Efficacy of urination in alleviating urethral pain associated with flexible cystoscopy - a single-center randomized trial

Abstract

Objective: This study aimed to assess whether urethral pain can be alleviated by urination in male patients undergoing flexible cystoscopy. Patient and Methods: Ninety-six male outpatients undergoing flexible cystoscopy were randomly divided into two groups. Patients in the test group urinated during flexible cystoscopy, whilst patients in the control group received no instructions to do so. All patients received 10mL of 2% lidocaine gel prior to assessment. Using 0 (no-pain) to 10 (unbearable severe pain) pain scores (VAS), we assessed patient discomfort prior to anesthesia gel perfusion (baseline), during gel perfusion, during cystoscope insertion through the urethra, and 15minutes post-examination analysis. The entire protocol was completed by a single doctor in our Department of Urology. Results: The groups showed no statistical differences regarding age or examination time. During cystoscope insertion, the test group recorded significantly lower pain scores 2 (IQR 1-3) - compared to the control group 3 (IQR 2-3) , (P = 0.001). No significant differences between other evaluation points were observed between groups. Conclusion: Urethral pain can be significantly alleviated by urination in male patients undergoing flexible cystoscopy through the urethra.

Several interventions to alleviate pain in male patients undergoing office-based flexible cystoscopy: a systematic review and meta-analysis

“…Overall, 717 records were initially identified, and fourteen RCTs [13][14][15][16][17][18][19][20][21][22][23][24][25][26] were included in the final analysis. Our study enrolled 1684 male patients who were from the United Kingdom, China, Canada, New Zealand, Spain, USA, Netherlands, Turkey, or South Korea.…”

“…Moreover, the two reviewers independently assessed the level of evidence of the included articles using the Oxford Centre for Evidence-Based Medicine criteria [12]. The strength of evidence was graded from level 1 (strongest) The RoB summary of the fourteen RCTs [13][14][15][16][17][18][19][20][21][22][23][24][25][26] is shown in Fig. 2.…”

“…In addition, anxiety was also reduced by hand-holding (41.4 ± 7.8 in hand-holding group versus 48.4 ± 10.8 in control group), and patient satisfaction was improved (8.5 ± 1.8 in hand-holding group versus 6.7 ± 2.4 in control group). Xie et al [25] investigated the effects of urination during FC on urethral pain in male patients, and they observed that the urination group showed significantly lower pain scores 2 (IQR 1-3) during cystoscope insertion compared to the control group 3 (IQR 2-3), (p = 0.001). In addition, Walker et al [26] assessed the ability of virtual reality distraction to relieve pain and anxiety during FC; however, virtual reality distraction did not reduce pain or anxiety in men during cystoscopy.…”

Does instillation of lidocaine gel following flexible cystoscopy decrease the severity of post procedure symptoms? A randomised controlled trial assessing the efficacy of lidocaine gel post flexible cystoscopy

“…Numerous novel techniques to reduce urinary symptoms following flexible cystoscopy have been attempted, including trans-cutaneous electrical nerve stimulation, pre-cystoscopy patient education videos, viewing the procedure in real time, listening to music during the process, increasing the hydrostatic pressure of irrigation fluid, inhalation of nitrous oxide and most recently urination during cystoscopy to relax the external sphincter. However, the use of topical local anaesthetic lubricating gel has been the mainstay and most widely accepted method used to try and reduce adverse symptoms associated with flexible cystoscopy [16][17][18][19][20][21][22][23].…”

Does office-based flexible cystoscopy provide better pain perception than rigid cystoscopy: a systematic review and meta- analysis

“…Currently, researchers have conducted many trials to seek potentially adjuvant therapy to alleviate patient pain during cystoscopy, especially for male patients. The proposed nonpharmacological methods included increasing irrigation pressure (3)(4)(5), delaying the instillation time of topical anesthetics in the urethra (6)(7)(8), allowing patients to watch the procedure process (9)(10)(11), listening to music (12,13), hand-holding (14), urinating during FC (15), and virtual reality distraction (16). All these interventions are practical, inexpensive, and harmless.…”