ABSTRACT

Cystoscopy is one of the most common interventions in urological practice. Before the introduction of flexible cystoscopy, many patients underwent rigid cystoscopy with great discomfort. With the technological developments, flexible instruments have been more popular in cystoscopic procedures for performing interventions with less pain and less discomfort. There is still no consensus about the amount, type and retention time of the local anesthetics in flexible cystoscopy, and various studies have been performed to assess these parameters related to local anesthetics. The purpose of this prospective randomized study is to compare the efficacy of prilocaine, a local anesthetic agent, on the control of perception of pain in male patients during flexible cystoscopy and to determine whether it is superior to lidocaine gel, which also has a lubricant effect.

A total of 70 male patients who underwent flexible cystoscopy between January 2012 and December 2012 enrolled in the study. Patients who had active urinary tract infection, urethral stenosis, and neurologic disease like spinal cord injury and needed additional procedures like bladder biopsy were excluded from the study. Patients were randomized into two groups and written consent was obtained from each patient. There were 34 patients in group 1, Thirty six patients in group 2 and all interventions were performed by the same urologist using a 15.5 F flexible cystoscope. In group 1, 10 mL 2% lidocaine gel was spread on the cystoscope and cystoscopy was performed immediately. In group 2 patients, 20 mL 2% prilocaine was applied intraurethrally followed by application of a penile clamp across the mid penis, and the procedure was performed after 15 minutes. At the end of the procedure, patients were questioned regarding pain perception using a visual analogue scale (VAS), by the appropriate physician.

Seventy male patients were recruited in the study. Forty three (61.4%) and 27 (38.6%) patients had cystoscopic examinations for diagnostic and therapeutic purposes(to remove double j stent), respectively. Although in our study no statistical difference was observed between the groups related to the mean ages (p=0.218), there was a significant difference in duration of cystoscopy (p=0.027), which was longer in group 1 than in group 2. Besides, VAS scores were also significantly higher in group 1 (p=0.001). Both groups were then divided into two subgroups according to the indication for cystoscopy. There was a statistical difference regarding the VAS score between the therapeutic and diagnostic groups in both groups (p=0.001, p=0.009).

In our study, we observed that the effect of prilocaine instilled into the urethra and maintained there for 15 minutes before cystoscopy led to a comfortable intervention, especially in younger men. (JAREM 2013; 3: 108-11)

Keywords: Flexible cystoscopy, pain, prilocaine, lidocaine