Cystoscopy—An Underutilized BPH Diagnostic Tool That Can Aid Shared Decision Making with Patients

A recent change in the American Urological Association’s (AUA) benign prostatic hyperplasia (BPH) guidelines recommends that clinicians consider a number of ways to assess prostate size and shape, including cystoscopy, abdominal or transrectal ultrasound, or by preexisting cross-sectional imaging (i.e., magnetic resonance imaging [MRI]/computed tomography [CT]).1 This change happened because the approach to the differential diagnosis and the differentiated treatment of male lower urinary tract symptoms (LUTS) attributed to BPH has become substantially more sophisticated—with prostate size and morphology playing an important role in the decision-making process.2

Cystoscopy is a common but often underutilized diagnostic tool in many urology practices. Research tells us that, “despite its long-standing established role in medicine,  cystoscopy is a widely under-recognized investigation…patients often first hear about cystoscopy and its value on the day they require it.”3 While it can help physicians determine the right treatment options with their BPH patients, a recent patient awareness survey reported that 63% of men had never heard of cystoscopy.4 According to a 2017 study, published in the Canadian Urological Association Journal, this unfamiliarity can lead to anxiety, embarrassment or even pain.5 The patient awareness survey also showed that a vast majority of men (84%) are willing to move forward with cystoscopy after reading this question: “If your doctor could perform a brief diagnostic prostate examination in their office to determine the cause of your symptoms and best treatment options and it was covered by your insurance, how willing would you be to undergo that examination?”4 These findings indicate that patient education can help address the fears associated with this diagnostic test and improve understanding.

A separate study sought to better understand the patient experience and preferences when faced with cystoscopy. This study showed most patients (85%) preferred “direct to cystoscopy” over “return clinic appointments before cystoscopy,” which can help consolidate appointments and minimize return visits.3 This can be especially impactful during a pandemic, when patients are looking for ways to limit their exposure to hospitals and doctors’ offices.

Educating patients on both the clinical value and what to expect during cystoscopy may help alleviate concern and facilitate a deeper understanding of their condition. Furthermore, allowing patients to see their anatomy during the exam may enable them to participate in shared decision-making more effectively with their physician, while considering a treatment plan. Cystoscopy also offers the physician an opportunity to assess procedural tolerability and offers time to educate patients more fully on what to expect. Ultimately, increasing a patient’s knowledge of their condition and treatment options can enable more confident decision making and adherence to medical guidance at home.

For many men whose BPH is being monitored (i.e., watchful waiting6,7,8) or treated with medication, and for those considering surgery, the UroLift® System may be the right, earlier alternative to medical therapy or traditional surgery. A minimally invasive outpatient procedure that can be performed in a doctor’s office, the UroLift System provides better symptom relief than reported for medication and a risk profile better than reported for TURP.9,10,11 Cystoscopy can be a valuable tool in the evaluation of BPH, including assessment of candidacy for minimally invasive procedures, like the UroLift System. Ultimately, making full use of cystoscopy as a diagnostic tool can better help men frustrated by continued BPH symptoms or concerned about bladder health make informed decisions, in partnership with their trusted physicians.