Patient comfort during flexible and rigid cystourethroscopy.

Abstract

IntroductionCystourethroscopy (CS) is an endoscopic method used to visualize the urethra and the bladder.AimIn this study, we prospectively evaluated pain in men undergoing cyclic cystoscopic assessment with rigid and flexible instruments after transurethral resection of bladder tumor (TURB).Material and methodsOne hundred and twenty male patients who were under surveillance after a TURB procedure due to urothelial cell carcinoma and who had undergone at least one rigid cystourethroscopy in the past were enrolled in the trial. Patients were prospectively randomized to age-matched groups for flexible (group F) or rigid (group R) CS. Patient's comfort was evaluated on an 11-grade scale, ranging from 0 (free from pain) to 10 points (unbearable pain).ResultsThe patients described the pain during the previous rigid CS as ranging from 4 to 10 (mean: 6.8) in group F and from 0 to 10 (mean: 5.8) in group R. Group R patients described the pain during the current rigid CS as ranging from 0 to 10 (mean: 5.7). No mean change in the grade was observed between the two pain descriptions (no change 11 patients, weaker pain 25 patients, stronger pain 24 patients, gamma 0.51, p < 0.0001). Group F described the pain as 1 to 5 (mean: 2.1). In the case of flexible CS the pain experience was greatly lowered compared to the previous rigid CS. All flexible CS patients reported lowered pain (by 1 to 9 grades). Patients’ age did not influence the comfort of the flexible CS or the change in pain level.ConclusionsFlexible CS is better tolerated than rigid cystoscopy by male patients regardless of patients’ age.

How different cystoscopy methods influence patient sexual satisfaction, anxiety, and depression levels: a randomized prospective trial

“…Similar to our previous study, it was shown that pain sensation remembered by patients from the previous CS is high (mean 5.7 ± 2.4 points) often reaching ten points, which is quoted as “unbearable pain” [ 5 ]. The level of the recalled pain was not related to the patients’ age and HADS anxiety level; however, it was positively associated with depression symptoms.…”

“…Rigid tools offer good irrigant flow and handiness along with wide working channel lumen. Flexible cystoscopes provide more possibilities for patient positioning, enable easy course over an elevated bladder neck or median lobe, facilitate full inspection of the bladder mucosa, and, what is the most important, significantly improve patient comfort [ 5 ]. Urologists often repeat an argument that rigid cystoscopes offer a better image quality.…”

Intervenciones no farmacológicas para la disminución del dolor en cistoscopia

“…8 Sin embargo, se ha demostrado que tanto los dispositivos rígidos como los flexibles tienen la misma eficacia para identificar tumores en la vejiga. 9 Aunque la cistoscopia flexible aumenta la tolerancia, especialmente en pacientes masculinos, el dolor sigue siendo inevitable durante la misma. El uso de técnicas anestésicas, incluida la lubricación uretral, el pretratamiento con narcóticos intramusculares, la evaluación del volumen de lidocaína, inyección intrauretral de gel de lidocaína enfriada, inhalación de óxido nitroso, la administración lenta de anestésicos locales y la estimulación eléctrica nerviosa transcutánea, se han descrito para disminuir la incomodidad del procedimiento en pacientes masculinos.…”

The grasper-integrated disposable flexible cystoscope is comparable to the reusable, flexible cystoscope for the detection of bladder cancer

“…Imaging 6 , 7 , and urinary marker tests 8 , 9 are complementary, and none has yet become an acceptable alternative to cystoscopy 10 . Flexible cystoscopy under local anaesthesia is associated with better patient acceptance, particularly in men 11 , 12 .…”