Flexible cystoscopy: outpatients or domiciliary?

Impact of the lack of community urinary catheter care services on the Emergency Department

OBJECTIVES

To conduct an audit of patients presenting with long-term urinary catheter (LTC)-associated problems to our Emergency Department (ED) and to assess the availability of community nursing support for their LTC. We also estimated the cost implication to the health service and the potential solutions to this issue, as although catheter care is provided by community nurses, LTC problems are common presentations to the ED and are often significant burdens to the services.

PATIENTS AND METHODS

A study was carried out of all patients presenting to the ED with a urinary catheter problem, specifically studying LTCs and the reason for presentation, district nurses' involvement, and the intervention received.

RESULTS

In all, 78 patients with a urinary catheter problem presented to the ED over a 69-day period, of whom 59 (68%) had a LTC. In all, 33 patients (42%) attended during normal working hours between 0900 and 1700 h. The mean (range) age was 74 (42-93) years and the duration the LTC had been in situ was 11 (1-120) months. The most common reasons for attendance were blocked catheter (37 patients, 47%) and catheter-bypass (18, 23%). Only 28 patients (36%) were known to district nursing services, and 14% were referred by a district nurse. Most of the remaining patients self-referred to the ED. No patient had any documented contact with their general practitioner. In addition, 64 patients (82%) had their catheter issues addressed adequately by ED nurses or doctors, without any urology involvement.

CONCLUSIONS

The high morbidity of LTCs causes a considerable demand on ED services, and has heavy cost implications to the health system. Most patients had minimal community nurse support, and their catheter problems were easily dealt with by ED nurses and doctors.

Evaluation of outpatient cystoscopy in urogynaecology

OBJECTIVE

Prospective evaluation of outpatient cystoscopy in a Urogynaecology Unit.

DESIGN

Prospective observational series.

SETTING

St. George's Hospital, London. Department of Pelvic Reconstructive Surgery and Urogynaecology.

POPULATION

A total of 131 consecutive women, who underwent outpatient rigid cystoscopy over a 24-month-period.

MATERIALS AND METHODS

Prospective data collection included cystoscopic findings, microbiology data, uroflowmetry and radiological results. An Immediate Feedback Questionnaire was completed at the end of the procedure.

MAIN OUTCOME MEASURES

Success rates of the procedure, cystoscopy findings, requirements for additional investigations, including inpatient cystoscopy and patient satisfaction rates.

RESULTS

The mean age was 56.4 years (range 20-87 years). A total 126 women (96.2%) had a successful outpatient cystoscopy. In five (3.8%) women the procedure had to be abandoned because of inability to insert the cystoscope. Eleven women (8.7%) experienced pain but were able to tolerate the discomfort. Fifty-three (42.7%) women had abnormalities detected at cystoscopy. Thirty-seven women had trabeculations. Focal vesical lesions were found in 21 women. Thirty-nine (30.9%) women did not require any additional treatment. Six (6.9%) women were scheduled for repeat cystoscopy under general anaesthetic to facilitate a bladder biopsy. Fifteen women (17.2%) were referred for urodynamics or renal imaging. Three women (3.4%) were referred to a urologist. More than 75% reported high satisfaction with the care they received. Four women had symptoms of UTI and two had positive urinary cultures and required antibiotics.

CONCLUSIONS

The benefits of outpatient cystoscopy include high levels of tolerability and patient satisfaction, shorter waiting time, quicker implementation of treatment strategies, avoidance of the risks of general anaesthesia and lower procedural cost.

Do We Need to Perform Cystoscopy on All Adults Attending Urology Centres as Outpatients?

INTRODUCTION

There has been considerable expansion in the use of flexible cystoscopy (FC) and people who can perform the procedure. Hence, there is a criticism that this procedure is being overused with no management benefit.

MATERIALS AND METHODS

We audited the use of FC in a district hospital for a period of 1 year. The results of FC for non-standard indications (other than haematuria and check cystoscopy) were analysed for their diagnostic yield.

RESULTS

Of the 1,390 FCs performed, 295 were done for non-standard indications. 46.14% of these cystoscopies had positive findings. Cancer detection rate was 6.10%. Cystoscopy altered the management in 14.08% of patients and was supportive to diagnosis and management in 32.06%.

CONCLUSION

This procedure is certainly not overused and the ever-increasing requirement of this simple procedure has serious resource implications for the National Health Service.

A pilot study of users' experiences of urinary catheter drainage bags

Despite the wealth of literature focused on the management of people living in the community with long-term indwelling urinary catheters, little attention has been paid to their impact on daily life. In a pilot study, a purposive sample of people with long-term indwelling urinary catheters were sent a questionnaire asking about their indwelling urinary catheter, method of drainage and impact of the catheter drainage bag on their daily life. Nearly one-quarter of respondents stated that wearing a drainage bag had a major impact on their normal daily living. The study also highlighted a number of methodological issues that need to be addressed in future research.