Cystoscopy Preparation for BPH Patients
Cystoscopy is not routinely required for BPH patients and should only be performed in specific clinical scenarios—most BPH patients undergoing watchful waiting or medical therapy do not need cystoscopy at all. 1
When Cystoscopy IS Indicated
Perform cystoscopy only when specific risk factors or clinical circumstances are present:
- History of hematuria (to rule out bladder cancer) 2, 1
- History of urethral stricture (may affect treatment planning) 2, 1
- History of bladder cancer (surveillance required) 2, 1
- Prior lower urinary tract surgery (anatomical assessment needed) 1
- Patient has already decided to proceed with invasive/surgical therapy AND the presence of a middle lobe would contraindicate certain procedures 2, 1
When Cystoscopy Should NOT Be Done
Do not perform cystoscopy routinely in the initial evaluation of uncomplicated BPH, as it adds cost without improving outcomes and does not predict treatment response. 1 The AUA guidelines explicitly state that cystoscopy should not be used to determine the need for treatment. 1
The endoscopic appearance of the prostatic urethra and bladder does not predict response to BPH therapy. 1 This is a critical pitfall—clinicians sometimes order cystoscopy thinking it will guide medical management, but guideline evidence shows this is unreliable. 1
What Cystoscopy Can Reveal (When Performed)
If cystoscopy is indicated based on the criteria above, it can provide useful anatomical information:
- Lateral lobe configuration versus middle lobe presence can forecast response to minimally invasive and surgical therapies 1
- Presence of intravesical lobes may impact the choice of surgical approach 1
Preferred Alternative for Anatomical Assessment
Use transabdominal ultrasound instead of cystoscopy when anatomical assessment is needed for surgical planning. 1 Ultrasound can measure prostate volume and identify intravesical lobes without the invasiveness of cystoscopy. 2, 1
No Special "Preparation" Protocol Needed
There is no specific preparation protocol for cystoscopy in BPH patients beyond standard cystoscopy preparation (which typically includes informed consent, prophylactic antibiotics if indicated by local protocols, and local anesthesia). The key clinical decision is whether cystoscopy is indicated at all—for most BPH patients, it is not. 1