The re-use of irrigating equipment for flexible cystoscopy is not safe

To determine the incidence of fluid reflux from the lower urinary tract into the connecting tubing used for irrigation in patients undergoing flexible cystoscopy.

The study was conducted in 94 consecutive male and female patients attending routine outpatient flexible cystoscopy lists. A sensor was designed and constructed to determine the presence of any retrograde flow of irrigating fluid, and the volume of any reflux through the connecting tubing. The mean (sd) cystoscope internal channel volume was 2.56 (0.25) mL; the level of significant reflux was set at >/=2. 25 mL.

Reflux of irrigating fluid occurred in 11 males (17%) and was significant in six (9%) of 65 male patients, with the irrigating fluid reservoir set at a height of 0.78 m above the patient's mid-coronal level. No reflux occurred in the 29 females studied.

Significant reflux can occur in males and hence the connecting tubing should be regarded as contaminated. Infection-control measures must include the prevention of transmission of blood-borne infections, e.g. hepatitis B and C viruses, and human immunodeficiency virus, because of the risk that blood may contaminate urine, and they should be implemented in all cases regardless of patient risk factors. From the available evidence, flexible cystoscopy should always be performed with single-use irrigation systems.