Cystoscopy for lower urinary tract symptoms in urogynecologic practice: the likelihood of finding bladder cancer

The objectives of this study were to estimate the detection rate of lower urinary tract malignancy among women evaluated with cystoscopy for lower urinary tract symptoms and to determine whether microscopic hematuria is a reliable predictor of cancer risk. The study population included 1,584 consecutive women undergoing office cystourethroscopy in a single urogynecology center between 1991 and 2001. The overall rate of biopsy-confirmed bladder cancer was 0.63%, including nine cases of transitional cell carcinoma and one superficial squamous cell carcinoma. Among women with initial microscopic hematuria, the rate of bladder cancer was 1.7%, significantly higher than 0.45% among those without hematuria (p = 0.03). However, in absolute terms, the majority of bladder cancer cases (60%; six of ten) presented with normal initial dipstick urinalysis. These findings suggest that outpatient cystourethroscopy is an integral tool for the evaluation of lower urinary tract symptoms, facilitating early recognition of both benign and malignant conditions. However, its expense and inconvenience must clearly be weighed against its potential yield.