Flexible cysto-urethroscopy findings in young adults investigated for lower urinary tract symptoms,urinary tract infection and haematuria

Abstract

Diagnostic flexible cysto-urethroscopy (FC) is widely performed to investigate a variety of symptoms, including haematuria, lower urinary tract symptoms (LUTS) and urinary tract infections (UTIs). The purpose of this study was to examine if FC provides useful diagnostic information in young patients investigated for urological symptoms. All patients under the age of 40 years who underwent FC in a single institution over a 12-month period from April 2009 were identified. Electronic records and case notes were then examined. A total of 270 procedures were performed in the study period. Sixty were excluded and data were unavailable in 28. Of the remaining 182, the median age was 31 and 53.8% were male. UTI was the most common indication for the procedure. Abnormalities were found at FC in only seven patients (3.8%), comprising strictures in three and inflammation in four. Of the 63 patients in whom UTI was the sole indication for performing an FC, a single stricture was the only abnormal finding. One hundred and forty (76.9%) patients underwent upper urinary tract imaging, with abnormalities present in 7.9%. This study has demonstrated a very low detection rate of clinically significant disease in patients under the age of 40 years undergoing FC for the investigation of haematuria, LUTS and UTI. We propose that before FC is used in younger patients, careful thought be given to whether it is absolutely necessary and to whether non-invasive tests may allow FC to be avoided altogether.