Flexible Cystoscopy and Urinary Tract Infections

Flexible cystoscopy is a minimally invasive procedure that enables direct visualisation of the urethra and bladder under local anaesthesia. It is widely employed for diagnosis, surveillance of urothelial lesions and removal of ureteric stents. Although generally safe and well tolerated, the procedure carries a small but significant risk of urinary tract infection (UTI), arising from introduction of organisms via the instrument or inadequate antisepsis of distal urethral flora. Reported post-procedure UTI rates vary from 2% to 20%, influenced by patient factors such as age, comorbidities and prior urinary colonisation. Strategies to mitigate infection include single-use device adoption, rigorous reprocessing of reusable scopes, antimicrobial prophylaxis and targeted antiseptic instillation. Emerging research addresses the balance between procedural efficiency, cost, environmental impact and patient safety, with a focus on optimising antisepsis protocols and exploring novel device technologies to minimise infectious complications without compromising diagnostic accuracy.

Research from Nature Portfolio

One randomised study evaluated additional urethral irrigation with povidone-iodine in male patients undergoing office-based flexible cystoscopy. Inclusion of distal urethral antisepsis reduced the incidence of culture-positive UTI from 22% in the standard preparation group to 7% in the intervention arm, supporting extension of antiseptic protocols beyond mid-stream urine sterility checks. Another investigation compared a grasper-integrated disposable flexible cystoscope with conventional reusable scopes for diagnostic surveillance of bladder lesions. While the primary focus was tumour detection, the single-use design offers the potential to eliminate reprocessing-related contamination and thereby lower infection risk without sacrificing diagnostic yield or patient comfort.

Flexible Cystoscopy and Urinary Tract Infections publication trend

The graph below shows the total number of articles in flexible cystoscopy and urinary tract infections across all publications each year (not limited to Nature Index journals).

Technical terms

Flexible cystoscopy: Endoscopic technique using a bendable fibre-optic or digital scope to inspect the lower urinary tract under local anaesthesia.

Urinary tract infection (UTI): Microbial invasion of the urinary tract leading to symptomatic or asymptomatic bacteriuria, often presenting with dysuria, frequency or fever.

Antibiotic prophylaxis: Administration of antimicrobial agents prior to a procedure to prevent postoperative infection.

Grasper-integrated disposable cystoscope: A single-use flexible cystoscope equipped with a built-in retrieval tool for ureteric stents or tissue sampling, designed to eliminate reprocessing.

References

1. Evaluation of post–flexible cystoscopy urinary tract infection rates. American Journal of Health-System Pharmacy (2020).
2. Urethral Instillation of Povidone-Iodine Reduces Post-Cystoscopy Urinary Tract Infection in Males: A Randomized Controlled Trial. Scientific Reports (2020).
3. The grasper-integrated disposable flexible cystoscope is comparable to the reusable, flexible cystoscope for the detection of bladder cancer. Scientific Reports (2020).
4. Efficacy of Antibiotic Prophylaxis in Cystoscopy to Prevent Urinary Tract Infection: a Systematic Review and Meta-Analysis. International braz j urol (2015).
5. Single-use digital flexible cystoscope for double J removal versus reusable instruments: a prospective, comparative study of functionality, risk of infection, and costs. World Journal of Urology (2023).