Western Michigan University Homer Stryker MD School of Medicine
Introduction: Flexible cystoscopy is typically performed under local anesthesia with intraurethral insertion of aqueous lidocaine gel. Male patients often experience significant discomfort as the cystoscope is negotiated past the membranous and prostatic urethra. The objective of this study is to determine whether patient controlled urethral hydrodistention can reduce patient discomfort during male flexible cystoscopy.
Methods: Flexible cystoscopy was performed using Karl Storz 15 F flexible cystoscope by a single urologist in cystoscopy naive male patients, with or without patient controlled urethral hydrodistention. 10 cc of 2% aqueous lidocaine gel was introduced into the urethra and left in place for 10 minutes prior to initiation of the procedure. Urethral hydrodistention was achieved by having the patients forcibly compress 250 ml flexible polyvinyl chloride container of sterile sale as the flexible cystoscope was negotiated past the urethra. clinical outcomes were assessed using analog pain scale post procedure to assess pain associated with the procedure.
Results: A total of 63 cystoscopy naive men underwent flexible cystoscopy.
32 patients were in the urethral hydrodistention group with median age of 47.
31 patients were in the control group with median age of 50.
Analog pain score was 1.96 in the urethral hydrodistention group and 5.68 in the control group (p < 0.01).
Conclusions: In our study, patient controlled urethral hydrodistention significantly reduces pain associated with flexible cystoscopy in cystoscopy naive male patients. It is reasonable to incorporate this technique as part of the male flexible cystoscopy procedure.