Meta‐analysis: does lidocaine gel before flexible cystoscopy provide pain relief?

Abstract

keywords, lidocaine, cystoscopy, gel and pain, yielding 14 studies. Ten studies were excluded as they provided no comparison with appropriate control groups or contained insufficient data for analysis. Attempts to contact the authors of these studies yielded no additional data. A metaanalysis was conducted using a randomeffects model. RESULTSFour studies were included in the analysis, two double-blind and two single-blind, totalling 411 male patients. Three of the studies found no statistical improvement and one study found a statistically significant improvement in pain relief using lidocaine gel. Studies varied on the quantity of gel instilled and on the dwell time of gel before cystoscopy. The meta-analysis found that subjects who received anaestheticimpregnated gel were 1.7 times more likely not to experience moderate to severe pain ( < 2, 3 or 30, based on the scale used; odds ratio 1.7, 95% confidence interval 1.1-2.8) than subjects who did not have intraurethral instillation of gel. CONCLUSIONSThese data suggest that intraurethral instillation of lidocaine gel vs plain lubricating gel reduces the likelihood of moderate to severe pain during flexible cystoscopy. KEYWORDSlidocaine gel, flexible cystoscopy, pain Study Type -Therapy (systematic review) Level of Evidence 1a OBJECTIVETo consolidate previous reports and conduct a meta-analysis to draw further conclusions on the efficacy of the instillation of lidocaine gel before flexible cystoscopy, as it has had varying efficacy in several randomized controlled studies. METHODSWe reviewed previous reports cited in PubMed, Biosis and the Cochrane Library, identified by a professional librarian searching for English language-only randomized controlled studies involving the

Music Reduces Panic: An Initial Study of Listening to Preferred Music Improves Male Patient Discomfort and Anxiety During Flexible Cystoscopy

“…17 Controversy still exists, however. Some randomized controlled trials and meta-analysis reported that there is no significant difference between lidocaine gel and placebo in the efficacy of reducing pain for male patients during flexible cystoscopy, 18,19 and Cornel and colleagues 20 reported that the pain score of men undergoing flexible cystoscopy could not be obviously affected by simultaneous visualization.…”

“…Third, there were no specific orientations for patients to watch the flexible cystoscopy procedure, so potentially simultaneous visualization of the procedure might divert attention and reduce discomfort. 13,36 Fourth, although some studies had confirmed that local anesthetic played a role just as a placebo 18 and might make patient exerience more pain when the physician injected the lidocaine jelly into the urethera, 37 leading to a conclusion that local anesthetic might be unnecessary, we still used lidocaine jelly for every patient in our study because of the clinical routine and patient demand for topical anesthesia. Fifth, VAS and SATI scores are partly subjective; some more objective parameters, such as the bispectral index, 38 were not used.…”

2% Lidocaine gel or plain lubricating gel: Which one should be used in male flexible cystoscopy?

“…[28] Conversely, in another meta-analysis, lidocaine was associated with higher probability of experiencing less than moderate pain compared with the plain lubricating gel. [29] Patel et al [30] reported that the men viewing cystoscopy on the video monitor experienced an approximately 40% decrease in the pain level compared to those who did not view the procedure on the monitor. Unfortunately, we could not make our patients view the procedure because of the absence of video monitor in our office.…”

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

“…Many strategies have been studied to relieve pain during such procedures, particularly cystoscopy, including pain lubricants, topical anesthetics, 15 flexible cystoscopes, pre-emptive non-steroidal anti-inflammatory drugs, 16 , nitrous oxide inhalation, 17 high irrigation pressure regimens, 18,19 relaxing music, 20,21 , realtime cystoscopy visualization, [22][23][24] and even virtual reality distraction. 25 However, more simply, we believe that the quality of medical information provided could play a major role in patient perceptions of anxiety, pain, or embarrassment and should be considered as a fundamental issue.…”