Transurethral and Lower Tract Procedures Flexible Cystoscopy Findings in Patients Investigated for Profound Lower Urinary Tract Symptoms, Recurrent Urinary Tract Infection, and Pain Sarah Howles, M.A., MRCS(Eng), 1 Heidi Tempest, M.A., M.B., M.D., FRCS(Urol), 1 Gemina Doolub, M.Sc., PGDip(Cardiology), MRCP, 1 Richard J. Bryant, BMedSci(Hons), MRCS(Ed), Ph.D., 1 Freddie C. Hamdy, M.D., FRCS(Urol), FMedSci, 1 Jeremy G. Noble, M.D., FRCS(Urol), 1 and Stephane Larre ´ , M.D., Ph.D. 1,2 Abstract Background and Purpose: The National Institute of Clinical Excellence published guidelines in 2010 re- commending the use of cystoscopy to investigate profound lower urinary tract symptoms (pLUTS), recurrent urinary tract infection (rUTI), and pain in men. Currently, there are no equivalent guidelines for women. We aimed to examine the diagnostic performance of flexible cystoscopy (FC) when it is used in this context in both men and women. Patients and Methods: Results of all outpatient FCs undertaken in our department between April 2009 and March 2010 were examined retrospectively. Patients undergoing FC for the investigation of pLUTS, rUTI, or pain were included. Diagnostic performance was calculated, which was defined as the number of patients receiving a diagnosis of a clinically relevant abnormality at FC divided by the total number of patients undergoing FC for this indication. Results: Of the 1809 patients who underwent FC during the study period, 113 underwent FC to investigate pLUTS, rUTI, or pain. Diagnostic performance was 11.5% (n = 13), being 11.4%, 19.2%, and 0% in those with pLUTS, rUTI, and pain, respectively. Bladder cancer was diagnosed in one (0.9%) patient who underwent FC to investigate pLUTS but also had nonvisible hematuria. Urethral stricture was diagnosed in nine (8.0%) cases and intravesical calculi in four (3.5%) cases. Conclusion: Clinically relevant abnormalities were found in 11.5% of patients with pLUTS, rUTI, or pain, supporting recently published NICE guidelines recommending cystoscopy in patients with pLUTS or rUTI. Of the 17 patients who were investigated for pain, none was found to have clinically relevant abnormalities; further studies are needed to define the clinical utility of FC in these cases. Introduction L ower urinary tract symptoms (LUTS) are extremely common, with up to 60% of men aged more than 40 years with bothersome symptoms. 1 Consequently, assessment and treatment of these patients constitutes a large proportion of the workload of urology departments. The most common cause of LUTS in the male population is benign prostatic enlargement, 2 but pathology such as urethral stricture, intravesical calculi, or malignant disease (prostatic or in- travesical) can also produce these symptoms. The National Institute of Clinical Excellence (NICE) pub- lished guidelines in May 2010 regarding the assessment and management of LUTS in men. 2 As yet, no equivalent guide- lines have been published regarding the assessment and management of LUTS in women. These guidelines recom- mend that cystoscopy should comprise part of the investiga- tion of LUTS by a hospital-based specialist if there is a history of profound symptoms (pLUTS), recurrent urinary tract in- fection (rUTI), sterile pyuria, hematuria, or pain. The guide- lines do not provide specific definitions of what constitutes pLUTS or rUTI or what type of pain should go forward to cystoscopy. In cases such as these, visualization of the bladder via flexible cystoscopy (FC) may diagnose pathology such as urethral stricture or bladder calculi and exclude life- threatening disease such as bladder malignancy. No studies, however, have examined the diagnostic per- formance of FC in men when it is used to investigate pLUTS, 1 Department of Urology, Nuffield Department of Surgical Sciences, Churchill Hospital, Oxford, United Kingdom. 2 Service d’Urologie, Centre Hospitalo-Universitaire d’Angers, Angers, France. JOURNAL OF ENDOUROLOGY Volume 26, Number 11, November 2012 ª Mary Ann Liebert, Inc. Pp. 1468–1472 DOI: 10.1089/end.2012.0139 1468