In their introduction to this article, Kimuli and Lloyd observed that waiting times for urgent flexible cystoscopy in their day-surgery unit in England had reached 9 months, but that purchase of the large number of cystoscopes that would be required to reduce waiting times was considered too costly. They therefore investigated the feasibility of moving cystoscopy to the outpatient setting by using a Vision Sciences CST-2000 flexible cystoscope with Slide-On® EndoSheath® Technology containing a working channel.
Twenty-seven patients were randomly chosen from the day-surgery cystoscopy waiting list to undergo an outpatient procedure. The cystoscope operators evaluated the ease of use, flexibility, and images provided by the Vision Sciences device. The patients were asked to give their opinion of the outpatient cystoscopy service.
The endoscope operators and their assistants found the process of sheathing and resheathing the cystoscope to be smooth and efficient (requiring about 2 minutes), though somewhat more complicated than standard procedures. There were no breaks in the integrity of the EndoSheath® Technology or instances of damage to the cystoscope. The operators found that the cystoscope handled identically to conventional instruments, with no restriction of movement, and that use of the EndoSheath® Technology had no noticeable effect on the quality of the image. All patients provided positive feedback on the outpatient cystoscopy service and preferred it to the day-surgery setting.
Kimuli and Lloyd commented that flexible cystoscopy using a disposable sheath avoids the need to support outpatient cystoscopy with sterilization units or several prepacked cystoscopes. They noted that high-level disinfection of flexible cystoscopes with either glutaraldehyde or peracetic acid is time consuming, labor intensive, and costly and that it may not always be effective in preventing iatrogenic infection. The researchers also found that the cost of cystoscopy using the Vision Sciences system was lower than that of cystoscopy with standard instruments. Kimuli and Lloyd recommended that outpatient flexible cystoscopy be considered for both diagnostic and surveillance procedures and that Vision Sciences® cystoscopes and EndoSheath® Technology be included in the planning of this service.
