Disposable cystoscope performs as well as reusable scope in detection of bladder cancer

Flexible cystoscopy using a new grasper incorporated disposable cystoscope, designed for the retrieval of ureteric stents, is comparable to a reusable cystoscope in the detection of bladder cancer, according to a retrospective review of more than 1200 consecutive diagnostic flexible cystoscopies performed at a single institution.¹

In the comparison, neither cancer detection rates (15.6% vs 14.4%; P = .574) nor the percentage of positive findings (20.2% vs 18.4%; P = .425) were significantly different between patients undergoing diagnostic flexible cystoscopy with a reusable versus disposable cystoscope.

“The grasper disposable scope may fill the gap as an alternative to the conventional reusable cystoscope,” concluded authors led by Raouf M. Seyam, MD, from the Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, who published their research in the journal Scientific Reports.

The authors explored the off-label diagnostic use of the disposable cystoscope because reusable cystoscopes can fail after repeated sterilizations. Proper sterilization of reusable flexible cystoscopes is performed to ensure patient safety but the practice can cause leakage “resulting in interruption of service, and delay of patient appointments,” they wrote. “Unfortunately, the life span of the scope becomes shorter with diligent maintenance of sterilization. When some of the scopes fail, the remaining are overused. Such an occurrence spirals quickly into multiple scopes failing.”

The review included 390 patients who underwent 1211 consecutive cystoscopy procedures, 608 with the reusable cystoscope and 603 with the disposable cystoscope, mostly for bladder tumor surveillance (97.7%). Underlying risk factors were similar between the 2 groups.

The procedures were performed twice weekly by 4 urologists throughout the study period (March 2016 to November 2018). Reusable scopes were used exclusively from March 2, 2016, to October 4, 2017, and disposable cystoscopes were used exclusively from October 9, 2017, to November 28, 2018. All procedures were done without a prophylactic antibiotic and used strict operative room sterilization protocol. None of the patients required analgesia following the procedure.

The type of cystoscopy did not have a significant impact on the outcome.

Significant factors that affected the positive result were gender, being a current smoker, and belonging to intermediate or high-risk stratification.

Of the 918 procedures with negative cystoscopy results and follow-up cystoscopy, after a mean follow-up of 217.7 days, 86.4% of the 918 negative procedures remained negative and 13.6% converted to positive, with no significant difference between the 2 groups. The cancer detection rate showed a significant association between higher risk at baseline and a higher stage and grade for the final pathology.

The median age of patients included was 61.5 years, 84.9% were men, prior tumor grade was high in 41.7%, and prior pathology was stage Ta cancer in 66.2%. Risk stratification was low in 49.3%, high in 47.4%, and intermediate in 3.3%.

Complications following cystoscopy were rare. In the group in whom reusable scopes were employed, 1 procedure was complicated by urosepsis and another by hematuria, and both patients required hospitalization and active treatment.

Limited flexion and image resolution were cited as difficulties by the authors during cystoscopy when using the disposable scope, as well as a lack of a working channel for biopsy or fulguration. To overcome these limitations, they described adoption of a retrograde J maneuver to visualize the anterior bladder wall, deferring examination of the ureteric orifices to the end of the procedure when the bladder was full. The J maneuver “adequately visualized small lesions at the bladder neck,” they wrote.

Despite the disadvantages mentioned, “the mere presence of an off-shelf cystoscope dominated our cystoscopy,” they added.

Reference

1. Seyam RM, Zeitouni OM, Alsibai TM, et al. The grasper-integrated disposable flexible cystoscope is comparable to the reusable, flexible cystoscope for the detection of bladder cancer. Sci Rep. 2020;10(1):13495. doi: 10.1038/s41598-020-70424-0