Is Diagnostic Cystoscopy Painful? Analysis of 1,320 Consecutive Procedures

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Objective: To prospectively evaluate self-reported pain levels associated with diagnostic cystoscopy. Materials and Methods:Patients who underwent diagnostic cystoscopy and subsequently graded their pain level during the procedure were enrolled. Pain was graded on a Likert visual analog scale (VAS) of 1-10 where 0 = no pain and 10 = excruciating unbearable pain. Local lidocaine gel 2% was used as intraurethral lubricant.Results: Data from 1320 consecutive cystoscopies (929 males, 391 females, age range 15-93 years) between 6/2009-1/2010 were analyzed. This was the first cystoscopy for 814 patients. The overall mean VAS was 2.74 ± 1.51 (range 0-9) for rigid cystoscopy and 2.48 ± 1.53 (range 0-10) for flexible cystoscopy (P = 0.004). The reported mean pain level for first-time cystoscopy was significantly higher than that for repeat cystoscopy (2.8 ± 1.6 vs. 2.2 ± 1.4, P < 0.001), regardless of gender or type of cystoscope. Men reported significantly higher pain levels than women 2.6 ± 1.5 vs. 2.4 ± 1.4 (P < 0.04). The highest mean pain level was reported by men (3.4 ± 1.6) and women (2.5 ± 1.6) for rigid cystoscopy compared to flexible cystoscopy (2.5 ± 1.4 and 1.1 ± 1.9, respectively, P < 0.001). Pain levels > 5 were reported in 75 (5.7%) cystoscopies. Conclusions: Cystoscopy was not associated with distressing levels of pain. Pain levels during first cystoscopies were higher than those for repeated ones. Using a flexible cystoscope is associated with a lower pain level in both men and women and it should be used for both genders.

Prospective evaluation of anxiety, pain, and embarrassment associated with cystoscopy and urodynamic testing in clinical practice

“…2,5,13,14 In the present study, however, gender, age, and history of previous procedure were not statistically correlated with pain perception. We assume that the absence of differences between genders could be partly explained by cystoscope type (flexible in men vs. rigid in women).…”

“…The procedure aims to diagnose lower urinary tract disorders through continuous measurement of abdominal, bladder, and urethral pressures during the filling and voiding phases. Despite their invasive nature, as recognized by the urological community, comprehensive evaluations of patients' experience during cystoscopy [1][2][3][4][5] and UDS [6][7][8][9] are scarcely reported in the literature. We prospectively assessed anxiety, pain, and embarrassment associated with such procedures and investigated factors that could potentially influence them to find potential ways of improving general tolerance during these examinations.…”

“…In the current literature, some factors have already been demonstrated to influence pain perception during cystoscopy, including gender, 2 age, 11 and, more controversially, history of previous procedure. 2,5,13,14 In the present study, however, gender, age, and history of previous procedure were not statistically correlated with pain perception.…”

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

“…; however, they are overlooked in this study. Greenstein et al's study [19] in 2014 asserted that a first-time cystoscopy may be more painful than repeat cystoscopy, regardless of the type of cystoscope. Third, a double-blind method was not possible in this study because the operator can recognize injection agent; hence, we conducted this study in a single-blind manner.…”

¿Está indicada la profilaxis antibiótica con ciprofloxacino en la realización de cistoscopia flexible?

“…Aunque el procedimiento diagnóstico con cistoscopia puede realizarse usando cistoscopio rígido o flexible, como hemos referido previamente, en los hombres es preferible el uso de los instrumentos flexibles porque son mejor tolerados, causando menos dolor y menos complicaciones 2 , sin embargo, en las mujeres el uso indistinto de la cistoscopia flexible o rígida es bien tolerada, con buenos resultados en términos de dolor y eficacia, debiéndose usar una u otra en función de las preferencias del urólogo y de la paciente 3 . En líneas generales, se considera que la cistoscopia no se asocia con una elevada percepción de dolor, siendo en cualquier caso habitualmente mayor en el primer procedimiento y disminuyendo en los posteriores, de tal manera que es tolerada tanto en hombres como en mujeres con anestesia local 4 . En la actualidad, aunque la Guía Europea de Urología 5 recomienda únicamente profilaxis antibiótica en pacientes de alto riesgo, los protocolos en cada hospital son diferentes y todavía sigue haciéndose profilaxis para disminuir el riesgo de bacteriuria e incluso existen estudios que afirman que el uso de antibióticos previene o disminuye la bacteriuria 6 .…”