title: Flexible cystoscopy findings in patients investigated for profound lower urinary tract symptoms, recurrent urinary tract infection, and pain.
abstract: OBJECTIVE
  The National Institute of Clinical Excellence published guidelines in 2010 recommending the use of cystoscopy to investigate profound lower urinary tract symptoms (pLUTS), recurrent urinary tract infection (rUTI), and pain in men. Currently, there are no equivalent guidelines for women. We aimed to examine the diagnostic performance of flexible cystoscopy (FC) when it is used in this context in both men and women.
  
  
  METHODS
  Results of all outpatient FCs undertaken in our department between April 2009 and March 2010 were examined retrospectively. Patients undergoing FC for the investigation of pLUTS, rUTI, or pain were included. Diagnostic performance was calculated, which was defined as the number of patients receiving a diagnosis of a clinically relevant abnormality at FC divided by the total number of patients undergoing FC for this indication.
  
  
  RESULTS
  Of the 1809 patients who underwent FC during the study period, 113 underwent FC to investigate pLUTS, rUTI, or pain. Diagnostic performance was 11.5% (n=13), being 11.4%, 19.2%, and 0% in those with pLUTS, rUTI, and pain, respectively. Bladder cancer was diagnosed in one (0.9%) patient who underwent FC to investigate pLUTS but also had nonvisible hematuria. Urethral stricture was diagnosed in nine (8.0%) cases and intravesical calculi in four (3.5%) cases.
  
  
  CONCLUSIONS
  Clinically relevant abnormalities were found in 11.5% of patients with pLUTS, rUTI, or pain, supporting recently published NICE guidelines recommending cystoscopy in patients with pLUTS or rUTI. Of the 17 patients who were investigated for pain, none was found to have clinically relevant abnormalities; further studies are needed to define the clinical utility of FC in these cases.
authors.affiliation: Department of Urology, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, United Kingdom. sarah.bounds@doctors.org.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Howles
authors.forename: Heidi
authors.initials: H
authors.lastname: Tempest
authors.forename: Gemina
authors.initials: G
authors.lastname: Doolub
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bryant
authors.forename: Freddie C
authors.initials: FC
authors.lastname: Hamdy
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Noble
authors.forename: Stephane
authors.initials: S
authors.lastname: Larré
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003558:Cystoscopy / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis*; D018583:Pliability; D012008:Recurrence; D014552:Urinary Tract Infections / Q000175:diagnosis*; D055815:Young Adult