What to assess in a patient 1 month post cystoscopy?

Post-Cystoscopy Assessment at 1 Month Follow-Up

At the 1-month post-cystoscopy follow-up, clinicians should perform a urinalysis with microscopy to assess for persistent microhematuria, and if present, engage in shared decision-making regarding whether to repeat urinalysis in the future or proceed with additional evaluation. 1

Key Assessment Components

Urinalysis and Symptom Evaluation

• Perform urinalysis with microscopy to detect persistent microhematuria 1
• Assess for urinary symptoms that may indicate complications:
  • Persistent hematuria (microscopic or gross)
  • Dysuria or pain on urination
  • Urinary frequency or urgency
  • Suprapubic discomfort
  • Fever or signs of infection 2

Risk Stratification for Persistent Microhematuria

If microhematuria is detected at the 1-month follow-up:

Low/Negligible Risk Patients:

• Engage in shared decision-making about future follow-up 1
• Consider repeat urinalysis at 6,12,24, and 36 months if risk factors exist 1

High Risk Patients:

• Consider additional imaging if not previously performed 1
• High-risk factors include:
  • Age >60 years
  • Male gender
  • Smoking history
  • Family history of renal cell carcinoma
  • Known genetic renal tumor syndrome
  • Personal or family history of Lynch syndrome 1

Evaluation Algorithm for Persistent Microhematuria

1. If microhematuria resolves at 1-month follow-up:

   • No further follow-up needed for microhematuria 1
   • Document resolution in patient records

2. If microhematuria persists at 1-month follow-up:

   • Review initial evaluation results (cystoscopy findings, imaging)
   • If initial evaluation was negative:
     • Consider upper tract imaging if not previously performed 3
     • CT urography is generally preferred for detecting stones, malignancy, and structural abnormalities 1
     • MR urography if contrast allergy or renal insufficiency exists 4
     • Renal ultrasound as an alternative, especially in younger patients 4

3. If benign etiology was identified during initial cystoscopy:

   • Document stable degree of microhematuria
   • Engage in shared decision-making regarding further evaluation 1
   • Consider factors such as time since initial evaluation, presence of other risk factors, and overall risk stratification 1

Special Considerations

Post-Procedure Complications Assessment

• Evaluate for signs of infection (fever, dysuria, cloudy urine)

  • Note: Risk of febrile UTI after cystoscopy is approximately 1.9% 5
  • Higher risk in patients with pre-procedure bacteriuria (3.7% vs 1.4% in those with sterile urine) 5

• Assess for persistent symptoms that were common after cystoscopy but should have resolved:

  • Dysuria (reported in 50% of patients post-procedure)
  • Urinary frequency (reported in 37%)
  • Gross hematuria (reported in 19%) 2

Changes in Clinical Status

• Any new or worsening urologic symptoms require careful consideration and may merit further evaluation 1
• Changes that warrant additional evaluation include:
  • Development of gross hematuria
  • Higher degrees of microhematuria
  • New urologic symptoms 1

Common Pitfalls to Avoid

• Relying solely on dipstick testing without microscopic confirmation 4
• Assuming persistent microhematuria is always benign 1
• Failing to consider upper tract pathology in patients with persistent microhematuria despite negative cystoscopy 3
• Unnecessary use of antibiotics for asymptomatic patients post-cystoscopy 5, 6

By following this structured approach to the 1-month post-cystoscopy assessment, clinicians can appropriately monitor for complications and ensure timely detection of any significant pathology while avoiding unnecessary testing in low-risk patients.