Who Performs Cystoscopy
Cystoscopy is primarily performed by urologists, but can also be safely and effectively performed by trained advanced practice providers (nurse practitioners and physician assistants) and pediatric urologists in specialized populations.
Adult Cystoscopy Providers
Primary Performers: Urologists
- Urologists are the primary specialists who perform cystoscopy in adults for diagnostic and therapeutic indications 1
- Board-certified urologists have completed urology residency training and are credentialed by the American Board of Urology 1
Advanced Practice Providers (APPs)
- Nurse practitioners and physician assistants can safely perform flexible cystoscopy after appropriate training and credentialing 2, 3
- Studies demonstrate that trained urology nurse practitioners achieve diagnostic accuracy comparable to consultant urologists, with kappa values of 0.94 indicating very close agreement in detecting bladder tumors 4, 5
- APPs performing cystoscopy in the United States and United Kingdom have consistently demonstrated safe practice with high-quality outcomes 3
- Standardized training curricula with skills checklists should be used for APP credentialing in flexible cystoscopy 2
Pediatric Cystoscopy Providers
Pediatric Urologists
- Cystoscopic procedures in infants and children should preferably be performed by a pediatric urologist 1
- Pediatric urologists have completed a 2-year pediatric urology fellowship after urology residency and may hold subspecialty certification from the American Board of Urology 1
Specific Pediatric Indications Requiring Pediatric Urologist
- Disorders of sex development require co-management by a pediatric urologist from the outset 1
- Solid malignancies of the kidney, bladder, and testicle should be treated by a pediatric urologist in conjunction with a pediatric medical cancer specialist 1
- Children with spinal cord disorders (e.g., myelomeningocele, spinal cord injuries) should have a pediatric urologist involved in their care 1
Clinical Context for Cystoscopy Performance
When Cystoscopy Should NOT Be Performed
- Cystoscopy should not be performed in index patients with stress urinary incontinence unless there is concern for urinary tract abnormalities 1
- In healthy SUI patients with normal urinalysis, there is no role for diagnostic cystoscopy 1
Common Indications Where Cystoscopy IS Indicated
- Evaluation of hematuria in patients aged 35 years and older 1, 6
- Patients with risk factors for urinary tract malignancies (tobacco use, chemical exposures, irritative voiding symptoms) regardless of age 1
- Surveillance of patients with previous bladder cancer 6
- Patients on anticoagulation therapy with microhematuria 1
Important Caveats
Training and Competency
- Proper training is essential regardless of provider type - both physicians and APPs require structured education and demonstrated competency before independent practice 2, 4, 5
- Legal and credentialing issues must be addressed at the institutional level when implementing APP-performed cystoscopy 3, 4
Flexible vs. Rigid Cystoscopy
- Flexible cystoscopy causes less pain and discomfort, has fewer post-procedure symptoms, requires simplified patient positioning, and has at least equivalent diagnostic accuracy to rigid cystoscopy 6
- Flexible cystoscopy offers superior visualization of anterior bladder neck lesions 6
- The technique for flexible cystoscopy differs from rigid cystoscopy but can be learned with practice 7