Performing Procedures

Is Cystoscopy Valuable in the Presence of Hematuria?

Cystoscopy is a vital urological procedure because of its ability to deliver prompt diagnoses and treatment, but it can be limited by poor visualization caused by blood.

Hospital-based cystoscopies can enable “a prompt diagnosis and an acceptable rate of diagnostic yield” in patients with blood in their urine.

That’s according to the authors of a recent study concluding that cystoscopy should be considered immediately in patients displaying macroscopic hematuria being examined at centers where the operating room is widely available. Otherwise, the procedure may be delayed for two weeks and performed in an outpatient setting.

The researchers, from Tel Aviv, Israel, shared their analysis in Urologia Internationalis. Their study aimed to assess the findings and yield of flexible cystoscopy in patients hospitalized for gross hematuria — a common issue but one which may indicate an underlying malignancy. Cystoscopy is a vital urological procedure because of its ability to deliver prompt diagnoses and treatment, but it can be limited by poor visualization caused by blood.  

The study included 69 patients with a median age of 76 years between September 2018 and December 2019. The median time between the onset of hematuria and cystoscopy was three days. Flexible cystoscopy diagnosed a malignancy in 20 patients (29 percent) and led to a diagnosis or treatment in 39 patients (57 percent).

It did not lead to a diagnosis, led to a misdiagnosis, or required a follow-up cystoscopy in 30 patients (43 percent).

Patients with gross hematuria have a demonstrable cause in 50 percent of cases and underling malignancy is found in 19-34 percent of case, according to previous research.

The authors state the small cohort size of the study as a limitation but add “our findings raise important questions about the yield of flexible cystoscopy in the acute setting which may affect its use in the management of patients admitted to the hospital due to hematuria.”

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