Is separate diagnostic cystoscopy justified in image Proven intra vesical space occupying lesions (IVSOL)

Tanveer Iqbal Dar; Abdul Rouf Khawaja; Mohd. Saleem Wani; Arif Hameed; Syed Sajjad Nazir

Volume : VII, Issue : IX, September - 2018

Is separate diagnostic cystoscopy justified in image Proven intra vesical space occupying lesions (IVSOL)

Tanveer Iqbal Dar, Abdul Rouf Khawaja, Mohd. Saleem Wani, Arif Hameed, Syed Sajjad Nazir

Abstract :

The aim of this study was to evaluate the role of separate diagnostic cystoscopy before transurethral resection of bladder tumor following image proven intra vesical space occupying lesions. Materials and Methods: This prospective, comparative, multi centric study was conducted over a period of 12 years.Data from 1430 patients who underwent separate rigid diagnostic cystoscopy under local anesthesia from May 2002– May2014 was collected. Patients with image proven intra vesical space occupying lesions (IVSOL), were identified and their signs symptoms, complications and sequele following imaging and cystoscopy recorded and compared. Results: 91.5% of patients had same findings on cystoscopy as on imaging, with additional small bladder lesions found in 8% of cases on cystoscopy which did not change the future management. Five patients (0.34%, P–value– >0.05) reported as having polypoid bladder mass on imaging, had intravesical extension of prostatic median lobe. Significant post cystoscopy morbidity was noticed in the form of meatal injury (6%, P–value–0.0001), with extravasation and abandoning the procedure in (0.5%, P–value–0.0001) patients, hematuria (1.25%, P–value–0.0001), precipitated urinary retention in (1.2%, P–value–0.0001) patients necessitating indwelling catheterization, meatal stenosis (1.0%, P–value–0.0001), and stricture urethra in (0.3%). Conclusion: Sonographic/ CECT evaluation is a non invasive technique in detecting bladder lesions, their localization, number of lesions and extravesical extension accurately. Further rigid cystoscopy is invasive, costly, and has significant risk of complications along with discomfort to the patient. Also it delays the definitive procedure (TURBT) by an average of 7 days. Hence we don�t recommend separate cystoscopy in an image proven IVSOL.