Objective: The study aimed to test the hypothesis that the instillation of lidocaine gel does not reduce the pain related to flexible cystoscopy. Material and Methods: A prospective randomized study was designed to compare the pain perception between intraurethral instillation of lidocaine gel and saline solution in flexible cystoscopy. One hundred consecutive male patients attending for flexible cystoscopy were randomized to receive 10 ml of lidocaine gel or 10 ml of saline solution. Saline solution was also used for the irrigation pressure. Patients recorded their pain on a 10 cm Visual Analog Scale before and after the procedure. Patients also assessed whether the cystoscopy was more painful than the previous one. Statistical comparison was made using the t test for parametrical data and the Mann-Whitney U test for non-parametrical data. Results: Mean pain score in the lidocaine group was 0.67 ± 1.11 cm (range 0-5) compared to 0.55 ± 1.10 cm (range 0-5) in the saline solution group. Pain perception did not differ significantly between the 2 groups (mean difference 0.12 cm, 95% CI -0.32 to 0.55, p = 0.40). Conclusions: Prior lubrication of the urethra does not reduce the pain produced during flexible cystoscopy. The introduction of flexible cystoscopes under direct vision and with an irrigation pressure might guarantee sufficient comfort and the lubricant gel instillation could be avoided.

Keywords:
Anesthetic gel, Flexible cystoscopy, Lidocaine gel, Lubricant, Pain
1.
Dryhurst DJ, Fowler CG: A new small-calibre diagnostic flexible cystoscope. BJU Int 2002;89:194-196.
2.
Rodríguez-Rubio F, Sanz G, Garrido S, Sánchez C, Estudillo F: Patient tolerance during outpatient flexible cystoscopy - a prospective, randomized, double-blind study comparing plain lubrication and lidocaine gel. Scand J Urol Nephrol 2004;38:477-480.
3.
Patel AR, Jones JS, Babineau D: Lidocaine 2% gel versus plain lubricating gel for pain reduction during flexible cystoscopy: a meta-analysis of prospective, randomized, controlled trials. J Urol 2008;179:986-990.
4.
Losco G, Antoniou S, Mark S: Male flexible cystoscopy: does waiting after insertion of topical anaesthetic lubricant improve patient comfort? BJU Int 2011;108(suppl 2):42-44.
5.
Stav K, Taleb E, Sabler IM, Siegel YI, Beberashvili I, Zisman A: Liquid paraffin is superior to 2% lidocaine gel in reducing urethral pain during urodynamic study in men: a pilot study. Neurourol Urodyn 2015;34:450-453.
6.
McFarlane N, Denstedt J, Ganapathy S, Razvi H: Randomized trial of 10 mL and 20 mL of 2% intraurethral lidocaine gel and placebo in men undergoing flexible cystoscopy. J Endourol 2001;15:541-544.
7.
Siderias J, Gaudio F, Singer AJ: Comparison of topical anesthetics and lubricants prior to urethral catheterization in males: a randomized controlled trial. Acad Emerg Med 2004;11:703-706.
8.
Chitale S, Hirani M, Swift L, Ho E: Prospective randomized crossover trial of lubricant gel against an anaesthetic gel for outpatient cystoscopy. Scand J Urol Nephrol 2008;42:164-167.
9.
Choong S, Whitfield HN, Meganathan V, Nathan MS, Razack A, Gleeson M: A prospective, randomized, double-blind study comparing lignocaine gel and plain lubricating gel in relieving pain during flexible cystoscopy. Br J Urol 1997;80:69-71.
10.
Birch BR, Ratan P, Morley R, Cumming J, Smart CJ, Jenkins JD: Flexible cystoscopy in men: is topical anaesthesia with lignocaine gel worthwhile? Br J Urol 1994;73:155-159.
11.
Goel R, Aron M: Cooled lignocaine gel: does it reduce urethral discomfort during instillation? Int Urol Nephrol 2003;35:375-377.
12.
Lugo-Janer G, Padial M, Sánchez JL: Less painful alternatives for local anesthesia. J Dermatol Surg Oncol 1993;19:237-240.
13.
Morris R, McKay W, Mushlin P: Comparison of pain associated with intradermal and subcutaneous infiltration with various local anesthetic solutions. Anesth Analg 1987;66:1180-1182.
14.
Ho KJ, Thompson TJ, O'Brien A, Young MR, McCleane G: Lignocaine gel: does it cause urethral pain rather than prevent it? Eur Urol 2003;43:194-196.
15.
Khan MA, Beyzade B, Tau W, Virdi JS, Potluri BS: Effect of the rate of delivery of lignocaine gel on patient discomfort perception prior to performing flexible cystoscopy. Urol Int 2002;68:164-167.
16.
Burke DM, Shackley DC, O'Reilly PH: The community-based morbidity of flexible cystoscopy. BJU Int 2002;89:347-349.
17.
Zhang ZS, Wang XL, Zeng SX, et al: Pressure makes pleasure: a preliminary study of increasing irrigation pressure of flexible cystoscopy improves male patient comfort by an easy way. J Endourol 2015;29:1361-1365.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.