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Evidence‐based approaches

Rationale

Flexible cystoscopy is undertaken to diagnose or conduct surveillance of cancer. Patient selection is based on locally agreed referral pathways. Commonly this would be through consultant referral or through diagnostic clinics.

Indications

  • Referral from outpatient/inpatient clinics.
  • Suspicion of a bladder abnormality based on clinical assessment in the outpatient department.
  • Abnormal urine cytology.
  • Routine bladder surveillance for bladder cancer based on national and local guidelines.
  • Diagnostic referral pathways (e.g. for haematuria).
  • Consultant referrals.
  • Removal of ureteric stents.

Contraindications

  • If the information can be obtained using an alternative non‐invasive approach such as an imaging scan to confirm or refute a diagnosis.
  • Acute urinary tract infection – treat infection and reschedule the procedure.
  • Warfarin or other anticoagulant therapy (if biopsies or cystodiathermy are required) – these should be discontinued according to patient risk/benefit profile and local guidelines.
  • Allergy/intolerance to local anaesthetic agent – the examination should then be performed under general anaesthetic.
  • High anxiety/phobia of the procedure – in this circumstance a general anaesthetic would be more appropriate (BAUS [18]).
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