How many cystoscopies necessary?

[erom43]

I am a 69 year old male with BPH, and a father who had prostate cancer for 15 years, but did not die from it.  I have had two bouts of acute prostatitis causing complete retention in the last 7 years, one requiring catheterization.  My PSA averages around 2.0, and I take Proscar and Cardura daily.  My BPH symptoms are fairly mild causing only about one or two nights a month of nocturia, reduced urine flow, and hardly ever the feeling of urgency.  I do feel like I have mild prostatitis from time to time, causing incomplete emptying of the bladder, and a more reduced urine flow.  My urologist has given me two cystoscopies in the past six years and now wants to schedule a third....because "I'm due".  Nothing was ever found in the exams, other that the expected urethral restriction in the prostate area.  My last cysto resulted in painful urination for three days afterward.  I am wondering about the justifications for the frequent cystoscopies.

I welcome any input on cysto frequencies.

[erom43]

Thank you for the response.  Although I do have incomplete emptying of the bladder (100-400cc), and occasional bouts of prostatitis, which usually clears up without treatment, my doctor routinely sees me twice a year, and schedules cystos every two years.  I don't mind the office visits, but I question the frequency of the cystos, since the only two I have had have been clear, and I have never had any blood in the urine.  Office visits always include the standard BPH quiz which I usually score between 7 and 11, a flow meter test followed by an ultrasound to measure retention, and of course the digital exam.
Although my prostate is significantly enlarged, I consider my symptoms to be fairly mild, as stated in my original post.  The key answer on the quiz is that I could comfortably live the rest of my life with my current symptoms.  This brings me to my next question, which is: at what point do you recommend a trans urethral procedure for BPH patients?

[S. Kaul, MD]

Hi there!

Well, there is no definite protocol of doing cystoscopies in BPH. The interval of the procedure may depend on the severity of symptoms or laboratory indications such as elevated PSA. Since these have not been severe/ elevated in your case, the cystoscopies may not have been necessary and less invasive procedures such as an ultrasound with PSA levels may be preferred. I would suggest discussing the situation and the suggested management plan in detail with your treating urologist.
Hope this is helpful.

Take care!