Pain and satisfaction during rigid cystoscopic ureteral stent removal: a preliminary study

Abstract

BackgroundCystoscopy evokes discomfort and pain, especially in males. The cystoscopic retrograde approach is standard in the removal of ureteral stents. However the satisfaction and degree of pain during the procedure according to the use of several pain controlling methods are unclear.MethodsThis is a cross-sectional survey of 60 patients who underwent cystoscopic ureteral stent removal under intravenous analgesics (group 1, n = 20), midazolam induction (group 2, n = 20), and propofol (group 3, n = 20). Procedural pain and post-procedure satisfaction were determined, and cost differences between the approaches were clarified.ResultsGroup 2 and 3 showed significantly less pain than group 1 (P < 0.001) and significantly higher satisfaction rate than group 1 (P < 0.001). Comparison of groups 2 and 3 revealed showed significantly less pain and higher satisfaction rate in group 3 (P < 0.001 for both). In Group 1, 17 (85.0%) patients wanted other treatment modalities, compared to eight group 2 patients (40.0%) and no group 3 patients.ConclusionsConsidering the potential pain and dissatisfaction of rigid cystoscopic ureteral stent removal, procedures utilizing moderate sedation with midazolam or general anesthesia using propofol without muscle relaxation should be considered.Trial registrationKCT0001260.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2490-14-90) contains supplementary material, which is available to authorized users.

The Role of Antegrade Irrigation via Percutaneous Nephrostomy on Surgical Outcomes in Semirigid Ureteroscopy among Patients with Upper Ureteral Stones

“…In Korea, when patients visit the department of emergency due to acute pain caused by ureter stones which is nonresponding to medications and when emergent operation such as ureteroscopy is unavailable, it is common that interventional radiologists support the preoperative pain management by placement of PCN, which has little burden on the use of the operating room and anesthesia. Moreover, double-J stenting using rigid cystoscopy by local anesthesia is painful, especially in male patients [21, 22]. In addition, when ureter stone(s) is large and/or multiple, there is a possibility of ureteral stenting failure.…”

Onset of the action of intravesical lidocaine after spinal cord injury

“…Previous literature advocates the use of intravesical lidocaine 5, 15, or 20 minutes before urologic procedures to have a clinical effect. Many studies cite Axelsson et al for their rationale for using these 15 to 20 minute parameters . However, Axelsson's study, which tracked serum levels of lidocaine after intravesical infusion, assessed safety to prevent cardiotoxic levels of lidocaine accumulation.…”

“…Many studies cite Axelsson et al 21 for their rationale for using these 15 to 20 minute parameters. 22,23 However, Axelsson's study, which tracked serum levels of lidocaine after intravesical infusion, assessed safety to prevent cardiotoxic levels of lidocaine accumulation. The earliest serum sample drawn in this study was at 15 minutes aftrer lidocaine infusion and already noted tangible lidocaine levels absorbed systemically.…”

Comparison of Two Lidocaine Administration Techniques on Perceived Pain From Bedside Procedures

“…22 Therefore, optimizing procedural analgesia may be important for improving safety and comfort for these bedside procedures. In addition, there is an established link between pain control and patient satisfaction, 23 a metric that is playing an increasingly prominent role in measures of hospital quality and reimbursement models. 24 Finally, previous research examining epidural steroid injections for lower back pain revealed an association between pain scores for local lidocaine injection just prior to the procedure and back pain scores at 1 and 3 months.…”