Single-Use Disposable Flexible Cystoscopes: Implementation in a Mobile Bedside Portable Cystoscopy Service

ABSTRACT

Introduction &Objective: Single-use disposable cystoscopes have recently been introduced, with portable smaller screens and good quality images. Within our institution, emergency cystoscopy was mainly done in the emergency operating theatre with reusable cystoscopes. We report our experience in developing a mobile bedside portable cystoscopy service with use of single-use disposable cystoscopes. Method(s) With the increase in COVID-19 admissions and unwell patients in isolation, to decrease patient transfers, exposure risks, reduce inpatient admissions and bed occupancy, we introduced the single use portable bedside cystoscopy service in our department. The Ambu aScopeTM 4 Cysto single-use disposable flexible cystoscope paired with a small portable viewing screen was used. From 24th September 2021 to 22nd Feb 2022, we deployed 17 cystoscopes, with 16 in the emergency setting. With the scope, we had a portable accessory kit, with an inventory of adjunct equipment including guidewires and urethral dilators. We also developed a standardised workflow to activate the service. We retrospectively review our series. Result(s) A total of 17 cystoscopes were deployed in this 5-month period. Location wise, 7 (41%) were in the emergency department, 3 (18%) in COVID-19 isolation ward and intensive care unit, 1 (6%) in high dependency, 5 (29%) in general ward, and 1 (6%) in the angiography suite. 6 patients (35%) had challenges for transfer out of the ward due to infectious isolation or clinical status. Indications included difficult urethral catheter insertion (n = 14, 82%), urethral evaluation in trauma (n = 1, 6%), urethral catheter malfunction (n = 1, 6%) and ureteric catheterisation before renal tumour ablation (n = 1, 6%). Adjunctive procedures performed with cystoscopy included indwelling urethral catheter insertion (n = 10, 59%), urethral dilatation with indwelling catheter insertion (n = 5, 29%), suprapubic catheter insertion (n = 1, 6%) and ureteric catheterisation (n = 1, 6%). No immediate complications were noted. 3 emergency department patients were discharged from the emergency department directly after cystoscopy, saving an inpatient bed and inpatient stay costs. Conclusion(s) The advent of single-use disposable flexible cystoscopes and its utilisation in a portable cystoscopy service has allowed us to bring cystoscopy in a compact mobile manner to the bedside of patients including those who emergently need cystoscopy, reducing need for patient transfer, inpatient stay, operating theatre usage and operating theatre nurse manpower, avoiding arrangements for emergency operating theatre.