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Updated: Feb 24, 2026

Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
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.
Introduction:
We aimed to compare patient pain perceptions and bladder cancer detection rates following cystoscopy performed by physician associates/physician assistants (PAs) versus staff urologists (SUs).
Methods:
We performed a secondary analysis of our earlier single-center, prospective, double-blind, randomized controlled trial that originally investigated irrigation "bag squeeze" versus standard cystoscopy. In this analysis, 98 men who underwent flexible cystoscopy by either a SU or a PA were included. Patients completed a pain questionnaire following the procedure.
Results:
The mean pain score for SU-performed cystoscopy was 2.67 compared with 2.62 for PA-performed cystoscopy ( p = .92). A total of 23 cystoscopies (SU-performed, 11 [23%]; PA-performed, 12 [24%]; p > .05) resulted in positive or suspicious findings. Pathologic sampling was performed for 15 (SU-performed, 6; PA-performed, 9), out of which 8 total (SU-performed, 3 [6.25%]; PA-performed 5 [10%]) were positive for urothelial cancer.
Conclusions:
PA-performed cystoscopies demonstrate similar outcomes to those performed by physicians in terms of patient-reported pain scores and malignancy detection rates.
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