Patients’ perceived burden of cystoscopic and urinary surveillance of bladder cancer: a randomized comparison

Abstract

OBJECTIVETo compare, in patients with non‐muscle‐invasive low‐grade (pTa/pT1, G1/G2) urothelial cell carcinoma of the urinary bladder, the perceived burden of flexible cystoscopy or surveillance by microsatellite analysis (MA) in voided urine, as such patients are normally recommended to adhere to regular cysto‐urethroscopic surveillance (CUS).PATIENTS AND METHODSIn all, 220 participants of a randomized trial comparing CUS and surveillance by MA were asked to complete questionnaires 1 week after cystoscopy or urine sample collection. We assessed the discomfort and pain reported during CUS, experiences with MA, and physical symptoms, medical consumption and general functioning in the week after CUS/urine sampling.RESULTSWe analysed data from 732 questionnaires (197 patients) completed after CUS and 184 (67 patients) after collecting urine. The introduction of the cystoscope was reported to cause discomfort in 39% and pain in 35% of the responses to the questionnaires; the waiting time for the results of MA was reported as burdensome in 19%. Painful micturition was significantly more frequent in the week after CUS than after MA (30% and 12%, respectively). The frequency of fever (1% and 2%) and haematuria (7% and 6%) was similar in both groups. Older patients reported significantly less pain and discomfort from cystoscopy, and this was not related to having more previous cystoscopies.CONCLUSIONCUS caused pain and discomfort in about a third of patients. The burden of MA appeared fully attributable to the waiting time for the test result. The present results are a further motivation in the search for less invasive surveillance tests.

Factors Predictive of Pain During Cystoscopy: A Prospective Study

“…In recent studies, age has been found as a predictor for the pain and discomfort during cystoscopy and declared that older patients are able to tolerate cystoscopy [12]. However, in our study increased age was not associated with lesser pain.…”

Does sodium bicarbonate reduce painful voiding after flexible cystoscopy? A prospective, randomized, double‐blind, controlled trial

“…Our study identified an incidence of postflexible-cystoscopy dysuria of 28%, which is at the lower end of the range when compared with reports in the literature (30-54% [1,2,11]). As the incidence found was lower than expected, the sample size of the study was adequate to detect a 50% reduction in dysuria, rather than the 33% reduction specified in the study design.…”

“…Cystoscopy is a common urological procedure, and painful voiding (dysuria) is frequently reported afterwards with an incidence of 30-54% [1,2]. Relief is often attempted through the use of alkalinizing agents such as Ural® (sodium bicarbonate 1.76 g, sodium citrate (anhyd) 0.63 g, citric acid (anhyd) 0.72 g, tartaric acid 0.89 g, saccharin sodium 1.4 mg per 4 g, $1.27 AUD (70p) for 2 days, Sigma Pharmaceuticals, Australia Pty Ltd).…”

External Validation of a Clinical Scoring System for Hematuria

“…Traditional screening tools (e.g., cystoscopy) are not practical for population-based screening because they are invasive and not cost-efficient (Botteman et al, 2003). In addition, the procedure has been associated with pain or discomfort in about a third of cases (Van Der Aa et al, 2008). Due to concerns about the number of unnecessary diagnostic evaluations as well as the low prevalence of bladder cancer in the general population (Sutton, 1990), screening is not currently recommended.…”