Urinary tract infection following flexible cystoscopy: a comparison between sterilised cystoscopes and disposable sterile sheaths

Objective: The objective of this article is to compare the incidence of post-cystoscopy urinary tract infections (UTIs) between cystoscopes sterilised between patients and cystoscopes that use removable sterile sheath technology. Patients and methods: A total of 200 patients undergoing flexible cystoscopy at the Norfolk and Norwich Hospital (Norwich, UK) between November 2011 and March 2012 were identified prospectively as part of an ongoing audit of the department’s services. One hundred patients were recruited from day procedure lists, using KeyMed® cystoscopes sterilised between patients (sterilised scope, SS); 100 patients were recruited from a ‘one-stop’ urology clinic, using a Vision Sciences® CST-5000 cystoscope with disposable sterile Endosheath® technology (removable sheath, RS). Mid-stream urine (MSUs) samples and patient symptoms were recorded prior to the cystoscopy and at least three days following the cystoscopy. Results: No significant difference was found in the incidence of new MSU-confirmed UTI (2.7% (SS) vs. 2.0% (RS)). In those undergoing their first cystoscopy, no significant differences were found in either new symptoms (34.1% (SS) vs. 36.7% (RS)) or requirement for antibiotics (13.6% (SS) vs. 13.0% (RS)). Conclusion: Flexible cystoscopy using removable sterile sheath technology does not have a higher incidence of UTI compared to a cystoscope sterilised between patients. The introduction of cystoscopes using this technology can therefore safely transform flexible cystoscopy into an outpatient clinic procedure.