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67th Annual Meeting Abstracts
Is Cystoscopy Indicated for Bladder Wall Thickening Identified Incidentally on Computerized Tomography?
*Dan McPartlin1, *Jeffrey P Wolters2, *Albert Petrossian2, Baruch Mayer Grob1, Lance Hampton2, Adam Klausner1
1Hunter Holmes McGuire VAMC, Richmond, VA;2Virginia Commonwealth University, Richmond, VA
Introduction: Bladder wall thickening is identified incidentally on many computerized tomography (CT) reports, prompting urologic consultation for cystoscopy. The goal of this investigation was to determine the value of cystoscopy for this indication.
Materials & Methods: Using a cystoscopy log and the medical record, indications for cystoscopy were reviewed on 1000 consecutive patients from January, 2007 to March, 2009 to identify patients whose sole indication for the procedure was incidentally identified bladder wall thickening on CT. Patients were excluded if found to have concurrent history of microscopic or gross hematuria or bladder cancer. Data collected included age, gender, race, cystoscopic findings, AUA symptom score, medical history, social history, and follow-up.
Results: 12 patients underwent cystoscopy for incidentally identified bladder wall thickening on CT for a total incidence to 1.2%. Of these, eight (66.7%) had diffuse and four (33.3%) had focal bladder wall thickening. Average patient age was 65.1 years and 53% reported smoking history. None of the eight patients with diffuse bladder wall thickening (0%) were found to have suspicious lesions on cystoscopy. Suspicious lesions were identified in 2 of 4 patients (50%) with focal bladder wall thickening; however subsequent biopsies were negative for malignancy. Overall, no patients with incidentally identified bladder wall thickening on CT were found to have malignancy and 2 of 12 (16.7%) underwent unnecessary biopsies.
Conclusions: In this initial series, incidentally identified bladder wall thickening on CT does not provide sufficient justification for cystoscopy.
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