Introduction: Current consensus statements recommend a wait time less than four weeks for cystoscopic evaluation of hematuria.¹ Disruptions to healthcare delivery have been prevalent throughout the COVID-19 pandemic. The goal of this study was to assess cystoscopy wait times for hematuria, and identify the impact of COVID-19 on access to care. 

Methods: New referrals for hematuria at The Ottawa Hospital (TOH) were identified across three time periods: December 2019 to February 2020 (P1); March to May 2020 (P2); and July to September 2020 (P3). June 2020 was omitted, as clinical activity transitioned to full capacity. We excluded patients <18 years, cystoscopies outside TOH, known bladder cancer, and patients with incomplete data.  

Results: Cystoscopy appointment offerings did not differ across time periods: M=5 weeks in P1, M=6 weeks in P2, and M=6 weeks in P3 (p=0.39). However, cancellations were more prevalent during the first wave of COVID-19 (P2, 34%) than during P1 (14%) and P3 (6%) (p<0.05). Of those patients that missed scheduled cystoscopy, patients in P2 (COVID-19 wave) waited longer to be rescheduled (13 weeks)  than those in P1 (seven weeks) and P3 (four weeks) but this difference did not reach statistical significance  (p=0.11). Sixty of 597 cystoscopies identified a bladder tumor (~10%) and most tumors (56/60, 93%) were in the context of gross hematuria. High-grade pathology was associated with shorter wait times than low-grade (three weeks vs. four weeks) but this finding did not reach statistical significance (p=0.61).

Conclusions: The first wave of COVID-19 resulted in delayed cystoscopic evaluation of hematuria. Our data continues to support hematuria as a warning sign for bladder cancer and timely evaluation and treatment is paramount.