Is anesthetic gel necessary in outpatient flexible cystoscopy ?

Abstract

Objectives : To study the benefit of intraurethral lidocaine jelly instillation before flexible cystoscopic examination regarding patients tolerance to pain compared with the plain lubricant.

Research design : Randomized prospective study

Setting : The Outpatient Urologic Clinic at King Chulalongkorn Memorial Hospital

Methods : We compared the anesthetic effect of 10 cc intraurethral 2 % lidocaine jelly (N= 80) and 10 cc plain lubricant (N = 80) for outpatient flexible cystoscope เท male patients. The age, diagnosis, prostatic size and examination time were recorded. After the procedure, the following data of the patient were recorded: level of pain experienced during gel instillation, during cystoscopic examination based on a 100 mm. visual analog scale. A questionnaire on satisfaction of anesthesia, requirement of analgesic drug, willingness to use the same anesthesia for next cystoscopy and requirement of general or spinal anesthesia for next cystoscopy were also recoreded.

Results : The mean pain score for 2 % lidocaine jelly and plain lubricant groups were 2.93 ± 1.93 and 3.30 ± 1.87 (p = 0.215) during gel instillation, while during cystoscopic examination were 3.34 ±2.18 and 3.34± 1.97 (p = 1.0). The satisfaction of anesthesia, the requirement of analgesic drug after procedure, the desire of the same anesthesia and number of patients requiring general anesthesia on next procedure were similar in both groups.

Conclusion : There was no difference in pain perception in men between 2% lidocaine jelly and plain lubricant intraurethral instillation before outpatient flexible cystoscope. The plain lubricant is cheaper and faster than applying lidocaine jelly.