<p><strong>Prior to procedural intervention in patients with LUTS/BPH, clinicians may perform a cystoscopy. (<em>Clinical Principle</em>)</strong></p>
Discussion
Discussion
<p>Cystoscopy may be utilized as a tool to evaluate prostate and bladder morphology and associated pathologies prior to surgical interventions. Patients with hematuria, suspicion of urothelial cancer, and urethral strictures may have a cystoscopy as part of their expected workup and follow-up. These studies may provide useful information for the management of BPH with the detection of a median lobe, obstructive lateral lobes, bladder trabeculations, bladder stones, and bladder diverticula that may be considered for treatment selection. Cystoscopy, however, may have a limited ability to determine the presence of obstruction caused by BPH if used as a single test.</p>
<p>The presence of a median lobe, its anatomy, and degree of obstruction is easily evaluated on cystoscopy, and correlates well with BOO with a positive predictive value (PPV) of 94%, and is negatively correlated with Q<sub>max</sub>.<sup>121, 129</sup> High bladder neck on cystoscopy can also play a role when evaluating for obstruction on cystoscopy. Bladder neck elevation of more than 35 degrees was found to predict obstructive patterns on UDS in patients with BPH.<sup>130</sup> Even though cystoscopy findings can provide useful information for surgical management, cystoscopy alone cannot definitively diagnose detrusor overactivity (DO), DU, or exclude BOO.<sup>131</sup></p>