A randomized trial of 2% lidocaine gel versus plain lubricating gel for minimizing pain in men undergoing flexible cystoscopy

This article presents findings from a randomized trial of intra-urethral lidocaine versus a plain lubricating gel for pain reduction in men undergoing flexible cystoscopy. Compared with the plain gel, use of lidocaine resulted in significantly less pain during the procedure.

Patients? experiences at home after day case cystoscopy

AIM

To determine patients' problems with day case cystoscopy and their problem solving ways and patients' self-care at home.

BACKGROUND

Day surgery has become increasingly common in the last 20 years. Cystoscopic procedures are increasingly being carried out as a diagnostic and therapeutic procedures.

DESIGN AND METHOD

This descriptive/prospective study comprised 50 patients undergoing day case cystoscopic procedures in the university hospital of Turkey. The data were collected using telephone interview three days after the procedure. The two questionnaire used were Symptom Measurement Questionnaire and Symptom Management Questionnaire. Discharge information and written instruction was given to all patients.

RESULTS

It was found in the investigation that the most common problems experienced by the patients were tiredness, haematuria, dysuria, pain over bladder and difficulty in voiding after flexible cystoscopy in first day. Generally, urinary elimination problems were experienced by majority of the patients. At second day, these problems were also common. The mean score for all problems decreased after three days. The patients stated that they were able to deal with their symptoms either independently or to a lesser extent with assistance of a carer. But they were unable to deal with problems such as especially haematuria.

CONCLUSION

Problems experiences by the patients at home after cystoscopy influenced some daily living activities. The problems related to voiding are more frequently observed after cystoscopy. Although some these problems are related to the procedures, some were present previously.

RELEVANCE TO CLINICAL PRACTICE

This findings indicate that patient-centred care should be strengthened at home in urological day surgery.

Robotic-assisted laparoscopic cystectomy with ileal conduit for urinary diversion

This case demonstrates the need for flexibility when approaching major abdominal surgery through a robotic approach. While the case was initiated with robotic technology, it ultimately had to be converted to an open procedure for reasons of patient safety and to ensure a good surgical outcome.

Care of the patient undergoing radical cystectomy with a robotic approach

Radical cystectomy or cystoprostatectomy with urinary diversion is the gold standard for the treatment of muscle-invasive bladder cancer. Cystectomy can be through an open or robotic-assisted laparoscopic approach. Advances in laparoscopy, robotic surgery, and urological oncology have made it possible for select surgeons to perform nerve-sparing robotic-assisted laparoscopic radical cystoprostatectomy. Advantages of robotic surgery may be minimal blood loss, shorter hospital stay, quicker recovery, and possibly more precise and rapid removal of the bladder depending on the experience and expertise of the surgeon. Appropriate patient selection and thorough pre-operative evaluation, however, are key in maximizing positive surgical outcomes. The experience at the University of Virginia with robotic-assisted laparoscopic radical cystectomy will be discussed.

The nurse cystoscopist. Extending the role

Nurse-led cystoscopy has become an established service for bladder tumour surveillance patients. The role of the nurse cystoscopist has been developed to include diagnostic cystoscopy with telephone follow-up and counselling. Direct access to the service has reduced waiting times from presentation to diagnosis. The telephone follow-up has improved patients' experience of a diagnostic urology service.

Practical cystoscopy: care of the instruments and preparation for a cystoscopic examination

Periodically, a look at the past helps health care professionals see how much practice has changed as well as how some concepts and practices remain similar to the original rationales and techniques. Two chapters from a 1911 textbook on cystoscopy have been reprinted that describe catheter and instrument care and preprocedure requirements for cystoscopy performed in the hospital, office, or home. Sterilization methods and instruments for cystoscopy have improved in the century since this book was written but the rationale for the procedure and concepts guiding the instrumentation have some similarity with the practices performed nearly 100 years ago. Some comments also provide a bit of comic relief. One example, "this undoubtedly shortens the life of the catheter, but it lengthens the life of the patient" appears in the discussion about catheter cleaning after use in a pus case.

An evaluation of a nurse-led cystoscopy surveillance service

The findings of a regional audit found that Salford had a high incidence of superficial bladder cancer. It was felt that the needs of the patient population could best be served by introducing a nurse-led cystoscopy service. This paper reports on the findings of a postal survey to evaluate the appropriateness and quality of care offered by the new service.

Nurse-led cystoscopy: the next step

OBJECTIVES

To determine and compare the accuracy of flexible cystoscopy and subsequent management by a specialist urology registrar (SpR) and a specialist urology nurse (SUN).

PATIENTS AND METHODS

Flexible cystoscopy was undertaken on 50 patients by both endoscopists each unaware of the results of the other's examination. The findings and management plans were independently declared and then compared. Any cystoscopic discrepancies were assessed by one consultant with the patients under a general anaesthetic.

RESULTS

Tumours were found in 20% of patients; there was a consensus of the endoscopic findings and subsequent management plan between the SpR and the SUN in 94% of the patients. Any missed tumours (all surveillance) were minute and clinically insignificant. The chance-corrected proportional agreement (kappa value) between the SUN and final diagnosis and management was 0.94.

CONCLUSION

A properly trained SUN can undertake both diagnostic and surveillance flexible cystoscopy, and decide upon further management to the same degree as can a urology SpR.

Improving a nurse-led flexible cystoscopy service through audit

The urology nurse practitioner in one trust expanded her skills to perform flexible cystoscopy. This has reduced waiting times for patients and has led to improved service delivery and continuity of care. Auditing of the protocol used ensures there is a high, consistent standard of follow-up care for all patients.

Perioperative nursing data set for the adult patient having a cystoscopy

This article gives a brief summary of a student project required in a perioperative internship program in a large medical center hospital. The Perioperative Nursing Data Set (PNDS) was used to determine activities necessary in developing a nursing care plan for patients undergoing cystoscopy. The project description and the total care plan is shared with the reader.

National guidelines for nurse cytoscopy

There is a growing demand for flexible cystoscopy, and nurse involvement can help meet this. Support for nurse cystoscopy from the UKCC depends on nurses' professional accountability and competence. It is important that national guidelines are adhered to if nurses are to undertake flexible cystoscopy safely.

Developing a nurse-led cystoscopy service

There is little doubt that nurses can develop practical skills in medical procedures that are comparable to those of medical practitioners. This has been shown where nurses have been trained in flexible sigmoidoscopy (Disario & Sanowski 1993, Maule 1994); similarly, nurses have become part of the surgical cardiac team recovering veins for coronary artery bypass surgery (Holmes 1994). There is also increasing interest and growing demand within the nursing and medical professions for advice and information regarding the development of nurse cystoscopist posts.

Test or trauma? The voiding cystourethrogram experience of young children

Many diagnostic procedures, while necessary and appropriate, may be experienced by a child as a trauma. Health care professionals often perceive invasive procedures such as surgery and needle biopsies as more painful and threatening to the child than "test" such as voiding cystourethrograms (VCUGs). However, clinical experience indicates that the VCUG is often perceived by children as more highly distressing than other procedures. Success and a sense of competence (or shame and doubt) in mastering challenging life experiences, such as medical procedures, contribute to a child's evolving self-concept (Harter, 1983). These memories and successful behaviors can be applied to future similar situations. Health care professionals are challenged to help the child and the parents through the procedure with minimal distress in an effective and efficient manner. A series of vignettes illustrating parents' and children's experiences with a VCUG procedure highlight the impact of the VCUG on children's coping ability and adjustment. Recommendations for developmentally appropriate clinical practice standards of care related to the VCUG procedure in young children also are presented. Preparation as an ongoing partnership process among children, parents, and health care professionals.