Aims To implement the use of an endosheath-covered cystoscope - a disposable sheath that fits over the cystoscope

Perform a service evaluation of performance of the new sheathed scope

To maintain safety and efficiency in the department

Become a leading centre for improvements in flexible cystoscopy techniques

Methods Participants undergoing flexible cystoscopy at Lymington hospital, UK between January 2018 to April 2020 participated in this service implementation of endosheath covered flexible cystoscopy. This received high levels of staff and participant engagement, quickly becoming part of the unit culture.

Participants completed 2 surveys, the first immediately post procedure; discomfort was rated on a 10 point visual analogue scale (1=no discomfort, 10=extreme discomfort). The second survey completed ~2-4 weeks later, development of subsequent urinary tract infection (UTI) (patient self-report, GP records or antibiotic prescription).

Results Management approved the study and received strong support from both staff and participants showing high levels of altruism. This was due to high levels of engagement, communication and a clear plan as to what was being done and why, how this was to be achieved and how success would be measured. Additionally, staff felt the sheathed cystoscope handled well.

Overall, 1091 endosheathed flexible cystoscopies were analysed. It was a very well tolerated procedure with 33.2% procedures causing no discomfort, 48.2% mild and only 3.1% severe discomfort.

The UTI rate was 13.3% and impressively there were no reports of urosepsis.

Conclusions This safe, well tolerated procedure provides both cost and time savings to the healthcare provider. This study paves the way for developments in endoscopic imaging techniques and can be used as a leading example for other hospitals to implement the new techniques. This is also translatable to other units performing diagnostic telescopic evaluations in other parts of the body (e.g. bronchoscopy).