 659-677.5) for the reusable cystoscope (p < 0.0001). More waste was disposed of by incineration after single-use than reusable cystoscopy (496 g [IQR 495-525] vs 415 g [IQR 403-421.5], p < 0.0001). However, more waste went to landfill after reusable cystoscopy (256 g ± 0 vs 126 g ± 0, p < 0.0001). There was no difference in weight of waste produced based on the indication for cystoscopy (p = 0.1570). A total of 2.41 kg of CO2 (IQR 2.40-2.44) was produced per case for the single-use flexible cystoscope compared with 4.23 kg of CO2 (IQR 4.22-4.24) for the reusable cystoscope (p < 0.0001). Conclusion: Environmental accountability is essential in modern health care. This study highlights that disposable flexible cystoscopes have a significantly lower impact on the environment in terms of carbon footprint and landfill. We propose that environmental impact studies should be a routine part of device development for a sustainable future.

MP10-12 COST-EFFECTIVENESS OF 90-DAY SINGLE-USE FLEXIBLE CYSTOSCOPE TRIAL: SINGLE CENTER MICRO-COSTING ANALYSIS

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP10)1 Sep 2021MP10-12 COST-EFFECTIVENESS OF 90-DAY SINGLE-USE FLEXIBLE CYSTOSCOPE TRIAL: SINGLE CENTER MICRO-COSTING ANALYSIS Mark Assmus, Amy Krambeck, Matthew Lee, Deepak Agarwal, Matthew Mellon, Marcelino Rivera, and Tim Large Mark AssmusMark Assmus More articles by this author , Amy KrambeckAmy Krambeck More articles by this author , Matthew LeeMatthew Lee More articles by this author , Deepak AgarwalDeepak Agarwal More articles by this author , Matthew MellonMatthew Mellon More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , and Tim LargeTim Large More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001983.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Use of flexible cystoscopy for hospital based urologic care (Emergency Department, intra-operative, inpatients) is invaluable for many urologic diseases. Reusable flexible cystoscopes have widespread utilization with known associated upfront purchasing, processing and service costs. Advances in single-use flexible cystoscope development have introduced alternative options to reusable flexible cystoscopes. However, there is a paucity of cost-effectiveness studies examining implementation of a hospital based transition to single-use scopes. Our primary objective was a 90-day cost-effectiveness evaluation of utilizing single-use flexible cystoscopes at a tertiary care center. METHODS: Following institutional device-approval we initiated a 90-Day trial period (November 1, 2020 - January 29, 2021) where urologic care was provided with a single-use disposable AMBU® aScopeTM 4 Cysto with reusable flexible cystoscopy only in cases where the single-use scope failed or was unavailable. We performed a micro-costing analysis examining per case cost of reusable flexible cystoscopy (including all servicing and processing costs) to the cost of the single-use. RESULTS: Over the 90 day period, we encountered 85 cases (78 operative, 6 inpatient, 1 ED) where flexible cystoscopy was required. 78/85 (92%) cases were successfully completed with one single-use disposable flexible cystoscope. Of the 7 failures, 4 were intraoperative cases where the AMBU scope failed to complete the required surgery and a reusable flexible cystoscope was required and 3 where access to the AMBU scope/monitor resulted in transition to reusable cystoscope use. Per use cost of the reusable flexible cystoscope at our center was $272.41 while per use cost for the single-use is $185.00. Accounting for backup reusable scopes for disposable failures at a rate of 3 uses/month, extrapolating our data over an average 3 month period results in $9,785.71 cost savings or $39,142.84 annually. CONCLUSIONS: This single center 90-Day trial of single-use flexible cystoscopies identified that based on our micro-costing analysis, per-use costs favor transitioning to single-use flexible cystoscopes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e173-e173 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Assmus More articles by this author Amy Krambeck More articles by this author Matthew Lee More articles by this author Deepak Agarwal More articles by this author Matthew Mellon More articles by this author Marcelino Rivera More articles by this author Tim Large More articles by this author Expand All Advertisement Loading ...

The Economics of Cystoscopy: A Microcost Analysis

ObjectiveTo evaluate the per-procedure cost of flexible cystoscopy in relation to reimbursement. Materials and MethodsCapital, maintenance, reprocessing, labor, and disposable costs were calculated at a high-volume academic institution over the fiscal year 2019. Five-year amortized values were used to calculate reusable cystoscope and automated endoscopic reprocessor (AER) per-procedure cost. Twenty flexible cystoscope procedure cycles were timed and multiplied by prevailing medical office assistant wages to determine labor costs. Medicare and commercially insured reimbursements were queried to evaluate the cost and profitability of cystoscopy. ResultsIn total, 3739 flexible cystoscopies were performed with 415 procedures per cystoscope. Total annual costs for capital and maintenance, reprocessing, labor, and disposable supplies was $202,494, $147,969, $128,117, and $121,904, respectively. The per-procedure cost for reusable cystoscopy with AER reprocessing, reusable cystoscopy with a high-level disinfectant (HLD), and theoretical costs of disposable cystoscopy were calculated to be $161, $133, and $222, respectively. The volume of procedures per scope had a significant impact on cost and profitability. The number of procedures per cystoscope performed to have equivalent cost as a disposable scope was, 196 and 145 cystoscopies per cystoscope per year, for AER and HLD-reprocessed cystoscopes, respectively. ConclusionsThere is a considerable contribution of capital equipment, maintenance, labor, and supplies to the cost of cystoscopy with profitability highly depend on the volume of cystoscopies performed for each cystoscope. The use of AER results in higher cost than HLD. Cost-effectiveness of disposable scopes needs to be determined but will vary by clinic volume and site of practice.

The First UK Experience with Single-use Disposable Flexible Cystoscopes: An In-depth Cost Analysis, Service Delivery and Patient Satisfaction Rate with Ambu® aScope™ 4 Cysto

Background and Objective Ambu® aScope™ 4 Cysto is a single-use disposable flexible cystoscope that allows clinicians to perform the procedure at any time and any place. It simplifies workflow, frees up resources and allows clinicians to treat more patients. Our trust became the first in the UK and Europe to utilise these cystoscopes. An in-depth evaluation was performed to test its practicality, cost analysis and patient satisfaction against traditional reusable flexible cystoscopes. Material and Methods We compared the cost of using Ambu® aScope™ 4 Cysto to perform flexible cystoscopies in 20 patients prospectively against traditional flexible cystoscopes in 20 patients retrospectively. The cost of the equipment, reprocessing, cleaning supplies and maintenance were consulted from relevant departments and companies. All prospective patients were also given a patient satisfaction questionnaire to complete. An unpaired t-test was used to analyse the data. Results Our study revealed that it costs £135.23 and £166.33 on average to perform a flexible cystoscopy using Ambu® aScope™ 4 Cysto and the traditional flexible cystoscopes, respectively. Our patient survey revealed that there was a statistical significance between the patient experience using the single-use disposable scopes compared with the traditional reusable flexible cystoscopes (P = 0.0455). Further, 95% of patients also preferred a single-use disposable cystoscope over traditional reusable ones, given the option. Conclusion Single-use disposable flexible cystoscopes are a safe and cost-efficient method of performing the procedure. It is portable and proves to be a simple, efficient and practical way of performing a flexible cystoscopy in an inpatient, outpatient, or emergency setting.

Flexible cystoscopy for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study.

Flexible cystoscopy for ureteral stent removal after ureteroscopy is widely performed. In this scenario, the real need for antimicrobial prophylaxis is still uncertain. Aim of this study is to determine the urinary tract infections rate after 4 weeks from outpatient flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis. A prospective observational study was performed between November 2017 and August 2018 in a single, high-volume Institution.Risk factors for UTIs were recorded. Immediately before cystoscopy, each patient submitted a voided urine specimen. Antibiotics were not given before or after cystoscopy. About 7 and 28 days after cystoscopy all the patients underwent abdomen US, urine analysis and culture, and clinical evaluation to assess possible symptoms of UTI. A total of 192 patients were enrolled in the study, 76 patients (39.2%) were female. Median age was 55 years [IQR 47- 68]. Median BMI was 24.2 [22.9-26.7]. Eighteen patients (9.4%) had asymptomatic bacteriuria before cystoscopy and 39 (20.3%) had positive culture at 7 days. About 21 patients (10.9%) were diagnosed with febrile UTI in the 28 days FU period. The 28.6 % of the Febrile patients had asymptomatic bacteriuria before the stent removal (p < 0.001), this group was slightly older (p = 0.085) and with higher BMI (p = 0.036).Forty-eight patients had positive urine culture at 7 days, of whom 27 (14.1%) were asymptomatic and were classified as asymptomatic bacteriuria. Multivariate analysis shows that only high BMI and bacteriuria before the procedure were significantly associated with developing a febrile UTI, none of the other risk factors was significant. Our data show a high rate of UTI after flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis especially in patients with asymptomatic bacteriuria, in those with high BMI and in the elderly; in these subgroups, antimicrobial prophylaxis should be recommended.

The grasper-integrated disposable flexible cystoscope is comparable to the reusable, flexible cystoscope for the detection of bladder cancer

Flexible cystoscopy under local anaesthesia is standard for the surveillance of bladder cancer. Frequently, several reusable cystoscopes fail to reprocess. With the new grasper incorporated single-use cystoscope for retrieval of ureteric stents, we explored the feasibility of using it off-label for diagnosis and the detection of bladder cancer. Consecutive diagnostic flexible cystoscopies between Mar 2016 and Nov 2018 were reviewed comparing the reusable versus the disposable cystoscopes. A total of 390 patients underwent 1211 cystoscopies. Median age was 61.5 years (SD 14.2, 18.8–91.4), males 331 (84.9%) and females 59 (15.1%). Indication for cystoscopy was prior malignancy in 1183 procedures (97.7%), haematuria 19 (1.6%) or bladder mass 7 (0.6%). There were 608 reusable and 603 disposable cystoscopies. There was no significant difference between groups at baseline in age, sex, BMI, smoking status, or prior tumor risk category. There was no significant difference in positive findings (123/608, 20.2% vs 111/603, 18.4%, p = 0.425) or cancer detection rates (95/608, 15.6% vs 88/603, 14.4%, p 0.574) among the two groups, respectively. We conclude that the disposable grasper integrated cystoscope is comparable to reusable cystoscope in the detection of bladder cancer.

A Novel Simulated Training Platform and Study of Performance Among Different Levels of Learners in Flexible Cystoscopy.

The aims of this study were to test a novel simulation platform suitable for flexible cystoscopy using a standard scope, to assess the platform's proposed use as a training tool for flexible cystoscopy, and to assess the user experience through surveyed response. Thirty-one urologists (11 novices, 20 experts) were evaluated using a novel light-based bladder model and standard flexible cystoscope. Time to complete full inspection of the simulated bladder was measured, and the scope trajectory was recorded. Participants also completed a survey of the training platform. Thirty participants completed a simulated inspection of a portable bladder model with a mean ± SD time for 153.1 ± 76.1 seconds. One participant failed to complete. Novice urologists (defined as those having completed less than 50 flexible cystoscopies in clinic) had a mean ± SD time of 176.9 ± 95.8 seconds, whereas with experts, this decreased to 139.3 ± 60.7 seconds. Dynamic trajectory maps identified "blind spots" within each user's cystoscopy performance. In a poststudy follow-up, 27 participants considered the tool valuable or extremely valuable for training, whereas 19 participants considered that the tool either very well or excellently replicated the clinical setting. All participants ranked the tool as very good or excellent for overall quality of training. Advances in electronic technology make portable low-cost models a potential low-cost alternative to endourology training platforms. In providing a quantifiable measure of user performance, the tool may shorten the learning curve in flexible cystoscopy and, potentially, reduce clinical errors and provide quantifiable measures for further clinical training.

Symptom and cost evaluation of ureteric stent extraction using strings versus flexible cystoscopy at a single high-volume centre

Background: This study evaluated ureteric stent symptoms using a modified ureteric stent symptom questionnaire (USSQ) for patients undergoing stent removal by either flexible cystoscopy, or manual, healthcare worker lead string extraction. Methods: Patients completed a stent symptom questionnaire derived from the USSQ. Mean data were compared between groups using paired Student’s t-tests. Data are presented as mean ± SD with associated p-values. A departmental cost analysis was undertaken. Results: Ninety patients completed questionnaires, 30 undergoing flexible cystoscopy and 60 string extraction. Six stents with strings were removed early (days 1–5, 6.67%, four female and two male). There were no adverse events recorded for this group. Men undergoing string extraction had significantly less pain (2.47 ± 1.88) compared to men undergoing flexible cystoscopic removal (5.67 ± 2.27, p &lt; 0.001). There was no significant difference in pain scores for women undergoing string and flexible cystoscopic stent removal (3.56 ± 2.56 versus 3.66 ± 3.14, p &gt; 0.90). The mean duration of stents left in situ was significantly less in the string group (10.1 ± 5.3 versus 26.5 ± 14.1 days, p &lt; 0.001). Urinary tract infection rates did not differ between the string and the cystoscopy groups (3.7% ± 0.19 versus 2.78% ± 0.46, p &gt; 0.90). The haematuria rates were 32.14% ± 0.47 and 66.67% ± 0.5, respectively ( p &lt; 0.001). In our study, 60 flexible cystoscopies were avoided, saving over £67,000 at the institution within our study period. Conclusions: In our small study, stents removed with strings reduced pain scores in men, the duration of an indwelling ureteric stent, and cost to the health service. Level of evidence: 2b

The diagnostic benefit of flexible cystoscopies in the investigation of recurrent urinary tract infections in women

The diagnostic benefit of flexible cystoscopies in the investigation of recurrent urinary tract infections in women

Nonspecialist Raters Can Provide Reliable Assessments of Procedural Skills

Competency-based learning has become a crucial component in medical education. Despite the advantages of competency-based learning, there are still challenges that need to be addressed. Currently, the common perception is that specialist assessment is needed for evaluating procedural skills which is difficult owing to the limited availability of faculty time. The aim of this study was to explore the validity of assessments of video recorded procedures performed by nonspecialist raters. This study was a blinded observational trial. Twenty-three novices (senior medical students) and 9 experienced doctors were video recorded while each performing 2 flexible cystoscopies on patients. The recordings were anonymized and placed in random order and then rated by 2 experienced cystoscopists (specialist raters) and 2 medical students (nonspecialist raters). Flexible cystoscopy was chosen as it is a simple procedural skill that is crucial to master in a resident urology program. The internal consistency of assessments was high, Cronbach's α = 0.93 and 0.95 for nonspecialist and specialist raters, respectively (p < 0.001 for both correlations). The interrater reliability was significant (p < 0.001) with a Pearson's correlation of 0.77 for the nonspecialists and 0.75 for the specialists. The test-retest reliability showed the biggest difference between the 2 groups, 0.59 and 0.38 for the nonspecialist raters and the specialist raters, respectively (p < 0.001). Our study suggests that nonspecialist raters can provide reliable and valid assessments of video recorded cystoscopies. This could make mastery learning and competency-based education more feasible.

Voided urine versus bladder washing cytology for detection of urothelial carcinoma: which is better?

Objective: Cytology is recommended as part of the follow-up of high-grade non-muscle-invasive bladder cancer (NMIBC). However, currently there are no solid guideline recommendations regarding the use of voided urine versus bladder washing for cytology as part of the diagnosis or follow-up of NMIBC. The aim of this study was to investigate whether the cytological outcome was equal regarding the two techniques.Materials and methods: The authors reviewed all outpatient flexible cystoscopies carried out in their department in 2013. Patient records in the registry of pathology were examined and those with simultaneous urine and bladder washing cytology were included. Previous urothelial disease and positive histology within 3 months after the cystoscopy were registered.Results: A total of 1458 patients had both voided urine and bladder washing cytology and were included in the study, of whom 643 (44%) had a history of urothelial disease. An equal outcome of urine and bladder washing cytology was found in 1447 patients (99.2%). For the remaining 11 patients, only four patients underwent further examinations based on cytology findings in addition to what had already been planned after cystoscopy. Of the included patients, 100 (6.9%) had a positive histological outcome within 3 months.Conclusions: In most patients, no relevant difference between voided urine and bladder washing cytology was observed. Therefore, if cytology is indicated, it is recommended to use the test that is most readily available locally. The additional gain in using both urine and bladder wash is minimal, and can therefore be discarded.

The effect of office based flexible and rigid cystoscopy on pain experience in female patients.

PurposeRigid and flexible cystoscopies are both routinely used in female patients. Literature is conflicting whether flexible cystoscopy is less painful compared to rigid cystoscopy. The aim of this study was therefore to investigate whether using flexible cystoscopy leads to less discomfort and pain compared to rigid cystoscopy in female patients who underwent first time cystoscopy.Materials and MethodsOne hundred eighty-nine female patients, who never had undergone cystoscopy, were randomized into 2 groups: 92 patients underwent rigid cystoscopy and 97 patients flexible cystoscopy. Directly after the cystoscopy procedure all patients were asked to fill out their pain experience on a 100-mm visual analogue pain scale (VAS).ResultsMedian VAS score was significantly lower for women undergoing flexible cystoscopy (0 [0–20]) compared to rigid cystoscopy (15 [0–38], p<0.001). In addition, age was inversely associated with VAS score, indicating that younger females experienced more pain (R=−0.30, p=0.001). The use of flexible cystoscopy was associated with a decrease in VAS score and remained significant after adjustment for age, sex of urologist, performing urologist and indication (standardized β=−0.17, p=0.048).ConclusionsThe use of flexible cystoscopy resulted in a significantly lower pain experience compared to rigid cystoscopy. Based on patient's pain experience during cystoscopy, this study implicates to use flexible cystoscopy in female patients who undergo first time cystoscopy.

Are specialist nurse‐led check flexible cystoscopy services as effective as doctor‐led sessions?

ABSTRACTThe demands on service provision have led to an increasing number of check flexible cystoscopies being performed by urology nurse specialists as opposed to doctors. We aimed to compare the performance of urology nurse specialists, in a nurse‐led service, with doctor‐led sessions. Retrospective case note analysis was performed on patients who required further treatment following their check flexible cystoscopies. Data was collected in two separate 3‐month time periods: first (1 October 2012–31 December 2012) all cases that were performed by doctors, second (1 March 2013–31 September 2013) all cases that were performed by nurse specialists. Details recorded included the findings at check flexible cystoscopy, treatment and initial and subsequent histology results. A total of 137 episodes were included in the study (71 – nurse, 66 – doctor). Correct reporting at initial check cystoscopy with subsequent confirmation of TCC, CIS or dysplasia occurred in 99 of 137 (72.3%) of episodes (55 – nurse, 44 – doctor). Over reporting at initial check flexible cystoscopy with findings later showing any variant of inflammation/cystitis, reactive changes, atypia or no lesion occurred in 38 of 137 (27.7%) episodes (16 – nurse, 22 – doctor). The nurse‐led service correctly reported 55 of 71 (77.5%) episodes and over‐reported 16 of 71 (22.5%). The doctors correctly reported 44 of 66 (66.7%) episodes and over reported 22 of 66 (33.3%). This study provides evidence that nurse led check flexible cystoscopy sessions are comparable in quality to doctor‐led sessions and supports the use of these services. This has clear implications on the delivery of a cost effective service to meet current financial demands.

MP14-20 THE IMPACT OF MUSIC ON PAIN AND ANXIETY EXPERIENCED IN PATIENTS UNDERGOING FLEXIBLE CYSTOSCOPY: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment II1 Apr 2014MP14-20 THE IMPACT OF MUSIC ON PAIN AND ANXIETY EXPERIENCED IN PATIENTS UNDERGOING FLEXIBLE CYSTOSCOPY: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL Luke Dixon, Alberto Coscione, and Mathias Winkler Luke DixonLuke Dixon More articles by this author , Alberto CoscioneAlberto Coscione More articles by this author , and Mathias WinklerMathias Winkler More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.648AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To ascertain the effect of music on patients’ experienced anxiety and pain whilst undergoing routine office-based flexible cystoscopies. METHODS Patients scheduled for flexible cystoscopy over a six-month period were randomized into two groups. Those in group 1 listened to music during cystoscopy and those in group 2 did not listen to music. The degree of experienced pain and anxiety was determined through patients completing 100 mm visual analogue scales before and after cystoscopy. Both female and male patients were included. Whether the patients had previous cystoscopies was also recorded to evaluate the possible ameliorating effect of prior experience. RESULTS One hundred patients were enrolled, fifty in group 1 and fifty in group 2. Demographic characteristics were comparable between the two groups. Before flexible cystoscopy patients in group 1 (music) had a significantly lower mean pain (1.6) and anxiety (17.5) versus mean pain (8.3) and anxiety (37.2) in group 2 (p<0.001). After flexible cystoscopy patients in group 1 had a significantly lower mean pain (3.5) and anxiety (4.2) versus mean pain (14.1) and anxiety (24.9) in group 2 (p<0.001). CONCLUSIONS Listening to music during flexible cystoscopy appears to help reduce patients’ experienced pain and anxiety. Finally employing music is a simple, low-cost and safe adjunct to improving patient experience during flexible cystoscopy. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e175 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Luke Dixon More articles by this author Alberto Coscione More articles by this author Mathias Winkler More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Utilizing the Productivity Analysis Module

Utilizing the Productivity Analysis Module