Objectives: To investigate the clinical benefit of flexible cystoscopy for the investigation of recurrent urinary tract infections (UTIs). Does this investigation add any diagnostic benefit that cannot be achieved with non-invasive investigations such as flowometry and ultrasound?

Patients and Methods: Retrospective analysis of a database of patients who underwent flexible cystoscopy for the investigation of recurrent UTIs at a single centre between January 2011 and September 2012.

Results: A total of 408 patients underwent flexible cystoscopy for the investigation of recurrent UTIs – 285 women and 123 men. 22 (8%) of female patients had a significant abnormality detected. The majority of abnormalities were found on ultrasound scan with 3 (1%) detected at cystoscopy alone.

No significant abnormalities detected in women under 55years.

30 (24%) of men had a significant abnormality, 8 (2.8%) of which were detected on flexible cystoscopy.

27 red patches were detected, of these all had either resolved at GA cystoscopy or had benign histology on biopsy. Two bladder tumours were detected, one of which was visible on ultrasound.

Conclusions: In our cohort, only 2.9% of patients had a significant abnormality detected on flexible cystoscopy that could not have been detected with ultrasound or uroflowometry. Our findings suggest that flexible cystoscopy is rarely helpful in the assessment of recurrent UTIs. The majority of significant pathology can be detected through careful clinical history + ultrasound +/- flowometry. Our findings also suggest that flexible cystoscopy is probably not necessary for female patients with recurrent UTIs under the age of 55years.