EndoSheath use in flexible cystoscopy: a prospective evaluation of >1000 cases

To investigate patient tolerability and safety (using urinary tract infection (UTI) as a proxy measure) following EndoSheath-assisted flexible cystoscopy (eFC). EndoSheaths are single-use, disposable sheaths used in FC. They reduce cystoscope turnaround times as complicated, time-consuming and costly sterilisation is no longer necessary. This reduces patient waiting times as cystoscope idle time, the most common rate limiting step, is reduced.

All adult patients undergoing eFC over a 26-month period at a single institution were evaluated prospectively. Post-eFC, participants rated discomfort on a visual analogue scale (discomfort 1 = none, 2-4 = mild, 5-7 = moderate, 8-10 = severe). The diagnosis of UTI was broad and based on any one of patient self-report, positive urine culture or antibiotic prescription within 30 days of eFC. Data were analysed using chi-squared testing (P < 0.05, two-tailed).

Of the 1091 eFCs analysed, 33.2% and 48.2% of were ranked as causing no or mild discomfort, respectively, with just 3.1% ranked severe. Discomfort was greater in younger participants but similar between sexes. Overall, post-eFC UTI incidence was 13.3%, with rates higher in females (18.1%) than males (11.2%). Participants aged ≥65 years reported a higher UTI rate (15.4%) than those aged <65 years (8.8%). No participants developed urosepsis.

This large, prospective, unselected, real-world study reports that eFC is well tolerated. UTI was higher in females than males, and in those aged ≥65 years, in line with other studies using the same broad based diagnostic criteria for UTI. The conclusion is that eFC is both well tolerated and safe.