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Expert highlights study assessing tele-cystoscopy

Commentary
Video

“The actions taken by those matched over 80% of the time. It seemed like what they saw, knowing the history, was a reasonable approximation of what an in-person urologist would do,” says Tracey L. Krupski, MD.

In this interview, Tracey L. Krupski, MD, discusses outcomes with tele-cystoscopy, which was assessed in the study, “Tele-cystoscopy: Feasibility of equipment and training,” for which she served as the senior author. Krupski is a professor of urology and the division chief at the University of Virginia in Charlottesville.

Video Transcript:

The [first of the] 3 pillars we thought of was the infrastructure, which is the technology, the internet speed, the coder, the decoder, and it's called a codec, as well as the scope itself. The second piece was training the nurse practitioners. As I said, there's several papers out and literature about that. It was interesting [that] the internet speed didn't matter. Actually, the slower speed was better in our study. The third is cancer control, which was a little harder to prove. Our primary outcome was what action was taken based on the cystoscopy. And you're like, "well, did they have cancer or not?" That sounds like the obvious thing, but if you're a urologist and you've looked in bladders, yes, you may see a big tumor, and then it's obvious. But you may see red spots. Or you may say, "Oh, they just finished some kind of intravesical therapy. I think the red spot in the bladder is simply a function of having had the medications; I don't think it's a tumor." So, the outcome we ended up choosing in our Journal of Urology paper was what was the action taken by blinded reviewers. So, did the urologist who didn't know whether it was being done as a televideo or whether it was the in-office cystoscopy [agree]? The actions taken by those matched over 80% of the time. It seemed like what they saw, knowing the history, was a reasonable approximation of what an in-person urologist would do. Unfortunately, you can't just say 10 people; you don't know who's going to have a tumor recurrence. Cancer control ended up being a trickier outcome to identify than we had originally thought. We were trying to go to surveillance adherence, meaning are you following up with the recommendations for how often you're getting cystoscopy? But then COVID went in the middle and then nobody could follow-up. So, there was just a few other confounders in this time period.

This transcription has been edited for clarity.

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