Diagnostic urethrocystoscopy: A five-year review of indications and findings in a tertiary hospital in Nigeria
Abdullahi M., Alhassan S. U.
Abstract
Background: Urethrocystoscopy is defined as endoscopic visualization of the urethra and the urinary bladder for the purpose of diagnosis or treatment of diseases of the lower urinary tract.
Objective: To study the indications, diagnosis and complications of diagnostic urethrocystoscopy in our hospital.
Materials and method: It was a retrospective descriptive study of all patients who had diagnostic urethrocystoscopy in our hospital between January 2016 to December 2021. Institutional ethical clearance was obtained. Particulars of the patients were collected from the operating theatre register and their medical case files were retrieved. Information about the patients’ bio-data, presentation, clinical/radiologic diagnosis, urethrocystoscopic findings and its complications were extracted.
The generated data was analyzed using statistical package for social sciences (SPSS) version 21 and results presented in tables, text and figures.
Results: A total of 673 patients had urethrocystoscopy/cystoscopy during the period out of which we recovered full medical records of 592 patients whose data were analyzed.
The patient’s age ranges between 9 to 86years with mean age of 43.7±9.3SD years and M: F = 3.9:1. The indications for diagnostic urethrocystoscopy were lower urinary tract symptoms [LUTS] (48.8%), bladder tumour (29.2%) and haematuria (11.1%) among others. The urethrocystoscopic diagnoses were bladder tumour (37.8%), prostate enlargement (19.1%) and urethral stricture (6.9%) among others. The complications recorded were urethral/bladder bleeding (2.4%), urosepsis (1.4%) and urethral/bladder injury (0.3%).
Conclusion: Urethrocystoscopy is a necessary tool for comprehensive practice of urology owing to its vital role in the diagnosis and treatment of different kinds of lower urinary tract diseases and it is generally a safe procedure.
Keywords: Urethrocystoscopy, diagnosis, indications
Introduction
Urethrocystoscopy is defined as endoscopic visualization of the urethra and the urinary bladder for the purpose of diagnosis or treatment of diseases of the lower urinary tract. It allows for direct visualization of the urethra, urethral sphincter, prostate, bladder neck, bladder and ureteral orifices. It is one of the common procedures performed by urological surgeons. It can be performed using rigid or flexible cystoscope in the operating theatre or as an office procedure. There are several indications for urethrocystoscopy which are mainly diseases of the lower urinary tract such as bladder tumour, haematuria, recurrent urinary tract infections and lower urinary tract symptoms (LUTS).1
The use of endoscope has transformed the diagnosis and treatment of urologic diseases; its use is however limited in our environment with facilities available in only very few hospitals despite the burden of urologic diseases.2
Despite its vast use in urology, instrumentation of the urinary tract, however, is not without complications which may include pain, bleeding and infection.3
We undertook a 5-year retrospective study to document the indications, diagnostic value and complications of diagnostic urethrocystoscopy in our hospital.
Subjects/Materials and method
It was a retrospective descriptive study of all patients who had urethrocystoscopy at the urology unit of our hospital over the period covered in this study (January 2016 to December 2021). Before conducting the study institutional approval with reference number: NHREC/28/01/2020/AKTH/EC/3273 was obtained from the research ethics committee of the hospital.
Particulars of the patients who underwent the procedure were collected from the operating theatre register and their medical case folders were retrieved with the help of the record staff of the hospital. Information about the patients’ bio-data, presentation, clinical/radiologic diagnosis, urethrocystoscopic findings and its complications were extracted and entered into the already designed proforma. Patients whose procedure were incomplete and those with incomplete records were excluded.
The generated data was entered into excel sheets and analyzed using statistical package for social sciences (SPSS) version 21 and results presented in tables, text and figures. Patients were prepared preoperatively and treated for urinary tract infection [UTI] if found. No routine prophylactic antibiotic was given.
Both rigid and flexible cystoscopes were used with patients under local, regional or general anaesthesia. Predominantly the male adults had the procedure under local urethral instillation of 2% plain lidocaine (with or without plain macaine) while their female counterparts had their procedure without any form of anaesthesia. This has been the unit policy which conforms to standard practice of diagnostic cystoscopy. General/regional anaesthesia was reserved for children and patients uncooperative under local anaesthetics. The components of the rigid cystoscope used include: sheath 22G (for adult) and paediatric sheath for children, bridge connector, telescope 0 and 30 degree, camera, light source, and monitor. And for flexible cystoscopy include the flexible cystoscope with a camera; light source and monitor. Two towers of these equipments were available in which the second serves as a back up in the event of failure of any of the equipment.
Results
A total of 673 patients had urethrocystoscopy/cystoscopy over the period covered by the study however, only 592 patients were analyzed whose full medical records were recovered. The age distributions of the patients found as is shown in Fig 1; Age ranges between 9 to 86years with a mean age of 43.7±9.3SD years. Majority of the patients were males (Fig 2) with M: F = 3.9:1.
Discussion
Urethrocystoscopy is a routine procedure now in urology with a range of indications in the diagnosis and treatment of lower urinary tract diseases. Our patients’ age ranged from 9 to 86years with mean age of 43.7±9.3SD years and a male: female ratio of 3.9:1. This is similar to findings in other studies from West Africa.4,5,6 The patients aged 60 to 69 years were more in number and were predominantly males; this is in keeping with the fact that symptomatic lower urinary tract obstruction has been shown to be most prevalent in the elderly and male patients.
Various indications for urethrocystoscopy were found in our patients and during the procedure, features suggestive of the diagnosis were noted as shown in Table 1 and 2 respectively. The indications for diagnostic urethrocystoscopy among our patients were predominantly (>80%) LUTS, clinical or radiological diagnosis of bladder tumour and haematuria, these are common urologic presentations among our patients. The findings are similar to report from other studies across West Africa.4-8 Following the procedure and based on the intraoperative findings, bladder tumour was the commonest pathology among our patients (37.8%). The finding shows high prevalence of bladder tumour among our patients and compared to findings from another study with similar sample size from Senegal6 and this goes to confirm an earlier report in our centre which showed bladder cancer as the second most common male cancer (after prostate cancer) and 11th in females.9 The high prevalence of bladder cancer in our environment has been attributed to schistosomiasis endemicity in a previous study in which chronic infestation with Schistosoma is a strong risk factor for squamous cell cancer (SCC) of the bladder.10 Significant percentage of our patients (13.8%) had essentially normal findings on urethrocystoscopy. Normal cystoscopic examinations on cystoscopy may suggest a resolving pathology such as UTI. This was similar to findings from other studies.5,6
Rigid cystoscopy was performed in all our patients with haematuria and bladder tumour which allows for better bladder irrigation and a biopsy. Rigid cystoscope was also used in all our children. Despite the use of rigid cystoscope in most of our patients most were done under local lidocaine instillation owing to observation of relative tolerance among our patients.
Despite being generally safe, when all necessary precautions are taken, however, being an invasive procedure, we recorded some complications as shown in Table 3. Morethan 95% of the patients did not have any complications. This is similar to findings in other studies.3,11,12
Conclusions
Urethrocystoscopy is a necessary tool for comprehensive practice of urology owing to its vital role in the diagnosis and treatment of different kinds of lower urinary tract diseases and it is generally a safe procedure.
References