Is it safe to carry out flexible cystoscopy when urinary dipstick is positive for 'infection'? Results of a prospective clinical study
BAUS ePoster online library. Trail M.
Jun 26, 2018; 211352
Mr. Matthew Trail
Mr. Matthew Trail
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Abstract
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Introduction: There is significant under-utilisation of valuable NHS resources when patients scheduled for flexible cystoscopy are cancelled consequent to positive pre-cystoscopy urinalysis, despite being asymptomatic for UTI. With our pilot evaluation (JCU 2017;10(2S):7-82) supporting a protocol avoiding automatic cancellation, we performed a larger study to primarily identify the association between the pre-flexible cystoscopy urinary Leucocyte-esterase, Nitrites, urine culture and post-cystoscopy UTI, whilst utilising this protocol.

Patients and Methods: We carried out a prospective clinical study in a high-volume UK centre, recruiting all patients undergoing flexible cystoscopy over a 6-month period. Urinalysis was carried out prior to cystoscopy in all patients. Cystoscopy was carried out regardless of the dipstick result, unless patients were symptomatic, in which case they were treated and rescheduled. Patients asymptomatic but considered 'high-risk' for UTI (on the basis of pre-determined criteria) were given prophylactic Gentamicin prior to cystoscopy. Every patient was followed up by a phone call and urine culture when applicable. We defined post-cystoscopy UTI as one that developed within 2 weeks of the procedure. Analysis of association was carried out.

Results: From over 2000 patients, preliminary results suggest that the overall risk of developing post-cystoscopy UTI in this cohort is low. While Leucocyte-esterase and Nitrite positivity appear to carry a slightly higher risk of developing a UTI, this risk was not clinically significant. The incidence of urosepsis is very low.

Conclusion: It appears safe to carry out flexible cystoscopy in asymptomatic patients with positive urinary Leucocyte-esterase and/or Nitrites, without the need for routine prophylactic antibiotics.
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