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      • Record: found
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      ABC of flexible cystoscopy for junior trainee and general practitioner

      review-article
      Author(s): ,
      Publication date (Electronic):
      Journal: International Journal of General Medicine
      Publisher: Dove Medical Press
      Keywords: clinical practice, urology, fiberscope, urethrocystoscopy

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          Abstract

          Introduction:

          Flexible cystoscopy is a diagnostic procedure usually performed under local anesthesia and has been used in the outpatient setting since the 1980s.

          Methods:

          We performed an electronic search of MEDLINE ® and the Cochrane Central Search Library between 1990 and 2010. Duplicate references were removed. One reviewer extracted the publications relevant to general clinical practice.

          Results:

          MEDLINE search using the MeSH (Medical Subject Headings) words “flexible” and “cystoscopy” revealed 274 titles, and there were 42 titles in the Cochrane Central Search Library. However, interestingly, only 13 published papers addressing the clinical practice of flexible cystoscopy in the English literature were identified.

          Conclusions:

          Flexible cystoscopy is a real revolution in the field of diagnostic urology.

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          Most cited references17

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          Urinary tract infection and patient satisfaction after flexible cystoscopy and urodynamic evaluation.

          Y. Almallah, Donna Rennie, David J. Stone … (2000)
          To investigate the incidence of symptomatic and asymptomatic bacteriuria and to assess patient satisfaction after flexible cystoscopy (FC) and urodynamic (UD) evaluation in a prospective survey. The incidence of urinary tract infection after FC and UD studies and the use of prophylactic antibiotics are issues of debate. The tolerability and acceptance of FC and UD studies by patients have not been thoroughly documented. It would be helpful to be able to give such information to patients before performing these procedures. A total of 215 nonconsecutive patients seen as outpatients for FC and UD studies to evaluate various indications were studied. A midstream urine sample was taken before and 48 hours after the procedures. Patients were given a questionnaire that inquired about the presence of lower urinary tract symptoms before and 48 hours after the procedures. The self-administered questionnaire included questions to assess patients' tolerance of the procedures and how it compared with their expectations. Of the 201 patients analyzed (FC 103, UD studies 98), 9 patients (4. 5%) developed significant bacteriuria within 48 hours of FC and UD studies. Only 2 patients with significant bacteriuria reported newly developed symptoms within 48 hours. In a subgroup of 25 patients who were given prophylactic antibiotics for various reasons, 6 (24%) reported new symptoms, although none developed significant bacteriuria. The association between patients who had preprocedure pyuria (n = 7) and the development of significant growth after the procedure (n = 6) was significant (P <0.01). In response to the patient-satisfaction questionnaire, 166 (82.5%) reported that the procedure was not as bad as they expected, and 200 (99.5%) said that they would undergo the test again if necessary. FC and UD studies are safe, well-tolerated procedures. The addition of prophylactic antibiotics in these procedures is unnecessary, unless specific indications are present.
          Article 0 comments Cited 24 times – based on 0 reviews     Review now
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            Lidocaine 2% gel versus plain lubricating gel for pain reduction during flexible cystoscopy: a meta-analysis of prospective, randomized, controlled trials.

            Amit R Patel, J Jones, Denise Babineau (2008)
            The current literature shows mixed results for the effectiveness of topical intraurethral lidocaine gel as local anesthesia during flexible cystoscopy. We performed a meta-analysis of randomized, controlled trials of the efficacy of 2% lidocaine vs plain gel for decreasing the pain that male patients incur during flexible cystoscopy. A search of the literature from 1950 to September 2006 yielded 46 applicable articles. Search terms included cystoscopy and pain. Study selection included randomized controlled trials, flexible cystoscopy, males, control groups receiving plain gel and treatment groups receiving 2% lidocaine before cystoscopy. Data extraction was done by 2 of us (ARP and JSJ) who independently reviewed each study and were blinded to identifying features. The primary outcome measured was pain incurred by the patient throughout the entire cystoscopy procedure, as measured using a visual analog score. Data from 9 eligible trials on a total of 817 patients in 7 publications were included in the meta-analysis. Using a random effects model the difference between visual analog scale pain scores in patients receiving 2% lidocaine and plain gel was estimated to be -4.61 (approximate 95% CI -9.6, 0.385), indicating no statistically significant difference. Based on a meta-analysis of 9 randomized controlled trials there is no evidence to suggest a statistically significant difference in the efficacy of pain control between lidocaine gel and plain gel lubrication in men during flexible cystoscopy. This supports the conclusion that its benefit is limited to lubrication and any other perceived benefit is consistent with placebo.
            Article 0 comments Cited 16 times – based on 0 reviews     Review now
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              Is antibiotic prophylaxis required for flexible cystoscopy? A truncated randomized double-blind controlled trial.

              C Thelning, Eric Ryan, John Masters … (2005)
              To examine the incidence of urinary tract infection (UTI) after flexible cystoscopy (FC) and determine whether prophylactic norfloxacin reduces this incidence compared with placebo. A double-blind trial was performed, randomizing 234 patients to either 400 mg of norfloxacin or placebo prior to FC. All patients provided a midstream urine specimen (MSU) before the procedure, as well as at day 3 and day 7 after FC. In addition, a telephone questionnaire was performed to correlate the nature and severity of any symptoms associated with UTI. Interim analysis was performed because of the low recruitment rate, and a significantly lower infection rate than expected meant that the trial was discontinued. There was one symptomatic UTI in the placebo group (0.82%) and one in the norfloxacin group (0.89%). The UTI in the placebo group was de novo, while the infection in the norfloxacin group was secondary to pre-FC bacteriuria. There was no difference in the infection rates in the two groups. The overall infection rate (de novo and secondary to existing bacteruria) after FC was 0.85%. Infection after flexible cystoscopy is rare and not associated with significant morbidity. A much larger study would be required to determine whether antibiotic prophylaxis significantly reduces the rate of postprocedure UTI.
              Article 0 comments Cited 12 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Gen Med
                Title: International Journal of General Medicine
                Publisher: Dove Medical Press
                ISSN (Electronic): 1178-7074
                Publication date Collection: 2011
                Publication date (Electronic): 19 August 2011
                Volume: 4
                Pages: 593-596
                Affiliations
                Urology Department, Sunderland Royal Hospital, Sunderland, England, UK
                Author notes
                Correspondence: Nourdin Kadi, 5 Melton Court, Derby, England, DE22 3EB, UK, Tel +44 191 565 6256, Fax +44 191 514 0220, Email nourdin@ 123456hotmail.co.uk
                Article
                Publisher ID: ijgm-4-593
                DOI: 10.2147/IJGM.S20267
                PMC ID: 3160869
                PubMed ID: 21887113
                SO-VID: 01add9df-8042-4372-a5f1-c6dccad1bfc1
                Copyright © © 2011 Kadi and Menezes, publisher and licensee Dove Medical Press Ltd.
                License:

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                Date received : 18 August 2011
                Categories
                Subject: Review

                ScienceOpen disciplines: Medicine
                Keywords: urethrocystoscopy,urology,fiberscope,clinical practice
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: urethrocystoscopy, urology, fiberscope, clinical practice

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