In what scenarios should I consider cystoscopy as part of the management plan for a patient with recurrent urinary tract infections?

Cystoscopy should be considered in patients with recurrent urinary tract infections (UTIs) primarily when there is suspicion or evidence of underlying structural abnormalities or complications such as bladder stones, haematuria, or suspected bladder cancer. Specifically, in patients with neurogenic lower urinary tract dysfunction who experience recurrent infections, recurrent catheter blockages, or haematuria, referral for cystoscopy is recommended to investigate for bladder stones or malignancy ¹.

Additionally, cystoscopy is not routinely indicated for surveillance in neurogenic bladder patients but should be reserved for those with symptoms suggestive of bladder pathology or complications related to long-term catheter use ¹. In the general population, cystoscopy may be considered when recurrent UTIs persist despite appropriate management and when imaging or clinical features raise concern for anatomical abnormalities or malignancy (Kwok et al., 2022).

In children, cystoscopy is rarely indicated; imaging such as ultrasound and DMSA scans are preferred unless atypical features or recurrent infections suggest the need for further invasive evaluation ².

Therefore, the clinical scenarios warranting cystoscopy in recurrent UTI management include:

• Recurrent UTIs associated with haematuria or recurrent catheter blockages (suggesting bladder stones) ¹
• Long-standing neurogenic bladder with recurrent infections and suspicion of bladder cancer ¹
• Failure to identify cause of recurrent infections after non-invasive imaging and investigations, especially in adults (Kwok et al., 2022)

In summary, cystoscopy is reserved for patients with recurrent UTIs when there is clinical suspicion of bladder stones, malignancy, or structural abnormalities not identified by less invasive methods, particularly in those with neurogenic bladder or long-term catheter use.