Lisa Peacock, M.D. Debates Universal Cystoscopy

Adapted from The American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting Report

Although more prospective studies are needed, debaters leaned toward universal cystoscopy after hysterectomy performed with reconstructive surgery as opposed to selective cystoscopy.  Lisa M. Peacock, M.D. (Chair of Obstetrics and Gynecology at LSUHSC) took the pro stance during the debate “Routine Cystoscopy at the Time of Hysterectomy” while Rebecca Rogers, M.D. (Associate Chair for Clinical Integrations and Operations, Department of Women’s Health at the Dell Medical School at the University of Texas at Austin) took the opposing stance.

Dr. Peacock reviewed several studies and programs that examined overall detection rates with universal cystoscopy, including the largest multi-site study involving 839 patients.  Researchers at LSU SOM and Tulane University found that prior to cystoscopy, the ureteral injury detection rate was 6.7 percent and the bladder injury detection rate was 37.5 percent.  With cystoscopy, the overall detection rate increased to 97.4 percent.

Using this information and data from other sources Dr. Peacock argued that universal cystoscopy is now a mandated expectation of resident training and has very low complication rates. “The proponents against universal cystoscopy would say that you are going to give them UTIs, bladder and ureteral trauma, and they’re going to react to our contrast again, but I will tell you that after the five major studies that I’ve pulled that represent 5,283 patients, there was one complication.  The one complication was one you wouldn’t even think to occur: the institution [reporting this complication] had bought a new warming unit and they put their fluid in there, and it was too hot and they scalded the bladder.”

Dr. Rogers acknowledged that as an urogynecologist, she does perform cystoscopy so she can “sleep at night”.  To support the case against universal cystoscopy she shared complication concerns and a systematic review that looked at 79 studies and 41,000 hysterectomies.  With routine cystoscopy there was a five-fold increase in injury detection but no reduction in the number of postoperatively detected injuries.

Both doctors agreed that more research and cost analysis is needed in order to determine the value of universal cystoscopy.