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PA-Performed Flexible Cystoscopy Matches Urologist Results in Pain and Cancer Detection
Physician associates performing flexible cystoscopy produced virtually identical patient-reported pain scores and bladder cancer detection rates compared to staff urologists, with mean pain scores of 2.62 versus 2.67 and no statistically meaningful difference in malignancy yield. These findings suggest that task-sharing this diagnostic procedure between advanced practice providers and physicians does not compromise measurable procedural or diagnostic outcomes.
What Was Studied
This study examined whether physician associates (PAs) can perform flexible cystoscopy with equivalent patient pain experience and diagnostic accuracy for bladder cancer detection as staff urologists (SUs). The question carries workforce relevance given growing interest in expanding PA roles in urology to address capacity constraints without sacrificing care quality.
How It Was Studied
This was a secondary analysis drawing on data from a previously conducted single-center, prospective, double-blind, randomized controlled trial that originally evaluated irrigation technique during cystoscopy. From that parent trial, 98 men who underwent flexible cystoscopy performed by either a staff urologist or a physician associate were selected for this comparative analysis. Patients completed a standardized pain questionnaire immediately following the procedure. The controlled, randomized origin of the parent dataset provides a relatively high-quality data source, though the secondary nature of this analysis means the comparison was not the primary hypothesis driving the original trial design.
What Was Observed
- Patient-reported pain was nearly identical between groups, with a mean score of 2.67 for urologist-performed procedures and 2.62 for PA-performed procedures — a difference so small as to be clinically and statistically negligible (p = .92). This strongly suggests no meaningful difference in procedural discomfort attributable to provider type.
- Rates of positive or suspicious cystoscopic findings were comparable across both groups: 23% of urologist-performed cases (11 of 48) and 24% of PA-performed cases (12 of 50) were flagged as abnormal, with no statistically significant difference between groups (p > .05). This indicates similar endoscopic recognition of concerning lesions regardless of operator background.
- Among the 15 cases that proceeded to pathologic tissue sampling, urothelial cancer was confirmed in 3 of 48 urologist cases (6.25%) and 5 of 50 PA cases (10%). While the PA group showed a numerically higher detection proportion, the small absolute numbers involved mean this difference should be interpreted with considerable caution and is unlikely to reflect a true performance differential.
Why This Matters
Flexible cystoscopy is one of the most frequently performed urological procedures, used both for initial bladder cancer diagnosis and for surveillance following treatment. Demonstrating that PAs can perform this procedure with equivalent pain outcomes and diagnostic yield is meaningful for healthcare systems evaluating scope-of-practice models and workforce allocation. This study adds to a growing body of evidence supporting expanded roles for advanced practice providers in procedural specialties, though the literature in urology specifically remains limited and further multi-center data are needed to consolidate these findings.
How to Read This Result
The study’s single-center design, all-male cohort of only 98 participants, and secondary analytical approach limit the generalizability and statistical power of these findings, and results should be confirmed in larger, prospectively designed comparative trials before broad conclusions are drawn.
Limitations
The abstract does not explicitly report study limitations.