Infectious Disease

Cystoscopy provides little to no clinical benefit for patients with recurrent UTIs

Source/Disclosures

sources:

Hasley, H. et al. “Is Cystoscopy Indicated in the Evaluation of Female Patients with Recurrent Urinary Tract Infections?” Presented at: American Urological Association meeting; May 13-16, 2022; (hybrid meeting).

Disclosures:
The researchers report no relevant financial disclosures.

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Cystoscopies for recurrent UTIs yield little clinical benefit for patients both with and without high-risk features, according to a study.

Hunter Hasleya medical student at Hackensack Meridian School of Medicine in New Jersey, presented the findings at this year’s American Urological Association (AUA) conference.

Data derived from: Hasley, H, et al. “Is Cystoscopy Indicated in the Evaluation of Female Patients with Recurrent Urinary Tract Infections?” Presented at: American Urological Association meeting; May 13-16, 2022; (hybrid meeting).

The study aimed to determine the value of cystoscopy in patients with recurrent UTIs (rUTIs) — defined as two or more infections in a 6-month period or three or more infections over a year — in the setting of uncomplicated and complicated UTIs.

Current AUA guidelines recommend against routine cystoscopies in index patients with rUTIs, according to the researchers. They also reported that there are weak recommendations for cystoscopy in patients over the age of 40 years or who have high-risk features, and that guidelines “lack robust supporting data and are based on expert opinion.”

The study, which Hasley said is the largest retrospective study to date, evaluated 467 patients who underwent cystoscopy for rUTI. The researchers looked at billing codes to “identify cystoscopy ease” from 2015 to 2021 at a tertiary academic medical center. Exclusion criteria were pediatric patients and those with a competing indication for cystoscopies.

Only 1.3% of cystoscopies — six people — yielded significant findings, which Hasley and colleagues defined as a change in patient management. All six had complicated rUTIs and high-risk features. The median age of patients with significant findings was 58 years.

Of those six patients, the cystoscopies revealed that two had bladder stones, and that one patient each had bladder cancer, lymphoma, urethral mesh erosion and urachal remnant.

“This suggests cystoscopies may be of value, but it’s low yield in complicated patients over 50 years old,” Hasley said.

The researchers concluded that cystoscopies have no clinical benefit in patients without high-risk features, limited clinical benefit in patients with high-risk features, and that “the median age in patients with significant cystoscopic findings was nearly two decades greater than the lower limit of current societal guidelines.”

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American Urological Association

American Urological Association

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