A randomized trial of 2% lidocaine gel versus plain lubricating gel for minimizing pain in men undergoing flexible cystoscopy.

This article presents findings from a randomized trial of intra-urethral lidocaine versus a plain lubricating gel for pain reduction in men undergoing flexible cystoscopy. Compared with the plain gel, use of lidocaine resulted in significantly less pain during the procedure.

Nurse-led flexible cystoscopy in Australia: initial experience and early results.

OBJECTIVE: • To present our initial experience implementing a nurse-led flexible cystoscopy (NLFC) service in a Victorian tertiary hospital and our initial results from that service, as NLFC has developed over the past decade with reports suggesting that adequately trained nurses can undertake FC competently. PATIENTS AND METHODS: • We describe the implementation of a NLFC service including approval, funding, nurses' training, and protocols. • Outcomes of all patients having a NLFC or subsequent interventions were recorded prospectively and analysed retrospectively. • To gauge patients' response to NLFC, an anonymous feedback questionnaire was administered to 60 consecutive participating patients in the recovery unit. • The effect of NLFC on waiting times was determined from surgical scheduling records. RESULTS: • In all, 272 patients had 720 NLFC done over a 2-year period. In all, 150 (21%) FCs had a suspected bladder cancer recurrence and were referred for a rigid cystoscopy. Of those, 83 (58%) revealed a recurrence comprising of 14 (17%) high-grade lesions, 45 (54%) low-grade lesions and 24 (29%) were diathermied without a biopsy. In all, 41 (27%) had benign pathology on biopsy and 21 (14%) had normal rigid cystoscopy. • There were two significant adverse events. • There was a 65% reduction in the waiting list for surveillance FC after introduction of the service. • Of 60 patients who completed the feedback questionnaire, 95% reported that they were given enough information by the nurses, 92% had all their questions answered satisfactorily and 97% had enough confidence and trust in the nurse. In all, 90% had a positive perception of the service overall and 93% were happy to have a FC performed by a nurse rather than a doctor. CONCLUSIONS: • Results from our NLFC audit compare favourably with other published reports. NLFC is a safe and feasible option when established alongside strong departmental support, comprehensive nurses' training according to established guidelines, service supervision by a designated consultant and regular audits. • NLFC clinics can provide an efficient service and excellent continuity of care for patients with non-muscle-invasive bladder cancer.

Urodynamics.

Voiding dysfunction has profound physical, emotional, and financial ramifications for patients and health care practitioners from all fields. The improvement of diagnostic testing in the area of voiding dysfunction, throughout decades, has resulted in improved patient outcomes. The components of urodynamic studies can allow practitioners an objective measurement to assist in making a correct diagnosis, hence appropriate interventions. An urodynamic study decreases the risk of a patient undergoing unnecessary surgical procedures. Urodynamics is an invasive procedure, though with the maintenance of sterile technique and patient education it is generally well tolerated with few adverse effects.

Patients' experiences at home after day case cystoscopy.

AIM: To determine patients' problems with day case cystoscopy and their problem solving ways and patients' self-care at home. BACKGROUND: Day surgery has become increasingly common in the last 20 years. Cystoscopic procedures are increasingly being carried out as a diagnostic and therapeutic procedures. DESIGN AND METHOD: This descriptive/prospective study comprised 50 patients undergoing day case cystoscopic procedures in the university hospital of Turkey. The data were collected using telephone interview three days after the procedure. The two questionnaire used were Symptom Measurement Questionnaire and Symptom Management Questionnaire. Discharge information and written instruction was given to all patients. RESULTS: It was found in the investigation that the most common problems experienced by the patients were tiredness, haematuria, dysuria, pain over bladder and difficulty in voiding after flexible cystoscopy in first day. Generally, urinary elimination problems were experienced by majority of the patients. At second day, these problems were also common. The mean score for all problems decreased after three days. The patients stated that they were able to deal with their symptoms either independently or to a lesser extent with assistance of a carer. But they were unable to deal with problems such as especially haematuria. CONCLUSION: Problems experiences by the patients at home after cystoscopy influenced some daily living activities. The problems related to voiding are more frequently observed after cystoscopy. Although some these problems are related to the procedures, some were present previously. RELEVANCE TO CLINICAL PRACTICE: This findings indicate that patient-centred care should be strengthened at home in urological day surgery.

Care of the patient undergoing radical cystectomy with a robotic approach.

Radical cystectomy or cystoprostatectomy with urinary diversion is the gold standard for the treatment of muscle-invasive bladder cancer. Cystectomy can be through an open or robotic-assisted laparoscopic approach. Advances in laparoscopy, robotic surgery, and urological oncology have made it possible for select surgeons to perform nerve-sparing robotic-assisted laparoscopic radical cystoprostatectomy. Advantages of robotic surgery may be minimal blood loss, shorter hospital stay, quicker recovery, and possibly more precise and rapid removal of the bladder depending on the experience and expertise of the surgeon. Appropriate patient selection and thorough pre-operative evaluation, however, are key in maximizing positive surgical outcomes. The experience at the University of Virginia with robotic-assisted laparoscopic radical cystectomy will be discussed.

Robotic-assisted laparoscopic cystectomy with ileal conduit for urinary diversion.

This case demonstrates the need for flexibility when approaching major abdominal surgery through a robotic approach. While the case was initiated with robotic technology, it ultimately had to be converted to an open procedure for reasons of patient safety and to ensure a good surgical outcome.

The nurse cystoscopist. Extending the role.

Nurse-led cystoscopy has become an established service for bladder tumour surveillance patients. The role of the nurse cystoscopist has been developed to include diagnostic cystoscopy with telephone follow-up and counselling. Direct access to the service has reduced waiting times from presentation to diagnosis. The telephone follow-up has improved patients' experience of a diagnostic urology service.

Practical cystoscopy: care of the instruments and preparation for a cystoscopic examination.

Periodically, a look at the past helps health care professionals see how much practice has changed as well as how some concepts and practices remain similar to the original rationales and techniques. Two chapters from a 1911 textbook on cystoscopy have been reprinted that describe catheter and instrument care and preprocedure requirements for cystoscopy performed in the hospital, office, or home. Sterilization methods and instruments for cystoscopy have improved in the century since this book was written but the rationale for the procedure and concepts guiding the instrumentation have some similarity with the practices performed nearly 100 years ago. Some comments also provide a bit of comic relief. One example, "this undoubtedly shortens the life of the catheter, but it lengthens the life of the patient" appears in the discussion about catheter cleaning after use in a pus case.

An evaluation of a nurse-led cystoscopy surveillance service.

The findings of a regional audit found that Salford had a high incidence of superficial bladder cancer. It was felt that the needs of the patient population could best be served by introducing a nurse-led cystoscopy service. This paper reports on the findings of a postal survey to evaluate the appropriateness and quality of care offered by the new service.

Nurse-led cystoscopy: the next step.

OBJECTIVES: To determine and compare the accuracy of flexible cystoscopy and subsequent management by a specialist urology registrar (SpR) and a specialist urology nurse (SUN). PATIENTS AND METHODS: Flexible cystoscopy was undertaken on 50 patients by both endoscopists each unaware of the results of the other's examination. The findings and management plans were independently declared and then compared. Any cystoscopic discrepancies were assessed by one consultant with the patients under a general anaesthetic. RESULTS: Tumours were found in 20% of patients; there was a consensus of the endoscopic findings and subsequent management plan between the SpR and the SUN in 94% of the patients. Any missed tumours (all surveillance) were minute and clinically insignificant. The chance-corrected proportional agreement (kappa value) between the SUN and final diagnosis and management was 0.94. CONCLUSION: A properly trained SUN can undertake both diagnostic and surveillance flexible cystoscopy, and decide upon further management to the same degree as can a urology SpR.

Improving a nurse-led flexible cystoscopy service through audit.

The urology nurse practitioner in one trust expanded her skills to perform flexible cystoscopy. This has reduced waiting times for patients and has led to improved service delivery and continuity of care. Auditing of the protocol used ensures there is a high, consistent standard of follow-up care for all patients.