Dr. Thiel on post-procedural complications with disposable cystoscopes versus reusable cystoscopes

In this video, David D. Thiel, MD, discusses the background and findings from his study, “Conversion to Disposable Cystoscopes Decreased Post-procedure Encounters and Infections Compared to Reusable Cystoscopes.” Thiel is the chief of clinical practice at Mayo Clinic in Jacksonville, Florida.

Video Transcript:

Could you describe the background for this study?

The background of the study is that, like every institution, a few years ago, we were having difficulties with instrument processing as far as finding – and I'm sure you hear this all the time – enough employees to cover the amount of instrument processing that we were generating at Mayo Clinic in Florida. And then added [to] that, we were having more and more issues with our repair rates on our reusable scopes. So, scopes were being damaged or broken. We always had something out repair. So, we had the expense of that that went out to repair. And as chair, I started to see the amount of money we were spending on repairs and instrument processing. So we started to look and see where there are other alternatives. And Ambu had the disposable scope at the time. Now it does seem expensive per use, but so are scope repairs and instrument processing, and not only instrument processing itself, but the act of instrument processing, the instrumentation, the chemicals, the FTEs, and so on. So, we converted our entire scope fleet to disposable scopes and went from there.

And then what we decided to do, our nurses had noticed, "hey, these patients that are having scopes, they don't seem to be calling as much afterwards." So, after a few years, we decided to start collecting the data and look at them. Do patients really not call as much after a disposable scope? Which in the article we call an encounter, so an encounter would be any engagement of our healthcare system or any healthcare system following the scope that wasn't planned. So, did they make a phone call? Urgency, frequency, blood in the urine, fever, anything like that? We counted that as an encounter. Did you go to the ER? Were you hospitalized with urinary tract infection? We wanted to look and see [if] there any differences between the disposable scope group and the reusable scope group, and as the paper shows, there were. Our patients who were getting the disposable scopes compared to the reusable scopes – and they're similar indications, as seen in the article, there were similar amounts for urinary tract infections, bladder tumor surveillance, and so on – when we looked at that, they did engage the system less. They did make less phone calls. They got less urine cultures. And that was the basis of the manuscript.

Could you discuss more on the study’s findings?

The biggest thing for us is that more patients in the reusable scope group called. They called with urgency frequency and dysuria. That led to a higher urine culture rate in the reusable scope group compared to the disposable scope group. But yet, the percentage that were positive, weren't as high as you would expect for the symptomatology. So, to me, what that may symbolize is there's something going on with the reprocessing of the reusable instruments that's causing urinary tract irritation. Now, we don't have proof of that. But there has to be, in my mind, something going on when these patients are getting scoped with the reusable instrument. They have the symptoms; they call; we do a culture as anywhere would, because it sounds like urinary tract infection, but not a lot of these cultures were positive. So something was irritating your urinary tract. So, in this, I conclude that the disposable scopes actually don't have the irritant of the urothelial lining or the irritant of the urinary tract to cause those symptoms, hence less phone calls, hence less cultures. And possibly because we got less cultures, we found less positive cultures. In the editorial, Dr. [Peter L.] Steinberg, following the article, I think he summed it up great, to tell you the truth, the cultures may be positive simply because you are getting more cultures.

This transcription has been edited for clarity.