Laparoscope Cystoscopy Offers Time and Cost Benefits

According to a randomized pilot study, cystoscopy performed with a laparoscope, compared with the traditional cystoscope, is more time-efficient and cost-effective.¹

Among the more serious complications of gynecological surgery, such as hysterectomy, is ureteral or bladder injury, with approximately 75% of ureteral injuries occurring during such procedures.² However, only 1 in 4 injuries to the bladder and ureter can be detected with visual examination alone. The routine use of cystoscopy after such procedures allows for early detection of any inadvertent injury to the bladder or ureter that may have occurred, greatly reducing the risk of postoperative complications, such as formation of a fistula, loss of renal function, and other complications that require additional surgery and hospitalization.³ Therefore, cystoscopy is a low-risk procedure that should be performed routinely after any gynecological procedure that is associated with a high risk of injury, according to Cheryl Iglesia, MD, associate professor of obstetrics, gynecology, and urology at Georgetown University.³

To determine the time involved in performing a cystoscopy using a laparoscope or a cystoscope, the study authors randomized 66 patients who underwent a laparoscopic hysterectomy to either laparoscope cystoscopy or traditional cystoscopy with a cystoscope. The authors also evaluated the incidence of urinary tract symptoms, infection, and adverse effects, as well as the expense related to each type of cystoscopy.

Laparoscope cystoscopy involved use of a suction-irrigator device, a 5-millimeter needle-nose suction irrigator tip, and a 5-millimeter 0-degree video laparoscope. Traditional cystoscopy involved use of a 70-degree video telescope with a 17F sleeve, irrigation fluid, and a light source, report the study authors.

Before surgery and 2 weeks after surgery, patients completed a questionnaire about urinary tract symptoms. In addition, clean catch urine samples were collected before surgery and at postoperative day 1 and day 14. Only 1 adverse event was reported in the laparoscope group, and 6 adverse events were reported in the cystoscope group. Two women in the cystoscope group experienced a urinary tract infection after surgery.

The total procedure time was significantly less for the laparoscope group compared with the cystoscope group (137 seconds vs 296 seconds, P<.001). Both groups showed similar postoperative improvements in urinary tract symptom scores from baseline. As for which procedure was most cost-effective, the cost of using a cystoscope was roughly $60 more per patient than that for a laparoscope.

Pertinent Points:
- Laparoscope cystoscopy is more time-efficient and cost-effective than traditional cystoscopy.
- The rates of urinary tract symptoms, infection, and injury did not increase with the use of laparoscope cystoscopy.

References:

1. Kratz KG, Spytek SH, Caceres A, et al. A randomized, single-blinded pilot study evaluating use of a laparoscope or a cystoscope for cystoscopy during gynecologic surgery. J Minim Invasive Gynecol. 2012;19:606-614.
2. Sharon A, Auslander R, Brandes-Klein O, et al. Cystoscopy after total or subtotal laparoscopic hysterectomy: the value of a routine procedure. Gynecol Surg. 2006;3:122-127.
3. Iglesia C. Should cystoscopy be routine at the time of hysterectomy? OBG Management. 2009;21(3):12-13.