Executive Summary

Standardized Office Cystoscopy Training for Advanced Practice Providers in Urology

Michelle J. Lajiness, FNP-BC; Heather Schultz, FNP-C; Susanne A. Quallich, PhD, ANP-BC, NPC, CUNP, FAANP


Urol Nurs. 2020;40(1):31-33. 

In This Article

Abstract and Introduction


With cystoscopy being a frequent reason for office visits to adult urology practices, there is a clear need for the development of formal training for nurse practitioners (NPs) and physician assistants (PAs) in the United States to gain skills in performing cystoscopy. This procedure is not presently incorporated in NP training curricula, meaning NPs had to look at post-licensure for training. Until Quallich and colleagues (2019) proposed a cystoscopy curricula, no U.S.-based recommendations existed; this presented a barrier to NPs training in cystoscopy and represented a lack of resources for privileging and credentialing. This column summarizes training recommendations presented by Quallich and colleagues (2019).


It has been well-documented that the need of the U.S. population for urology care is exceeding the number of urologists (McKibben et al., 2016), and there will be an increasing burden of urologic disease for both aging women and men. Advanced practice providers (APPs), physician assistants (PAs), and nurse practitioners (NPs) are moving into urology care environments in increasing numbers to provide access and urologic care. APPs have grown to represent upwards of 25% of all medical providers (American Association of Nurse Practitioners [AANP], 2020; National Commission on Certification of Physician Assistants [NCCPA], 2015). NPs alone comprise roughly 25% of the U.S. primary care workforce, with that percentage growing annually. NPs comprise a larger percentage of the health care workforce in rural and underserved communities, and may be the only providers providing urologic or urogynecology care. This points to the need to expand the APP role further in procedure-based care.

Langston and colleagues (2017) documented the expansion of APPs into performing cystoscopy, showing a 10,000% increase since 1996. These authors also reported 12% of APPs surveyed were performing cystoscopy, despite the lack of a formal training program. Langston and colleagues (2016) also reported 2,600 office cystoscopies for Medicare patients were billed by APPs; however, this number is not factually accurate, owing to the likelihood that many more procedures were billed under a supervising or collaborating physician due to each individual state's scope of practice laws.

Urologists have been hesitant to embrace APPs performing cystoscopy, in part due to the lack of a formal program that ensures consistent didactic content, guidelines, and performance standards. This has resulted in a model of "on-the-job" training, which lacks uniformity and consistency among urologists (although it does parallel the manner in which residents are taught), making it probable that different facilities provide varying emphasis on components of the training content. Formal training programs have been developed in the United States for APPs to learn how to perform a coloposcopy (Drexel University, 2018), and internationally, for nurses to learn office cystoscopy (British Association of Urological Nurses [BAUN] & British Association of Urological Surgeons [BAUS], 2017). Shields (2016) reviewed the world literature that examined the quality and effectiveness of specially trained nurses performing cystoscopy; the literature to date shows that specially trained nurses are safe and effective when performing this procedure, but perhaps most importantly, improve access, allowing health systems to meet the screening guidelines for patients who have low-grade bladder cancer. To date, no papers have evaluated physician assistants performing cystoscopy.

Quallich and colleagues (2019) proposed the first systematic program to train APPs to perform office cystoscopy in the United States by review of the available world literature and developing guidelines to guide training.