Optimizing Rigid Cystoscopy and Biopsy Requests for Red Patches After Flexible Cystoscopy: A Two‑Cycle Quality...

Area of Science:

• Urology
• Quality Improvement
• Diagnostic Procedures

Background:

• Flat erythematous "red patches" (RPs) found during flexible cystoscopy are common but often benign.
• Historically, RPs have led to unnecessary rigid cystoscopies and biopsies, increasing patient morbidity and healthcare costs.

Purpose of the Study:

• To evaluate local practices for rigid cystoscopy and biopsy of RPs.
• To assess the impact of a targeted departmental intervention aimed at optimizing RP management.

Main Methods:

• A single-center, retrospective, two-cycle quality improvement audit was conducted.
• Data included patient demographics, cystoscopy indications, UTI status, biopsy decisions, histology, and relook outcomes.
• An intervention involving mandatory image capture, consultant review, and structured teaching was implemented between cycles.

Main Results:

• The rate of biopsies for RPs decreased from 58.7% in Cycle 1 to 31.5% in Cycle 2.
• Malignancy detection rates remained low (8.1% in Cycle 1, 4.3% in Cycle 2), with all cases in patients >60 years.
• Most RPs resolved spontaneously or after UTI treatment, and persistent low-risk lesions were safely managed conservatively.

Conclusions:

• A consultant-led, image-supported, risk-stratified pathway can reduce unnecessary rigid cystoscopies and biopsies for RPs.
• The intervention showed potential for improving practice without compromising cancer detection.
• Further research is needed to confirm oncological safety, optimize antibiotic stewardship, and standardize follow-up protocols.