Morbidity Following Cystoscopy: Comparison of Flexible and Rigid Techniques

Abstract

Recent reports on the value of local anaesthetic flexible cystoscopy have emphasised excellent tolerance and preference for the technique over general anaesthetic rigid cystoscopy. However, no study has yet compared the post-operative morbidity rates of these procedures. Tolerance, preference and post-operative symptoms in 100 patients undergoing local anaesthetic flexible cystoscopy were compared with those in 100 patients undergoing general anaesthetic rigid cystoscopy. On initial questioning, 89% of patients found flexible cystoscopy painless and 92% expressed a preference for the same procedure on a future occasion; 98 patients who underwent flexible cystoscopy and 87 who underwent rigid cystoscopy returned a questionnaire on symptoms 1 week after the procedure. The incidence of post-operative symptoms was 33% following flexible cystoscopy and 76% following rigid cystoscopy. Patients in both groups who were undergoing check cystoscopy had a lower incidence of morbidity than those undergoing cystoscopy for other reasons. The results suggest that flexible cystoscopy was well tolerated and preferred by most patients. The morbidity associated with the procedure was also significantly less than that associated with rigid cystoscopy under general anaesthesia.

Factors Predictive of Pain During Cystoscopy: A Prospective Study

“…[2,5]. Denholm et al compared the tolerability of flexible and rigid cystoscopes and noted that 89% of patients reported flexible cystoscopy as painless [5]. Our results confirm these findings, as we have used small calibred cystoscopes (17F rigid, 16.2F flexible cystoscopes) and demonstrated that instrument type is strongly associated with the pain during cystoscopy.…”

“…Several studies have demonstrated similar efficacy between rigid and flexible cystoscopy in identifying tumors [2]. Although excellent tolerability was noted in both techniques, earlier results revealed that male patients prefer flexible cystoscopy in the outpatient clinic rather than rigid cystoscopy in the operating room with general anesthesia [2,4,5]. The major advantages of flexible endoscopy are the ease of performance due to smaller calibre instruments, improved global visualisation of the vesical surface especially in men presumably due to urethral length and the angle required to inspect the bladder, enhanced patient comfort and tolerability.…”

“…The major advantages of flexible endoscopy are the ease of performance due to smaller calibre instruments, improved global visualisation of the vesical surface especially in men presumably due to urethral length and the angle required to inspect the bladder, enhanced patient comfort and tolerability. [2,5]. Denholm et al compared the tolerability of flexible and rigid cystoscopes and noted that 89% of patients reported flexible cystoscopy as painless [5].…”

Safety of Hexaminolevulinate for Blue Light Cystoscopy in Bladder Cancer. A Combined Analysis of the Trials Used for Registration and Postmarketing Data

“…Our overall frequency of hematuria after cystoscopy and TURB was 13.7%, compared to reported gross hematuria after flexible cystoscopy in 19% [17]. In all, since symptoms after rigid cystoscopy are reported twice as frequent compared to flexible cystoscopy [20], this puts symptoms in our studies in a positive perspective, having used rigid instruments in all studies.…”

Does sodium bicarbonate reduce painful voiding after flexible cystoscopy? A prospective, randomized, double‐blind, controlled trial

“…Our study identified an incidence of postflexible-cystoscopy dysuria of 28%, which is at the lower end of the range when compared with reports in the literature (30-54% [1,2,11]). As the incidence found was lower than expected, the sample size of the study was adequate to detect a 50% reduction in dysuria, rather than the 33% reduction specified in the study design.…”