Routine surveillance cystoscopy for patients with augmentation and substitution cystoplasty for benign urological conditions: is it necessary?
OBJECTIVE
To evaluate screening cystoscopy as the long-term follow up in patients with an enterocystoplasty for > or =10 years.


METHODS
We performed a prospective analysis of 92 consecutive patients who attended our endoscopy suite for regular check cystoscopy as per standard follow-up. This is performed for all patients with cystoplasty performed at our institute after 10 years. The data were recorded on patient demographics, original diagnosis and type of cystoplasty. In all, 53 of these patients consented to undergo bladder biopsies at the same time.


RESULTS
The median (range) follow-up was 15 (10-33) years. No cancer was identified with either surveillance cystoscopy or on routine biopsies. Chronic inflammation was identified in 25 biopsies (27%). Villous atrophy was present in 12 (55%) ileal patch and three (12.5%) colonic patch biopsies. During this study, the first and only case of malignancy in a cystoplasty at our institution was diagnosed in a symptomatic patient. She had intermittent haematuria and recurrent urinary tract infections (UTIs). She previously had a normal surveillance cystoscopy.


CONCLUSIONS
We feel that it is not necessary to perform yearly check cystoscopies in patients with augmented bladders at least in the first 15 years, as cancer has not yet been detected with surveillance cystoscopy in this patient group. However, if the patient develops haematuria or other worrisome symptoms including suprapubic pain and recurrent unexplained UTIs a full evaluation, including cystoscopy and computerized tomography should be undertaken.
Hamid
Rizwan
R
Institute of Urology and University College London Hospital, London, UK. hamid_rizwan@hotmail.com
Greenwell
Tamsin J
TJ
Nethercliffe
Janine M
JM
Freeman
Alexander
A
Venn
Suzie N
SN
Woodhouse
Christopher R J
CR
D000328:Adult; D000368:Aged; D003556:Cystitis / Q000209:etiology; D003558:Cystoscopy / Q000706:statistics & numerical data*; D004812:Epidemiologic Methods; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D001745:Urinary Bladder Diseases / Q000150:complications / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000209:etiology; D014547:Urinary Diversion; D016476:Urinary Reservoirs, Continent; D055815:Young Adult