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Objectives Patients and Methods Results Conclusion To investigate patient tolerability and safety (using urinary tract infection (UTI) as a proxy measure) following EndoSheath‐assisted flexible cystoscopy (eFC). EndoSheaths are single‐use, disposable sheaths used in FC. They reduce cystoscope turnaround times as complicated, time‐consuming and costly sterilisation is no longer necessary. This reduces patient waiting times as cystoscope idle time, the most common rate limiting step, is reduced.All adult patients undergoing eFC over a 26‐month period at a single institution were evaluated prospectively. Post‐eFC, participants rated discomfort on a visual analogue scale (discomfort 1 = none, 2–4 = mild, 5–7 = moderate, 8–10 = severe). The diagnosis of UTI was broad and based on any one of patient self‐report, positive urine culture or antibiotic prescription within 30 days of eFC. Data were analysed using chi‐squared testing (P < 0.05, two‐tailed).Of the 1091 eFCs analysed, 33.2% and 48.2% of were ranked as causing no or mild discomfort, respectively, with just 3.1% ranked severe. Discomfort was greater in younger participants but similar between sexes. Overall, post‐eFC UTI incidence was 13.3%, with rates higher in females (18.1%) than males (11.2%). Participants aged ≥65 years reported a higher UTI rate (15.4%) than those aged <65 years (8.8%). No participants developed urosepsis.This large, prospective, unselected, real‐world study reports that eFC is well tolerated. UTI was higher in females than males, and in those aged ≥65 years, in line with other studies using the same broad based diagnostic criteria for UTI. The conclusion is that eFC is both well tolerated and safe. [ABSTRACT FROM AUTHOR]

Objective: To compare the value of flexible blue‐light cystoscopy (BLC) vs flexible white‐light cystoscopy (WLC) in the surveillance setting of non‐muscle‐invasive bladder cancer (NMIBC). Methods: All major databases were searched for articles published before May 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. The primary outcome was the accuracy of flexible BLC vs WLC in detecting bladder cancer recurrence among suspicious bladder lesions. Results: A total of 10 articles, comprising 1634 patients, were deemed eligible for the quantitative synthesis. In the meta‐analysis focusing on the detection of disease recurrence, there was no difference between flexible BLC and WLC (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.82–1.41)]; the risk difference (RD) showed 1% of flexible BLC, corresponding to a number needed to treat (NNT) of 100. In the subgroup meta‐analysis of detection of carcinoma in situ (CIS) only, there was again no significant difference between flexible BLC and WLC (OR 1.19, 95% CI 0.82–1.69), BLC was associated with a RD of 2% (NNT = 50). The positive predictive values for flexible BLC and WLC in detecting all types of recurrence were 72% and 66%, respectively, and for CIS they were 39% and 29%, respectively. Conclusion: Surveillance of NMIBC with flexible BLC could detect more suspicious lesions and consequently more tumour recurrences compared to flexible WLC, with a increase in the rate of false positives leading to overtreatment. A total of 100 and 50 flexible BLC procedures would need to be performed to find on additional tumor and CIS recurences, respectively. A risk‐stratified strategy for patient selection could be considered when using flexible BLC for the surveillance of NMIBC patients. [ABSTRACT FROM AUTHOR]

Objective: Single-use flexible cystoscopes provide a safe and cost-effective evolution to current practice. However, the environmental impact of single-use devices needs to be considered in a healthcare system that is being increasingly scrutinised for its carbon footprint. We performed a single-centre simplified lifecycle analysis to compare the carbon footprint of the single-use Ambu® aScope™ 4 Cysto System (Ambu®) with the reusable Olympus CYF-VH flexible video-cystoscope (Olympus). Methods: Manufacturing, transportation and waste costs were calculated for the Ambu® cystoscope. Manufacturing costs incorporating the average lifecycle of the reusable cystoscope was included in the carbon footprint calculation for the Olympus reusable cystoscope as were waste costs and re-processing costs using the Soluscope 3 automatic endoscope re-processor that is used in our centre. Results: Results demonstrate that Ambu® cystoscopes are a carbon-friendly alternative to reusable Olympus cystoscopes, with a 36% lower carbon footprint. The carbon footprint of the Ambu® scope is 1.43 kg CO2 compared with 2.22 kg CO2 for the reusable Olympus cystoscope. These results may vary from centre to centre depending on the cystoscope re-processor used. Conclusion: The Ambu® single-use flexible cystoscopes provide a carbon-friendly alternative to Olympus CYF-VH reusable cystoscopes. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Introduction: There is an absence of data on the environmental impact of single-use flexible cystoscopes. We wanted to review the existing literature about carbon footprint of flexible cystoscopy and analyze the environmental impact of the Isiris® (Coloplast©) single-use flexible cystoscope compared to reusable flexible cystoscopes. Methods: First, a systematic review on single-use and reusable cystoscope carbon footprint was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Second, carbon footprints of Isiris single-use flexible cystoscope and reusable cystoscope were analyzed and compared. Life cycle of the single-use flexible cystoscope was divided in three steps: manufacturing, sterilization, and disposal. For the reusable cystoscope, several steps were considered to estimate the carbon footprint over the life cycle: manufacturing, washing/sterilization, repackaging, repair, and disposal. For each step, the carbon footprint values were collected and adapted from previous comparable published data on flexible ureteroscope. Results: The systematic literature review evidenced total carbon emissions within a range of 2.06 to 2.41 kg carbon dioxide (CO2) per each use of single-use flexible cystoscope compared to a wide range of 0.53 to 4.23 kg CO2 per each case of reusable flexible cystoscope. The carbon footprint comparative analysis between Isiris single-use flexible cystoscope and reusable cystoscope concluded in favor of the single-use cystoscope. Based on our calculation, the total carbon emissions for a reusable flexible cystoscope could be refined to an estimated range of 2.40 to 3.99 kg CO2 per case, depending on the endoscopic activity of the unit, and to 1.76 kg CO2 per case for Isiris single-use cystoscope. Conclusion: The results and our systematic literature review demonstrated disparate results depending on the calculation method used for carbon footprint analysis. However, the results tend rather toward a lower environmental impact of single-use devices. In comparison to a reusable flexible cystoscope, Isiris compared favorably in terms of carbon footprint. [ABSTRACT FROM AUTHOR]

Objective: To compare clinical outcomes of single‐use endoscopes with those of reusable endoscopes to better define their role within urology. Methods: A systematic search of electronic databases was performed. All studies comparing the clinical outcomes of participants undergoing urological procedures with single‐use endoscopes to those of participants treated with reusable endoscopes were included. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 statement. Results: Twenty‐one studies in 3943 participants were identified. Six different single‐use flexible ureteroscopes and two different single‐use flexible cystoscopes were assessed. There were no differences in mean postoperative infection rates (4.0% vs 4.4%; P = 0.87) or overall complication rates (11.5% vs 11.9%; P = 0.88) between single‐use and reusable endoscopes. For patients undergoing flexible ureteroscopy there were no differences in operating time (mean difference −0.05 min; P = 0.96), length of hospital stay (LOS; mean difference 0.06 days; P = 0.18) or stone‐free rate (SFR; 74% vs 74.3%; P = 0.54) between the single‐use and reusable flexible ureteroscope groups. Conclusion: This study is the largest to compare the clinical outcomes of single‐use endoscopes to those of reusable endoscopes within urology, and demonstrated no difference in LOS, complication rate or SFR, with a shorter operating time associated with single‐use flexible cystoscope use. It also highlights that the cost efficiency and environmental impact of single‐use endoscopes is largely dependent on the caseload and reprocessing facilities available within a given institution. Urologists can therefore feel confident that whether they choose to 'use' or to 'reuse' based on the financial and environmental implications, they can do so without negatively impacting patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: A noninferiority assessment of single-use digital flexible cystoscopy (FC) compared with standard reusable FC for bladder cancer surveillance, and investigation of lower urinary tract symptoms. Patients and Methods: Patients requiring FC who met inclusion criteria were randomly assigned to have their procedure performed using a single-use cystoscope (Ambu® aScope™ 4 Cysto System) or a standard reusable cystoscope (Olympus CYF-VH flexible video cystoscope). Primary outcomes were noninferiority of the single-use cystoscope, in terms of effective procedure completion rate, image quality, light quality, and maneuverability. Secondary objectives compared safety, operative, and perioperative time. The noninferiority margin was set at −10%. Results: One hundred one patients completed the study (n = 50 trial, n = 51 control). All primary outcomes demonstrated noninferiority of the single-use cystoscope, compared with standard reusable FC. Effective completion rate, image quality, light quality, and maneuverability between single-use and reusable cystoscopes were 100% and 98% (confidence interval [CI]: −0.059 to 0.019); 96% and 100% (CI: −0.014 to 0.092); 98% and 100% (CI: −0.018 to 0.058); and 98% and 100% (CI: −0.018 to 0.058). There was no difference in operation time (p = 0.415) or total theater use time (p = 0.441) between groups. Adverse event rates were 4.08% and 4.16% in the trial group and control groups, respectively. Conclusion: The single-use Ambu flexible cystoscope is noninferior to standard FC in terms of procedure completion and light quality, image quality, and maneuverability. Single-use flexible cystoscopes are an effective and safe alternative to reusable flexible cystoscopes and may act as a suitable alternative or adjunct in the urologist's armamentarium. [ABSTRACT FROM AUTHOR]

Objective:Portability and miniaturization of endoscopic instruments are important in urological practice for flexible cystoscopy in bedside and office conditions. However, the adequacy of portable light sources is doubtful. Thus, this study aimed to compare the portable halogen and conventional light sources in terms of image quality and cost.Materials and Methods:An in vitro model was designed using portable halogen and a conventional endoscopy light source. Two videos of simulated cystoscopy were recorded using the portable and another two using the conventional light source. These videos were rated in the following 5 areas: overall video quality, brightness, sharpness, contrast, and color. The imaging quality of the two light sources was compared. Additionally, the cost analysis was compared in both light sources.Results:The image quality rating was performed by 83 evaluators. The overall video quality, brightness, sharpness, and contrast evaluation revealed a significant difference between the light sources in terms of brightness, and the score was higher in the conventional light source (p

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. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of immersive VR distraction technology in alleviating anxiety and pain during flexible cystoscopy. Methods: We prospectively recruited 270 study participants who qualified for flexible cystoscopy and randomly assigned them to experimental and control groups. The experimental group consisted of 135 patients who employed a VR set during flexible cystoscopy, and the control group consisted of 135 patients who underwent the procedure without a VR set. Patient anxiety was determined quantitatively according to the State-Trait Anxiety Inventory. A visual analog scale for assessing pain intensity, satisfaction, and willingness to repeat the procedure was evaluated. In addition, difference in the hemodynamic parameter was also examined. Results: The study findings demonstrated that the use of a VR set during flexible cystoscopy significantly improved the anxiety level over that of the control group (p = 0.001). Furthermore, this intervention led to a significantly increased level of satisfaction and willingness to repeat the procedure and a decrease in hemodynamic variables, specifically, systolic pressure, diastolic pressure, and heart rate (p = 0.001 in each case). Nonetheless, there were no significant differences between the groups with respect to the basic characteristic data, pain intensity, or oxygen saturation. Conclusions: Based on the present study, immersive VR can measurably decrease anxiety and increase satisfaction and willingness to repeat the procedure during flexible cystoscopy. Trial registration date: 14 September 2019; number: TCTR20190914002. [ABSTRACT FROM AUTHOR]

Abstract Objectives Objective of this study is to report the results of nurse led hematuria clinic service outcome of 2,714 patients. Subjects and methods We conducted a retrospective, single center review of 2714 patients with visible and nonvisible hematuria managed by a well‐trained nurse specialist in a rapid access clinic (RAC) between 2014 and 2020. All patients received a full review, flexible cystoscopy performed by a nurse, and ultrasound of urinary tracts. After investigations, patients were reassured and discharged or referred for rigid cystoscopy, TURBT, and CT urography. Results In total, 2714 patients attended the RAC between October 2014 and March 2020. Of these, 1684 (62%) were males and 1030 (38%) females. The median age of patients was 68.3 (IQR 58‐79). Of the 1030 females, 500 (48.5%) presented with nonvisible hematuria (NVH), and 530 (51.5%) presented with visible hematuria (VH). The median age was 66 (IQR 56‐76). The number of females diagnosed with any form of malignancy was 72 (7% of all females). Of the 1684 males, 288 (17.1%) presented with NVH, and 1396 (82.9%) presented with VH. The median age was 72 (IQR 59‐81). The number of males diagnosed with some form of malignancy was 258 (15.3% of all males). Overall, 1926 patients presented with VH and 788 patients presented with NVH. After investigations, 290 patients (15.1%) with VH and 40 (5.1%) patients with NVH had some form of malignancy. The highest number of malignancies found in VH was bladder cancer (n = 222, 11.5%), followed by prostate (n = 28, 1%), renal (n = 23, 0.8%), UT urothelial (n = 17, 0.6%), gynaecological (n = 7, 0.3%), and gastrointestinal (n = 5, 0.2%) cancer. The highest number of pathologies found in NVH was infection (n = 44, 5.6%). Cancer detection rate for symptomatic NVH was more than double that of asymptomatic NVH, 6.5% versus 3.1%, respectively. Conclusion Overall, 15.1% with VH and 5.1% with NVH present with malignancy. Nurse‐led rapid access hematuria clinic and flexible cystoscopy investigation by trained nurse is safe and feasible.

Introduction: Many patients with non-muscle invasive bladder cancer (NMIBC) will develop recurrences of their tumour after their first resection. Flexible cystoscopy under local anaesthesia with Holmium-YAG laser ablation of tumour (FHoLAT) is safe, well tolerated procedure with significant cost savings when compared to cystoscopy under general or regional anaesthesia. We retrospectively analysed the outcomes of a large series of patients undergoing FHoLAT at our institution between April 2006 and September 2013. Patients and methods: Patients were offered FHoLAT if the tumour recurrence was small and/or they were deemed unfit for regional or general anaesthesia. Patient data was extracted from medical records. The primary outcomes were overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS) and recurrence-free survival (RFS). Results: 232 patients with a total 522 FHoLAT procedures were included. The median follow-up was 74.8 (43.5–101) months; 18% were discharged after a recurrence free follow-up duration; 52.2% had one FHoLAT, 19.8% had two FHoLATs, 11.2% had three FHoLATs and 16.8% had four or more FHoLAT. At initial diagnosis 24.1% of patients had G1pTa, 47% G2pTa, 9.9% G3pTa and T1 in 18.9%. 4.3% had concurrent carcinoma in situ. At 10 years, OS was 47.4%, CSS was 94.1%, PFS was 82.1%, RFS was 15.8%. Conclusions: FHoLAT for bladder tumour recurrences has an acceptable CSS and PFS for patients with small low-grade tumours or patients with high-grade or T1 tumours who are unfit for regional or general anaesthesia. The role of FHoLAT in unfit patients seems clear, but further prospective trials are needed to define its role in other patient groups, particularly high-grade NMIBC. Level of evidence: 3b-4 [ABSTRACT FROM AUTHOR]

Background: Informed consent is an integral part of the process prior to any surgical procedure [1]. Flexible cystoscopy is a common day case urological procedure and it is the gold standard investigation for visible haematuria [2]. Aim: To assess if postal consent is a suitable form of gaining informed consent for flexible cystoscopy. Methods: Patients booked for a flexible cystoscopy are initially reviewed in clinic. An information leaflet with an attached consent form is then posted to their home 2 weeks prior to their procedure. We designed a short questionnaire, to assess patient's satisfaction and understanding of the literature, given to them after the procedure. Results: Sixty-seven questionnaires were completed. The mean age was 54. Sixty patients (93%) think that postal consent is of benefit to the patient. Sixty-one patients (91%) read the information sheet and felt that there was enough information regarding the procedure on it. Fifty-four patients (81%) had no difficulty understanding the consent form. Forty patients (60%) signed the form prior to arrival in the hospital. Conclusion: Postal consent is commonly used for gastro-intestinal endoscopy procedures. Postal consent for flexible cystoscopy is not well reported in the literature. Our study shows postal consent to be a suitable form of gaining informed consent for flexible cystoscopy. [ABSTRACT FROM AUTHOR]

Objective: Portability and miniaturization of endoscopic instruments are important in urological practice for flexible cystoscopy in bedside and office conditions. However, the adequacy of portable light sources is doubtful. Thus, this study aimed to compare the portable halogen and conventional light sources in terms of image quality and cost. Materials and Methods: An in vitro model was designed using portable halogen and a conventional endoscopy light source. Two videos of simulated cystoscopy were recorded using the portable and another two using the conventional light source. These videos were rated in the following 5 areas: overall video quality, brightness, sharpness, contrast, and color. The imaging quality of the two light sources was compared. Additionally, the cost analysis was compared in both light sources. Results: The image quality rating was performed by 83 evaluators. The overall video quality, brightness, sharpness, and contrast evaluation revealed a significant difference between the light sources in terms of brightness, and the score was higher in the conventional light source (p<0.05). Color reproduction results were as follows: 68.67% great similarity, 27.71% little similarity, and 3.61% no similarity between the images produced using the two light sources. A portable light source was considered to be cost-effective. Conclusion: The portable light source resulted in minimal degradation in image quality for flexible cystoscopy compared with the conventional endoscopy light source. This system can capture high-quality images with minimal equipment and is easy to set up. We believe that a portable halogen light source is sufficient to perform cystoscopic procedures in bedside and office conditions with limited cost. Further studies are needed to evaluate the efficacy of new cystoscopy systems that integrate mobile technology and new portable light sources. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to assess whether urethral pain can be alleviated by urination in male patients undergoing flexible cystoscopy. Methods Ninety-six male outpatients undergoing flexible cystoscopy were randomly divided into two groups. Patients in the test group urinated during flexible cystoscopy, whilst patients in the control group received no instructions to do so. All patients received 10 mL of 2% lidocaine gel prior to assessment. Using 0 (no-pain) to 10 (unbearable severe pain) pain scores (VAS), we assessed patient discomfort prior to anesthesia gel perfusion (baseline), during gel perfusion, during cystoscope insertion through the urethra, and 15 min post-examination analysis. The entire protocol was completed by a single doctor in our Department of Urology. Results The groups showed no statistical differences regarding age or examination time. During cystoscope insertion, the test group recorded significantly lower pain scores 2 (IQR 1–3) - compared to the control group 3 (IQR 2–3), (P = 0.001). No significant differences between other evaluation points were observed between groups. Conclusion Urethral pain can be significantly alleviated by urination in male patients undergoing flexible cystoscopy through the urethra. Trial registration Registry name: Clinical study of urination action to relieve urethral pain associated with flexible cystoscopy. Registration number: ChiCTR-INR-17013294 Date of Registration: 2017-11-08

Following renal transplant, ureteral stents aim to minimise ureteroneocystostomy anastomotic complications. Although there is no specified timing for stent removal after transplantation, these are ideally removed at between 2 and 4 weeks. However, forgotten stents can adversely affect renal allograft function and contribute to obstructive uropathy. We present a 59-year-old man with a retained ureteral stent for more than 19 years with an absence of encrustations, fragmentation, migration and stone formation. To our knowledge, this is the longest retained ureteral stent in a renal transplant patient and the first forgotten stent removed via flexible cystoscopy under local anaesthetic.

Objective: To investigate the short-term efficacy of combining flexible cystoscopy with flexible ureteroscopy in the treatment of complex renal stones., Methods: The medical records of 145 patients with complex renal stones admitted to Yan'an People's Hospital from February 2020 to February 2022 were retrospectively analyzed. Among these, 65 patients treated with flexible ureteroscopy alone constituted the control group. The research group consisted of 81 patients receiving both flexible cystoscopy and flexible ureteroscopy. Outcomes compared between the two groups included stone removal rate, operative time, time to ambulation, hospitalization duration, and intraoperative bleeding. Logistic regression analysis was used to assess the risk of stone retention., Results: In the research group, the stone removal rate was 85.19% and the residual stone rate was 14.81%, compared to a stone removal rate of 70.77% and a residual rate of 29.23% in the control group, with a statistically significant difference (P<0.05). The research group had a significantly longer operative time than the control group (P<0.05). However, intraoperative bleeding and hospitalization duration were significantly lower in the research group (P<0.05). There was no statistically significant difference in time to ambulation between the groups (P>0.05). Multivariate logistic regression analysis identified multiple stones (OR=3.581, P=0.013) as an independent risk factor for residual stones, while stone location outside the lower calyx (OR=0.305, P=0.021) and treatment with combined flexible cystoscopy and ureteroscopy (OR=0.398, P=0.160) were independent protective factors against residual stones. The area under the curve for predicting stone retention based on the number of stones, stone location, and treatment modality were 0.647, 0.642, and 0.606, respectively., Conclusion: The combination of flexible cystoscopy and flexible ureteroscopy in treating patients with complex renal stones significantly improves the stone clearance rate and postoperative patient recovery., Competing Interests: None., (AJTR Copyright © 2024.)

Objective: To assess whether instillation of lidocaine gel both before and after flexible cystoscopy is more effective at reducing post procedural symptoms than instillation of lidocaine gel pre flexible cystoscopy alone. We hypothesise that inadequate urethral dwell time and dilution of lidocaine gel by the irrigation fluid during flexible cystoscopy limits its anaesthetic efficacy. Only one other study has attempted to reduce bothersome urinary symptoms through an intervention after flexible cystoscopy. Methods: This was a randomised controlled trial in which patients were randomised 1:1 to receive lidocaine gel pre and post flexible cystoscopy (treatment) or lidocaine gel pre flexible cystoscopy only (control). Patient-reported outcome measures were used to assess symptoms and quality of life prior to cystoscopy, on day 2 and day 7 post cystoscopy. Result: Fifty patients were divided equally between the treatment and control groups. There were no significant differences in baseline characteristics between the groups (p = 1.000). An overall symptoms variable was measured, though no significant difference was found in the distribution of responses between the groups at baseline, 2 or 7 days after the flexible cystoscopy (p = 0.423, 0.651,0.735). In the treatment group, 1 patient (4.0%) presented to a doctor for review following flexible cystoscopy, and 4 patients (16.0%) presented in the control group (p = 0.349). Conclusion: Initial study results suggest that post-operative lidocaine does not significantly limit the exacerbation of urinary symptoms following flexible cystoscopy; however, our results are not powered to detect a small difference. We do not recommend a change in practice based on our results. [ABSTRACT FROM AUTHOR]

Difficult airway still is one of the dreaded crises in anesthesia. A well-formulated plan with all the necessary equipment should be ready when such situations are anticipated, but unanticipated difficulties can arise, and managing such cases is a nightmare for the anesthesiologist. Most hospitals in the developing countries are not equipped technically with all the modern equipment and gadgets as far as anesthesia is concerned. In a resource-constrained area, the skill and innovative ideas of the anesthesiologist often emerge as an alternative option in dealing with such cases. Here, we describe two cases of difficult intubation by conventional approach, which were managed successfully using a pediatric gastroscope and a flexible cystoscope as an alternative to fiberoptic bronchoscope.

Objective: To determine if a modified cystoscopy technique utilizing the peak-end rule cognitive bias decreases pain and anxiety during flexible cystoscopy in patients who undergo cystoscopy.Methods: A total of 85 participants undergoing their first diagnostic cystoscopy were enrolled in a blinded single-center, prospective, randomized controlled trial. Patients with lower urinary tract abnormalities, prior radiation and chronic pelvic pain were excluded. Participants were randomized to a standard cystoscopy (arm A) or a modified cystoscopy (arm B) where a two-minute period at the end of the procedure was completed during which the cystoscope was left in the bladder without being manipulated. Following the cystoscopy, participants completed a standard pain and anxiety questionnaire. Differences in mean pain and anxiety score between arms were evaluated using a Mann-Whitney test with a two-sided alpha of 0.05.Results: Eighty-five patients were randomized and underwent flexible cystoscopy. Three participants were ineligible, one required secondary procedures, and two did not complete the questionnaires. Among the 82 eligible patients, 45 were randomized to standard cystoscopy (arm A) and 37 to the modified cystoscopy (arm B) with mean pain scores of 23.20 and 11.97, respectively (P = .039). Mean anxiety scores were 2.09 and 0.88 for arm A and B, respectively (P = .013).Conclusion: This study demonstrated a clinically meaningful decrease in pain and anxiety for patients undergoing flexible cystoscopy when employing the modified cystoscopy technique versus the standard practice. This free and straightforward method to improve patient comfort and decrease stress during first time flexible cystoscopy should be considered by clinicians. [ABSTRACT FROM AUTHOR]

To investigate whether outpatient blue-light flexible cystoscopy could solve the diagnostic challenge of positive or suspicious urine cytology findings despite normal white-light flexible cystoscopy results and normal findings on computerized tomography urography, in patients investigated for urothelial cancer. In a multicentre study, a total of 70 examinations were performed with the use of blue-light flexible cystoscopy (photodynamic diagnosis) after intravesical instillation of the fluorescence agent hexaminolevulinate. The examination started with a conventional white-light flexible cystoscopy and then the settings were switched to use blue light. Suspicious lesions were biopsied. Afterwards, the patients were interviewed regarding their experience of the examinations. Bladder cancer was diagnosed in 29 out of 70 (41%) cases, among them 14/29 (48%) had malignant lesions seen only in blue light. The majority had carcinoma in situ (21/29). Normal findings were seen in 41 cases that underwent BLFC. During the further course, malignancy of the bladder was detected in six cases (9%) and malignancy of the upper urinary tract was detected in one case (1%). The majority of patients (93%) preferred the blue-light flexible cystoscopy performed at the outpatient clinic instead of the transurethral resection under general anaesthesia. Blue-light flexible cystoscopy at the outpatient clinic may be a useful tool to solve unclear cases of a malignant or suspicious urinary cytology suggestive of bladder cancer. The procedure was well tolerated by the patients. [ABSTRACT FROM AUTHOR]

Transurethral cystoscopy (CS) is a common urological procedure, performed mostly for diagnostic but also for therapeutic purposes. Although CS is generally well tolerated, some patients describe the pain related to the procedure as high or even "unbearable". As a result, many patients fear and avoid both primary and/or follow-up cystoscopies. This may lead to uncontrolled progression of neoplastic disease. Therefore, it is crucial to maximally increase the comfort of the patient and to implement safe and effective analgesia before the procedure. Providing the patients with appropriate care during CS can encourage them to comply with diagnostic schedules and improve their prognosis. The aim of this review is to analyze the available literature on various methods of pain reduction during transurethral CS. The PubMed electronic database limited to English articles published until January 2021 was used in the process. Meta-analyses, systematic reviews, randomized controlled trials, clinical trials, prospective randomized studies, multicenter comparisons, reviews and retrospective comparisons were used. As a result, 65 articles were included in this review. [ABSTRACT FROM AUTHOR]

Introduction: The effect of repeated cystoscopy on bladder cancer (BC) patient anxiety and feelings is rarely evaluated. Aim: To compare the difference of patients' anxiety and subjective feelings caused by different cystoscopes. Material and methods: We prospectively included 192 BC patients who accepted regular cystoscopy follow-up after transurethral resection of bladder tumor (TURBT): 93 in the flexible group and 99 in the rigid group. The method of anesthesia and the order of examinations were consistent between different groups. We analyzed the anxiety level before cystoscopy, the maximum pain during the examination and the change of lower urinary tract symptoms (LUTS) before and after cystoscopy. Meanwhile, we analyzed the rate of gross hematuria and pyuria after cystoscopy. The anxiety and pain levels were evaluated by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and visual analogue scale (VAS). LUTS was reflected by the Core Lower Urinary Tract Symptom Score (CLSS). We distinguished gender during analysis. Results: The median APAIS score of male patients undergoing flexible or rigid cystoscopy was 8 vs. 12 (p < 0.01), and this result for females was 8 vs. 9 (p = 0.048). The median pain scores for men in the two groups was 1 vs. 2 (p < 0.01), respectively, and this outcome in female patients was 0 vs. 1 (p < 0.01). Patients in the rigid group had more CLSS change (0 vs. 1, p < 0.01). There was no difference in pyuria or gross hematuria rate after examination. Analysis in respective groups showed that men have more severe pain than women, 1 vs. 0 (p = 0.001) in the flexible group and 2 vs. 1 (p = 0.009) in the rigid group. Conclusions: A flexible cystoscope can improve anxiety and subjective feelings of BC patients during cystoscopy follow-up. [ABSTRACT FROM AUTHOR]

Objective: The objective is to measure the change in overactive bladder (OAB) symptoms in patients undergoing flexible cystoscopy in the early postoperative period using a validated OAB-V8 tool., Patients and Methods: It was a prospective, cross-sectional, observational study conducted by a section of Urology at the Aga Khan University Hospital, Karachi. The total duration of the study was 12 months (July 2022 to June 2023). All adult patients who underwent flexible cystoscopy under local anesthesia for diagnostic and surveillance purposes were included in the study. OAB symptoms were evaluated using the validated eight-item OAB-V8 tool just before the cystoscopy and on postoperative days 1 and 4. Patients were categorized as either OAB-negative (<8) or OAB-positive (≥8) based on their sum scores. Mean sum scores of different variables and OAB subdomains were assessed., Results: Sixty-three patients were included in the final analysis with a predominantly male population. The mean pre-cystoscopy (screen) score was 7.46 + 5.58, which increased to 9.89 + 6.82 on day 1 (p<0.01) before decreasing back to 7.68 + 5.7 on day 4 (p=0.08). Twenty-one patients (33.3%) were labeled OAB positive on day 0. Following cystoscopy, this number increased to 32 patients (50.8%) as 11 patients (26.2 %) developed de-novo OAB symptoms. The sub-group analysis showed an insignificant impact of age (p=0.5), gender (p=0.51), indication (p=0.22), and use of alpha-blocker (p= 0.30) on change in OAB score., Conclusion:  OAB symptoms are frequently encountered in patients undergoing awake (flexible) cystoscopy. This procedure can also trigger de novo OAB symptoms, albeit transiently, which typically resolve over time. This information could help in patient counseling, management, and the need for intervention in the future., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Review Committee of Aga Khan University Hospital, Karachi, PAK issued approval 2022-7365-21844. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khan et al.)

Objective: This study aims to evaluate the clinical efficacy and short-term prognosis of using flexible cystoscopy with percutaneous nephrolithotomy to treat complex renal stones., Methods: A retrospective analysis was conducted on patients with complex kidney stones treated at Gansu Provincial Hospital of TCM and Lanzhou City No. 2 People's Hospital from July 2019 to July 2022. The study divided the patients into a control group (n=95), who underwent percutaneous nephrolithotomy alone, and an observation group (n=109), who received additional holmium laser lithotripsy and cystoscopy. We compared stone clearance rates at 5 days and 1 month post-surgery, analyzed patient prognosis over a year based on stone recurrence, and assessed risk factors through logistic regression. Perioperative data, changes in renal function indiex 3 days post-surgery, and complication rates were also evaluated., Results: The observation group exhibited a significantly higher stone clearance rate at 5 days post-surgery (P=0.002) compared to the control group, although no significant difference was observed at 1 month (P=0.823). The operative time was significantly shorter (P<0.001), and postoperative levels of BUA, Cys-c, and β2-BMG were lower (P<0.05) in the observation group. Additionally, treatment regimen, BMI, and STONE score were influencing factors for stone recurrence within 1 year., Conclusion: Flexible cystoscopy combined with percutaneous nephrolithotomy offers superior short-term outcomes in the treatment of complex renal stones, including enhanced stone clearance, reduced operative time, and minimized renal function impairment shortly after surgery. Moreover, treatment approach, BMI, and STONE score play pivotal roles in predicting stone recurrence., Competing Interests: None., (AJTR Copyright © 2024.)

Introduction: There is an absence of data on the environmental impact of single-use flexible cystoscopes. We wanted to review the existing literature about carbon footprint of flexible cystoscopy and analyze the environmental impact of the Isiris ® (Coloplast © ) single-use flexible cystoscope compared to reusable flexible cystoscopes. Methods: First, a systematic review on single-use and reusable cystoscope carbon footprint was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Second, carbon footprints of Isiris single-use flexible cystoscope and reusable cystoscope were analyzed and compared. Life cycle of the single-use flexible cystoscope was divided in three steps: manufacturing, sterilization, and disposal. For the reusable cystoscope, several steps were considered to estimate the carbon footprint over the life cycle: manufacturing, washing/sterilization, repackaging, repair, and disposal. For each step, the carbon footprint values were collected and adapted from previous comparable published data on flexible ureteroscope. Results: The systematic literature review evidenced total carbon emissions within a range of 2.06 to 2.41 kg carbon dioxide (CO 2 ) per each use of single-use flexible cystoscope compared to a wide range of 0.53 to 4.23 kg CO 2 per each case of reusable flexible cystoscope. The carbon footprint comparative analysis between Isiris single-use flexible cystoscope and reusable cystoscope concluded in favor of the single-use cystoscope. Based on our calculation, the total carbon emissions for a reusable flexible cystoscope could be refined to an estimated range of 2.40 to 3.99 kg CO 2 per case, depending on the endoscopic activity of the unit, and to 1.76 kg CO 2 per case for Isiris single-use cystoscope. Conclusion: The results and our systematic literature review demonstrated disparate results depending on the calculation method used for carbon footprint analysis. However, the results tend rather toward a lower environmental impact of single-use devices. In comparison to a reusable flexible cystoscope, Isiris compared favorably in terms of carbon footprint.

Reza Zare,1 Magnus Grabe,2 Gregers G Hermann,3 Per-Uno Malmström4 1Department of Urology, Vestre Viken HF Bærum Hospital, Oslo, Norway; 2Department of Urology, Skåne University Hospital, University of Lund, Malmö, Sweden; 3Department of Urology, Herlev and Gentofte Hospital, Copenhagen University, Denmark; 4Department of Urology, Institute of Surgical Sciences, Uppsala University, Uppsala, Sweden Background: The aim of this prospective cohort study was to determine the feasibility of incorporating blue light flexible cystoscopy (BLFC) and biopsy/fulguration into routine outpatient follow-up of non-muscle invasive bladder cancer patients. Methods: The study included patients with non-muscle-invasive bladder cancer (NMIBC) who were scheduled for routine follow-up. Hexaminolevulinate was instilled in the outpatient department, and the bladder was examined under white light and then with BLFC. Biopsies were taken from all suspicious lesions. Small tumors and suspicious lesions were fulgurated on site; patients with larger lesions were referred to the operating room for resection. Results: The study included 69 patients, with a mean age of 70 years (range 33–89 years) and a mean duration since NMIBC diagnosis of 8 years. Most patients had high-grade cancer at initial diagnosis (52/69) and were at high risk of recurrence (48/69). Two patients per hour could be assessed using outpatient BLFC. Preparation and instillation of hexaminolevulinate took less than 10 minutes per patient, and patients had an additional waiting time of 45–60 minutes following instillation, while the hexaminolevulinate solution was retained in the bladder before examination. Eleven patients had histologically confirmed tumors that were identified using both white light flexible cystoscopy and BLFC. An additional three patients had tumors that were identified by BLFC only: two with Ta tumors and one with carcinoma in situ. Of the 14 patients with confirmed tumors, 11 could be managed on site with fulguration, whereas three were referred to the operating room. No adverse events attributable to BLFC were reported. Conclusion: Routine outpatient management of patients with NMIBC using BLFC and on-site biopsy/fulguration is feasible, despite the additional time required for hexaminolevulinate instillation, and appears to allow early detection of recurrent lesions, which can be fulgurated without the need for hospitalization. Keywords: bladder cancer, blue light, diagnosis, flexible cystoscopy, hexaminolevulinate, outpatients

Introduction: Acquisition costs and prohibitively expensive technical support for endoscope maintenance, repair, and reprocessing have deterred adoption of flexible cystoscopes by many urologists internationally. This study evaluated the performance of a novel single-use digital cystoscope that can directly connect to a laptop or computer monitor for visualization, obviating the need for a tower. Materials and Methods: The performance characteristics of flexible single-use cystoscopes (NeoScope) were prospectively evaluated vs a reusable flexible cystoscope (Olympus) in three clinical cases and two independent benchtop testing episodes in Canada. Cystoscope maneuverability, imaging, deflection, irrigation, and ease of use of instrumentation were investigated. Additional investigations were performed during clinical use in Zimbabwe (7 patients), Egypt (10 patients), and Dominica (5 patients). Results: Bench testing revealed smaller tip diameter (4.06 vs 6.09 mm) and shorter (35.4 vs 38 cm) single-use cystoscopes vs reusable cystoscopes. Deflection of the single-use scope was superior with an empty working channel (230 up/220 down) vs the reusable (195 up/95 down) but showed a more substantial decrease in deflection on placement of instruments including a grasper. Clinical use revealed satisfactory maneuverability, ease of use of instruments, deflection, and visualization. Conclusions: Benchtop testing performance of the single-use digital flexible cystoscopes was inferior compared with reusable digital cystoscopes. However, these single-use endoscopes offer adequate illumination, imaging, and maneuverability. Direct connection to any computer monitor allowed truly portable use, allowing for treatment of patients in a variety of clinical settings without the need for ancillary equipment. [ABSTRACT FROM AUTHOR]

Introduction: Flexible cystoscopy (FC) is a common and useful diagnostic tool. Because of its broader applications, availability and simplicity, there has been criticism of its overuse with accompanying financial burden to the health system and unnecessary invasive intervention to the patient. Therefore, we reviewed our local practice against current guidelines to evaluate compliance, enhance patient safety and capacity utilisation. Patients and methodology: Data were collected retrospectively on all patients having FC over two months. The indications and findings of FC were gathered from the hospital electronic patient record system. Results: A total of 413 FCs were carried out over the study period. The most common indications were cancer surveillance 116 (28%) and visible haematuria 76 (18.4%). A total of 152 (37%) FCs were performed for non-recommended indications. The most common conditions that deviated from guidelines were lower urinary tract symptoms (LUTS) (72, 17.4%), urinary tract infection (UTI) (41, 9.9%) and asymptomatic non-visible haematuria (35, 8.5%). In all non-visible haematuria cases, 65 (90%) of LUTS and 39 (95%) of UTI patients, FC was non-contributory. Adherence to guidelines would have yielded 37% of FC slots. Based on current UK National Tariffs, cost savings would have been £352,032 annually in this trust. Conclusions: FC is a frequent investigation within urology departments for which referral guidelines exist. Protocol-driven practice enables appropriate use, ensures patient safety and leads to efficient utilisation of capacity with substantial cost savings. Level of evidence: Not applicable for this multicentre audit. [ABSTRACT FROM AUTHOR]

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Introduction: Ureteric stents are frequently placed following endo-urological procedures. These stents cause significant morbidity for patients. Standard ureteric stents are removed by flexible cystoscopy. This procedure can be unpleasant for patients and requires additional resources. A newly designed magnetic stent allows removal in an outpatient setting. The aim of our study is to compare the magnetic stent and standard ureteric stents with regard to morbidity, pain on stent removal and cost-effectiveness. Methods: This study was carried out across two sites between September 2016 and July 2017. In site A, a magnetic stent (Urotech, Black-Star®) is removed by magnetic retrieval device. Fifty consecutive patients completed the validated Ureteric Stent Symptom Questionnaire (USSQ) and visual analogue scale (VAS) at the time of stent removal. On site B, a soft polyurethane stent (Cook Universa) was removed by flexible cystoscopy. Fifty patients were identified retrospectively and completed questionnaires by post. Cost analysis was also performed. Results: One hundred questionnaires were included for analysis. No significant difference in stent morbidity as assessed by the USSQ was shown between both groups. Median duration of stenting was significantly shorter in the magnetic stent group (5.5 versus 21.5 days, p < 0.001). Mean pain on stent removal was significantly less with magnetic retrieval (2.9 versus 3.9, p < 0.05). Complication rates were similar in both groups. Cost analysis showed a cost saving of €203 per patient with the magnetic stent group. Conclusion: Magnetic stents cause similar morbidity for patients compared with standard stents removed by flexible cystoscopy; they are associated with less pain at removal and are cost saving. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess whether urethral pain can be alleviated by urination in male patients undergoing flexible cystoscopy.Methods: Ninety-six male outpatients undergoing flexible cystoscopy were randomly divided into two groups. Patients in the test group urinated during flexible cystoscopy, whilst patients in the control group received no instructions to do so. All patients received 10 mL of 2% lidocaine gel prior to assessment. Using 0 (no-pain) to 10 (unbearable severe pain) pain scores (VAS), we assessed patient discomfort prior to anesthesia gel perfusion (baseline), during gel perfusion, during cystoscope insertion through the urethra, and 15 min post-examination analysis. The entire protocol was completed by a single doctor in our Department of Urology.Results: The groups showed no statistical differences regarding age or examination time. During cystoscope insertion, the test group recorded significantly lower pain scores 2 (IQR 1-3) - compared to the control group 3 (IQR 2-3), (P = 0.001). No significant differences between other evaluation points were observed between groups.Conclusion: Urethral pain can be significantly alleviated by urination in male patients undergoing flexible cystoscopy through the urethra.Trial Registration: Registry name: Clinical study of urination action to relieve urethral pain associated with flexible cystoscopy. Registration number: ChiCTR-INR-17013294 Date of Registration: 2017-11-08. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to explore the ability of nonpharmacologic adjuvant interventions to alleviate pain in male patients during flexible cystoscopy (FC) under local anesthesia. Methods: Electronic databases including PubMed, the Cochrane Library, and Embase were searched to identify eligible clinical trials from inception to 31 December 2020, with no language restrictions. Two independent reviewers used Cochrane Collaboration tools to assess the selection criteria, methodological rigor and risk of bias. Statistical analyses were performed using STATA 14.2. Results: In total, 717 studies were initially identified, and fourteen randomized controlled trials were ultimately included. We observed that patients who underwent FC with higher irrigation pressures had significantly lower pain scores on the visual analog scale than their counterparts with lower irrigation pressure during FC (weight mean difference (WMD): −1.43; 95% confidence interval (CI): −1.72 to −1.14) with no between-study heterogeneity (p = 0.661). There were no significant differences in pain between immediate or delayed FC groups under the same local anesthetic (standard mean difference (SMD): −0.19; 95% CI: −0.39 to 0.01). A pooled analysis of three studies including 340 male patients showed that men who observed the cystoscopy on the monitor had significantly lower pain ratings compared to those who did not view the operation on the monitor (SMD: −0.64; 95% CI: −1.14 to −0.15). Two studies, including a total of 272 patients, assessed the influence of listening to music on pain and anxiety in male patients during FC. Our meta-analysis found that music significantly improved patient pain (WMD: −0.92; 95% CI: −1.29 to −0.54). Hand-holding and urination during FC also relieved pain and anxiety in male patients undergoing FC. Conclusions: We observed that elevated irrigation pressure, real-time cystoscopy visualization, and music therapy alleviated pain in male patients undergoing FC. Well-designed trials are needed to confirm our findings.

Objective: To compare the difference in pain score between the patients who visualized their flexible cystoscopy finding on the video monitor and those who did not view the procedure. Materials and Methods: A prospective randomized controlled trial was conducted at Ratchaburi Hospital between December 2017 and February 2018. Forty male patients undergoing flexible cystoscopy were randomized into two groups. Group A patients (n = 20) were allowed to view their procedure real-time on the video monitor. Group B patients (n = 20) were unable to view the video monitor. All patients recorded their pain on a visual analog scale (VAS) ranging from 0 to 10 after completing the procedure. The blood pressure and pulse were also recorded five minutes before the procedure and immediately after the procedure. Results: The pain score on the VAS in group A was statistically significantly lower than that in group B (1.0 (0, 2.0) vs. 3.0 (1.0, 5.0), p=0.004). There was no statistically significant difference in the post-procedure systolic blood pressure and pulse between the two groups. Conclusion: Real-time visualization of flexible cystoscopy finding in male patients made the procedure less painful on the VAS. Therefore, the authors highly recommend this useful technique during flexible cystoscopy. [ABSTRACT FROM AUTHOR]

Introduction : Cystourethroscopy (CS) is an endoscopic method used to visualize the urethra and the bladder. Aim: In this study , we prospectively evaluated pain in men undergoing cyclic cystoscopic assessment with rigid and flexible instruments after transurethral resection of bladder tumor (TURB). Material and methods : One hundred and twenty male patients who were under surveillance after a TURB procedure due to urothelial cell carcinoma and who had undergone at least one rigid cystourethroscopy in the past were enrolled in the trial. Patients were prospectively randomized to age-matched groups for flexible (group F) or rigid (group R) CS. Patient’s comfort was evaluated on an 11-grade scale, ranging from 0 (free from pain) to 10 points (unbearable pain). Results : The patients described the pain during the previous rigid CS as ranging from 4 to 10 (mean: 6.8) in group F and from 0 to 10 (mean: 5.8) in group R. Group R patients described the pain during the current rigid CS as ranging from 0 to 10 (mean: 5.7). No mean change in the grade was observed between the two pain descriptions (no change 11 patients, weaker pain 25 patients, stronger pain 24 patients, gamma 0.51, p < 0.0001). Group F described the pain as 1 to 5 (mean: 2.1). In the case of flexible CS the pain experience was greatly lowered compared to the previous rigid CS. All flexible CS patients reported lowered pain (by 1 to 9 grades). Patients’ age did not influence the comfort of the flexible CS or the change in pain level. Conclusions : Flexible CS is better tolerated than rigid cystoscopy by male patients regardless of patients’ age.

Difficult airway still is one of the dreaded crises in anesthesia. A well-formulated plan with all the necessary equipment should be ready when such situations are anticipated, but unanticipated difficulties can arise, and managing such cases is a nightmare for the anesthesiologist. Most hospitals in the developing countries are not equipped technically with all the modern equipment and gadgets as far as anesthesia is concerned. In a resource-constrained area, the skill and innovative ideas of the anesthesiologist often emerge as an alternative option in dealing with such cases. Here, we describe two cases of difficult intubation by conventional approach, which were managed successfully using a pediatric gastroscope and a flexible cystoscope as an alternative to fiberoptic bronchoscope. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to investigate the effects of 2% lidocaine gel only and 2% lidocaine gel-diclofenac combination on pain in male patients undergoing flexible cystoscopy. Methods: The records of male patients who underwent flexible cystoscopy for lower urinary system symptoms and bladder tumor contol cystoscopy between April 2016, and April 2017, were reviewed. Patients with active urinary infection, urethral stricture, additional procedures during cystoscopy like biopsy, catheter withdrawal, or insertion, and sensory neurological defects were excluded from the study. Patients were divided into two groups according to the analgesic used. Overall, 116 patients in Group I were treated with 2% lidocaine gel, and patients in Group II were treated with 2% lidocaine gel and intramuscular diclofenac. In the gel group, 10 cc of 2% lidocaine gel was instilled into the urethra 15 min before the procedure and immediately before the procedure. In the other group, 75 mg diclofenac was intramuscularly administered 30 min before the 2% lidocaine gel instillation. All operations were performed by the same urologist. VAS scores were filled after the procedure, and the groups were compared. Results: The mean age of the patients was 61±13.1 years in Group I and 59±13.2 years in Group II (p=0.060). The mean duration of the procedure was 341±427 in Group I and 342±51.1 in Group II (p=0.586). There was a statistically significant difference between the groups in pain scores (group I: 6.1±2.5; group II: 4.3±1.7; p<0.001). Conclusion: Intravenous administration of diclofenac, which was performed 30 min before the use of 2% lidocaine gel in males undergoing flexible cystoscopy, provides more effective analgesia than urethral gel alone. [ABSTRACT FROM AUTHOR]

Background/Aims/Objectives: Women with recurrent urinary tract infections (UTIs) are commonly referred to urology outpatient clinics. However, there is no clear consensus in existing guidelines as to if, or how, these should be investigated. The primary outcome was to evaluate all available literature to determine the percentage of abnormal findings in non-pregnant women with recurrent simple UTIs. Secondary outcomes were to determine the percentage that were serious, consequential or incidental findings. Methods: A full literature search was performed of the following databases: MEDLINE; Pubmed; Cochrane Central Register of Controlled Trials-CENTRAL; and ClinicalTrials.gov. Two assessors reviewed the articles independently. Any discrepancy was discussed and an agreement reached. Results: The literature search yielded 662 titles; 652 were excluded on initial review. A further 13 studies were gathered from references of yielded papers. After full review, 12 were included for analysis. These showed that < 1.5% of women investigated for recurrent simple UTIs with imaging or flexible cystoscopy had life-threatening pathology, but up to 67% had abnormal urodynamics. Conclusions: Women presenting with simple recurrent UTIs should have a flow rate and post-void residual measured. Cystoscopy is not warranted and imaging is unlikely to be of value in the absence of symptoms of upper tract disease or gynaecological problems. [ABSTRACT FROM AUTHOR]

Introduction/Objective: Good surgical practice dictates that comprehensive and legible records are maintained by surgeons of all their interactions with patients. Flexible cystoscopy (FC) notes should be no exception to this standard. Currently at our institution, for every cystoscopy, FC operators document the same information in two different locations: handwritten in patient notes and electronic discharge letter. Methods: A closed-loop audit of FC notes at our institution was undertaken and data were collected prospectively using patients’ notes. Notes were scrutinised against the Royal College of Surgeons (RCS)/British Association of Urological Surgeons (BAUS) standards. The first period was 13–17 October 2015, and the second period was 20–31 May 2016. A total of 73 patients were included (43+30). Results: The first cycle highlighted several areas requiring improvement. Eight of 15 parameters fell short of the 100% target compliance: time (5.9%), responsible consultant (32.4%), operator (50%), postoperative instructions (82.4%), indication for FC (85.3%), date (88.2%), procedure name (91.2%) and signature (97%). Subsequently, a new electronic FC proforma was designed using the RCS/BAUS criteria for data to be documented. A successive re-audit using identical criteria established 100% compliance in all fields. Conclusion: Adopting the new proforma significantly improved the quality of FC documentation. Subsequently, new online software incorporating our proforma was introduced as part of electronic patient records, allowing for data to be easily accessed and read. We discuss the relevance of this in the context of existing literature. Level of evidence: Not applicable for this multicentre audit. [ABSTRACT FROM AUTHOR]

Advanced nurse practitioner (ANP) roles are continuing to emerge and evolve worldwide, including in the Republic of Ireland. Progress has been influenced by a number of factors which include; affording opportunities for nurses to advance their careers while remaining in clinical practice; health care cost containment; improving access to care; continuity of patient care and due to limits on junior doctors working hours. Confusion related to the definition of the ANP role, a multitude of role titles, what the role entails and what differentiates it from other specialist roles has impeded its overall development. This has led to difficulties in measuring clinical impact, and leads to conflicting conceptualizations of the role. This article focuses on the application of two domains of advanced practice as identified by Hutchinson et al. and applies the components of those domains of practice to an emerging advanced practice role in urology. The purpose of the article is to provide a tentative professional development framework for the advanced practice urology nursing role involved in managing a caseload of patients diagnosed with non‐muscle invasive bladder cancer (NMIBC) focusing on autonomous practice and improving systems of care. These domains of practice are discussed in cognisance of the needs of the population, the demands on the health care organization, and within the defined framework of advanced nursing practice in Ireland. [ABSTRACT FROM AUTHOR]

Purpose: This trial assessed if written information on procedural findings and subsequent treatment improved understanding and reduced anxiety among patients undergoing day case flexible cystoscopy (FC).Methods: Participants completed pre- and post-procedure questionnaires self-rating anxiety and feeling well informed on 5-point Likert scales. Supplemental written information was provided after FC to half the patients on a standardized template, according to randomized allocation. Comparisons between the groups were undertaken using the Wilcoxon test.Results: Two hundred patients were recruited, with 171 evaluable questionnaires (83 from written group). The distribution of age, sex and prior FC, as well as the pre-procedure self-assessment of anxiety and understanding, was similar between the two groups. Patients receiving written information reported feeling better informed, with median (range) Likert score of 5 (4-5) compared to 4 (1-5) out of 5 (p < 0.0001) and less anxious (score 1 [1-4] compared to 2 [1-5] out of 5, p < 0.005), although all except four patients had an accurate understanding of the information provided (p = NS).Conclusions: Written information at the time of FC leads to patients feeling better informed and less anxious, although verbal information alone appears to lead to an adequate understanding.Clinical trial registration number: ACTRN12616000288426 [ABSTRACT FROM AUTHOR]

Introduction: Cystoscopy is a basic urologic skill necessary for the endoscopic evaluation of the urethra and bladder. Presented is a step-by-step guide for flexible cystoscopy of the male and female patient. Materials/Methods: Routine flexible cystoscopy was performed on a male patient with a history of upper tract urothelial carcinoma and a female patient as part of a hematuria evaluation. The male patient was positioned supine, and the female patient frog-leg supine. Preoperative equipment included a flexible cystoscope (Storz 11272 VP; Karl Storz, Inc., Germany), irrigant, lubricating gel, sterile gloves, and towels/drapes. A typical cystoscopy room layout is shown. Results: This guide outlines the indications, preoperative preparation, and procedural steps for each gender, postoperative care, and troubleshooting recommendations. The video depicts the author's (R.V.C.) typical office cystoscopy procedure. In both cases, the cystoscopies were within normal limits. Conclusion: A simple, standardized manner for performing office-based flexible cystoscopy is essential to the practice of all urologists. By following the outlined steps, the urethra and the entire bladder, including the bladder neck area, can be thoroughly evaluated. [ABSTRACT FROM AUTHOR]