SCOTTSDALE, AZ USA (UroToday.com) - This was the first of two posters that addressed the poor yield of invasive and expensive urologic testing in patients with recurrent UTIs. Despite the fact that current guidelines are lacking, it is common clinical practice to perform cystoscopy and various imaging in women with recurrent UTIs.
This study was a retrospective database review of 123 women with a mean age of 63 presenting to a single urologist with chief complaint of recurrent UTI. All women who underwent a cystoscopy were included (patients with gross or microscopic hematuria were excluded). Patients considered high risk for abnormal findings included 22 patients with immunosuppression for solid organ transplant, 20 with prior gynecologic surgery, and 3 with prior nephrolithiasis. A total of 8 cases (6.5%) yielded significant cystoscopic findings: debris/foreign material (2), bladder diverticulum (2), urethral stenosis (2), bladder carcinoma in situ (1), and ureterocele (1). Five of these cases (4.1%) had unique findings only discovered by cystoscopy.
A total of 105 patients (85.4%) had imaging available, including 88 RBUS and 17 abdominal CT scans. A total of 17 significant findings were noted in 14 patients (13.3%), including kidney stones (9), solid renal masses (2), complex renal cysts (2), diverticulum (1), ureterocele (1), bladder debris (1), and hydronephrosis (1). The negative predictive value (NPV) of normal imaging was 95%. Patients considered high risk were not predictive of abnormal cystoscopy, although risk of abnormal imaging trended near significance.
From this data, the authors had to conclude that cystoscopy has low yield in workup of recurrent UTI and imaging studies alone have high NPV (95%) in ruling out significant pathology.
Presented by M. Pagano, Y. Barbalat, and K. Cooper at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Winter Meeting - February 24 - 28, 2015 - JW Marriott Camelback Inn Resort & Spa - Scottsdale, AZ USA
Columbia University College of Physicians and Surgeons, New York, NY USA
Reported by Diane K. Newman, DNP, FAAN, BCB-PMD, medical writer for UroToday.com.