Blinded Comparison of Clarity, Proficiency and Diagnostic Capability of Tele-Cystoscopy Compared to Traditional Cystoscopy: A Pilot Study

Jennifer M. Lobo, Bethany Horton, Randy A. Jones, Teresa Tyson, Paula Hill-Collins, Terran Sims, Jessica J. Rueb, Thomas Corey, Karen Rheuban, Patricia Battle, Haerin Beller, Noah Schenkman, Stephen Culp, Tracey L. Krupski

Research output: Contribution to journalArticlepeer-review


Purpose:In order to expand the availability of cystoscopy to underserved areas we have proposed using advanced practice providers to perform cystoscopy with real-time interpretation by the urologist on a telemedicine platform, termed "tele-cystoscopy." The purpose of this study is to have blinded external reviewers retrospectively compare multisite, prospectively collected video data from tele-cystoscopy with the video of traditional cystoscopy in terms of video clarity, practitioner proficiency and diagnostic capability.Materials and Methods:Each patient underwent tele-cystoscopy by a trained advanced practice provider and traditional cystoscopy with an onsite urologist. Prospectively collected tele-cystoscopy transmitted video, tele-cystoscopy onsite video and traditional cystoscopy video were de-identified and blinded to external reviewers. Each video was evaluated and rated twice by independent reviewers and diagnostic agreement was quantified.Results:Six tele-cystoscopy encounters were reviewed for a total of 36 assessments. Video clarity, defined by speed of transmission and image resolution, was better for onsite compared to transmitted tele-cystoscopy. Practitioner proficiency for thoroughness of inspection was rated at 92% for tele-cystoscopy and 100% for traditional cystoscopy. Confidence in identification of an abnormality was equivalent. Four of 6 videos had 100% agreement between reviewers for next action taken, indicating high diagnostic agreement. Additionally, provider performing cystoscopy and location did not statistically influence the ability to make a diagnosis or action taken.Conclusions:This model has excellent completeness of examination, equivalent ability to identify abnormalities and external validation of action taken. This pilot study demonstrates that tele-cystoscopy may expand access to bladder cancer surveillance.

Original languageEnglish (US)
Pages (from-to)811-817
Number of pages7
JournalJournal of Urology
Issue number4
StatePublished - Oct 1 2020
Externally publishedYes


  • cystoscopy
  • telemedicine
  • urinary bladder neoplasms
  • watchful waiting

ASJC Scopus subject areas

  • Urology


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