Nurse-led cystoscopy: the next step

Objectives To determine and compare the accuracy of flexible cystoscopy and subsequent management by a specialist urology registrar (SpR) and a specialist urology nurse (SUN). Patients and methods Flexible cystoscopy was undertaken on 50 patients by both endoscopists each unaware of the results of the other's examination. The findings and management plans were independently declared and then compared. Any cystoscopic discrepancies were assessed by one consultant with the patients under a general anaesthetic. Results Tumours were found in 20% of patients: there was a consensus of the endoscopic findings and subsequent management plan between the SpR and the SUN in 94% of the patients. Any missed tumours (all surveillance) were minute and clinically insignificant. The chance-corrected proportional agreement (kappa value) between the SUN and final diagnosis and management was 0.94. Conclusion A property trained SUN can undertake both diagnostic and surveillance flexible cystoscopy, and decide upon further management to the same degree as can a urology SpR.