Dorsal penile nerve block for rigid cystoscopy in men: study protocol for a randomized controlled trial

Abstract

BackgroundPain is common in men undergoing rigid cystoscopy. Even with the application of a lubricant containing 2 % lidocaine, about 76 % of men suffer from mild to severe pain when undergoing rigid cystoscopy. The most painful part of the procedure for men is when the cystoscope passes through the membranous urethra. Song et al. (Neurourol Urodyn 29:592–5, 2010) did autopsies on males and found that the dorsal nerve of the penis (DNP), the terminal branch of the pudendal nerve, innervates the membranous urethra in 53.3 % of specimens. In addition, the urethral mucosa has branches of innervated DNP. Dorsal penile nerve block (DPNB) is usually used for circumcision in children, and it has been shown to provide effective analgesia for penile surgeries. In this study, we hypothesized that DPNB could reduce the overall pain level in men during rigid cystoscopy.Methods/designThe trial is a prospective, randomized, double-blind, placebo-controlled, single-center trial to evaluate the effectiveness and safety of DPNB in analgesia for men undergoing rigid cystoscopy. Participants will be enrolled and randomly allocated into one of three groups according to the different analgesia regimens: 1) tetracaine gel group (DPNB with saline), 2) DPNB group (DPNB with ropivacaine plus plain lubricant), 3) combination group (DPNB with ropivacaine plus tetracaine gel). The primary outcome of this study is the visual analog scale (VAS, 0–10) for pain at cystoscopic inspection of the external sphincter. VAS scores evaluated at other time points serve as secondary outcomes. Vital signs are secondary outcomes that address the discomfort and pain during the procedure. Furthermore, the incidence of adverse events as secondary outcomes will also be recorded for evaluation of the safety of DPNB in rigid cystoscopy. Clinical assessments will be evaluated prior to DPNB, at administration of the lubricant gel, at cystoscopic inspection of the penile and bulbar urethra, external sphincter, prostate, and bladder, as well as at withdrawal of the cystoscope.DiscussionThis research will determine the effectiveness and safety of DPNB in men undergoing rigid cystoscopy. The results of this trial may have important implications for exploring the role of DPNB in analgesia for cystoscopy in men.Trial registrationClinicalTrials.gov identifier NCT02502487 (6 Jul 2015).

Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries

“…[ 25 , 26 , 31 ] Song et al [ 27 ] performed autopsies on males and found that the dorsal nerve of the penis (DNP), the terminal branch of the pudendal nerve, innervates the membranous urethra in 53.3% of specimens. [ 32 ] Thus based on this theoretical knowledge, we formed a hypothesis that CRBD could be prevented by PNB.…”

A Randomized Clinical Trial on the Effect of Hypnosis on Anxiety and Pain in Rigid Cystoscopy Patients

“…[20][21][22] Various approaches such as topical urethral analgesia, dorsal penile nerve block, sedation, and listening music therapy have been used to make this procedure more tolerable for patients. [5][6][7]23 Our results suggest that in rigid cystoscopy patients, hypnosis was effective in reducing anxiety and pain as measured by STAI and VAS, respectively, along with physiologic measures such as MAP and heart rate. This observation accords well with the likelihood that the anxiety and pain are often associated, providing a vicious cycle between the two.…”

Intraurethral Lidocaine Usage in Office-Based Rigid Cystoscopy on Pain Experience

“…In fact, a study published by Gooran et al [17] reported that an injection of lidocaine into the glans with lidocaine gels into the urethra resulted in significantly pain relief than gel alone. Qiu et al's study [18] in 2016 also showed better pain relief with dorsal penile nerve block in addition to intraurethral gel injection.…”