In order to expand the availability of cystoscopy to underserved areas we have proposed utilizing advanced practice providers (APPs) to perform cystoscopy with real-time interpretation by the urologist on a telemedicine platform, termed "tele-cystoscopy". The purpose of this study is to have blinded external reviewers retrospectively compare multi-site, prospectively collected video data from tele-cystoscopy with the video of traditional cystoscopy in terms of video clarity, practitioner proficiency and diagnostic capability.
Each patient underwent tele-cystoscopy by a trained APP and traditional cystoscopy with an onsite urologist. Prospectively collected tele-cystoscopy transmitted video, tele-cystoscopy onsite video, and traditional cystoscopy video were de-identified and blinded to external reviewers. Each video was evaluated and rated twice by independent reviewers, and diagnostic agreement was quantified.
Six tele-cystoscopy encounters were reviewed for a total of 36 assessments. Video clarity, defined by speed of transmission and image resolution, was better for onsite compared to transmitted tele-cystoscopy. Practitioner proficiency for thoroughness of inspection was rated at 92% for tele-cystoscopy and 100% for traditional cystoscopy. Confidence in identification of an abnormality was equivalent. Four of six videos had 100% agreement between reviewers for next action taken, indicating high diagnostic agreement. Additionally, provider performing the cystoscopy and location did not statistically influence the ability to make a diagnosis or action taken.
This model has excellent completeness of exam, equivalent ability to identify abnormalities and external validation of action taken. This pilot study demonstrates that tele-cystoscopy may expand access to bladder cancer surveillance.
The Journal of urology. 2020 Apr 24 [Epub ahead of print]
Jennifer M Lobo, Bethany Horton, Randy A Jones, Teresa Tyson, Paula Hill-Collins, Terran Sims, Jessica J Rueb, Thomas Corey, Karen Rheuban, Patricia Battle, Haerin Beller, Noah Schenkman, Stephen Culp, Tracey L Krupski
Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia., School of Nursing, University of Virginia, Charlottesville, Virginia., The Health Wagon, Wise, Virginia., Urology Department, University of Virginia, Charlottesville, Virginia., Telehealth, University of Virginia, Charlottesville, Virginia.