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PA- versus urologist-performed flexible cystoscopy: A comparative study.

James Misurka1, Mohamad B Berjaoui, Katherine Lajkosz

  • 1In the Department of Surgery within the Division of Urology at University Health Network, part of the University of Toronto in Toronto, Ontario, Canada, James Misurka is a PA, Mohamad B. Berjaoui is a surgeon, Katherine Lajkosz is a biostatistician, Jess Cockburn is a scientific associate, Dhiral Kot is a PA, Robert J. Hamilton is a professor, Girish S. Kulkarni is a professor, Alexandre R. Zlotta is a professor, Jason Y. Lee is an associate professor, Nathan Perlis is an assistant professor, Antonio Finelli is a professor, and Neil E. Fleshner is a professor. J. Cockburn discloses receipt of funding from the Princess Margaret Foundation. G.S. Kulkarni discloses payment from Ferring Pharmaceuticals, Johnson & Johnson, Merck & Co., Bristol Myers Squibb, EMD Serono, Verity Pharmaceuticals, Theralase Technologies, AbbVie Inc., AstraZeneca, Tolmar Pharmaceuticals, Knight Therapeutics, TerSera Therapeutics, enGene Inc., CG Oncology, and Astellas Pharma for various services. The authors have disclosed no other potential conflicts of interest, financial or otherwise.

JAAPA : Official Journal of the American Academy of Physician Assistants
|February 22, 2026
PubMed
Summary

Physician associates/assistants (PAs) and staff urologists (SUs) showed similar patient pain perceptions and bladder cancer detection rates during cystoscopy procedures. This study highlights comparable outcomes between PAs and SUs in urological care.

Keywords:
bladder cancercystoscopymalignancy detectionpatient outcomesshortagesurology

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Area of Science:

  • Urology
  • Oncology
  • Medical Practice

Background:

  • Cystoscopy is a key diagnostic procedure for bladder cancer.
  • Evaluating the performance of physician associates/assistants (PAs) compared to staff urologists (SUs) is crucial for healthcare delivery.
  • Patient outcomes and diagnostic accuracy are important metrics for procedural comparison.

Purpose of the Study:

  • To compare patient-reported pain and bladder cancer detection rates between cystoscopies performed by PAs and SUs.
  • To assess the non-inferiority of PA-performed cystoscopies regarding patient comfort and diagnostic yield.
  • To inform healthcare policy and clinical practice regarding the role of PAs in urological procedures.

Main Methods:

  • Secondary analysis of a single-center, prospective, double-blind, randomized controlled trial.
  • Included 98 male patients undergoing flexible cystoscopy by either a SU or a PA.
  • Patient pain perception assessed via a post-procedure questionnaire.

Main Results:

  • Mean pain scores were comparable: 2.67 for SU-performed and 2.62 for PA-performed cystoscopies (p = .92).
  • Bladder cancer detection rates were similar: 6.25% for SU-performed and 10% for PA-performed cystoscopies.
  • Positive or suspicious findings were observed in 23% of SU-performed and 24% of PA-performed procedures (p > .05).

Conclusions:

  • PA-performed cystoscopies yield comparable patient pain scores to those performed by SUs.
  • Malignancy detection rates are similar between PAs and SUs performing cystoscopies.
  • PAs demonstrate equivalent efficacy to physicians in cystoscopy for bladder cancer diagnosis.