Urogenit Tract Infect.  2017 Dec;12(3):117-121. 10.14777/uti.2017.12.3.117.

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

Affiliations
  • 1Department of Urology, National Police Hospital, Seoul, Korea. msk0701@hanmail.net

Abstract

PURPOSE
Cystoscopy is one of the most reliable urological examinations. However, it also a painful one. Intraurethral lidocaine gel injection is widely used to relieve pain during cystoscopy. The purpose of this study is to compare between the use of lidocaine gel and lidocaine solution as a pretreatment for cystoscopy.
MATERIALS AND METHODS
Between March 2016 and May 2017, we studied 147 patients who had undergone cystoscopy at our institution. Patients were divided into four groups. Lidocaine gel and solution were administered just 10 minutes before each test. For randomization, the patient groups were divided into either odd or even number for the test day and as the patient number, irrespective of medical condition. The amount of lidocaine gel and solution of 10 ml each was uniformly injected. After the procedure, patients were asked to rate their pain on a 10-point visual analogue scale.
RESULTS
The average degree of pain relief was in the order of solution/10 minutes, gel/immediately, gel/10 minutes, and solution/immediately. The gel was associated with significantly less pain in the immediate group than in 10-minute before group, whereas the solution was associated with significantly better pain relief in the 10-minute before group than in the immediate group. There were no complications to report in all groups.
CONCLUSIONS
Lidocaine gel and solution showed different changes of pain relief over time. Further prospective studies with a larger population is necessary to better develop a less painful method of cystoscopy in the future.

Keyword

Cystoscopy; Lidocaine; Pain

MeSH Terms

Cystoscopy*
Humans
Lidocaine*
Methods
Prospective Studies
Random Allocation
Lidocaine

Figure

  • Fig. 1. Box plot for pain score distribution in each group and the results of t-test. VAS: visual analogue scale.


Reference

1.Burke DM., Shackley DC., O'Reilly PH. The community-based morbidity of flexible cystoscopy. BJU Int. 2002. 89:347–9.
Article
2.Goldfischer ER., Cromie WJ., Karrison TG., Naszkiewicz L., Gerber GS. Randomized, prospective, double-blind study of the effects on pain perception of lidocaine jelly versus plain lubricant during outpatient rigid cystoscopy. J Urol. 1997. 157:90–4.
Article
3.Chen YT., Hsiao PJ., Wong WY., Wang CC., Yang SS., Hsieh CH. Randomized double-blind comparison of lidocaine gel and plain lubricating gel in relieving pain during flexible cystoscopy. J Endourol. 2005. 19:163–6.
Article
4.Seklehner S., Remzi M., Fajkovic H., Saratlija-Novakovic Z., Skopek M., Resch I, et al. Prospective multi-institutional study analyzing pain perception of flexible and rigid cystoscopy in men. Urology. 2015. 85:737–41.
Article
5.Song LJ., Lu HK., Wang JP., Xu YM. Cadaveric study of nerves supplying the membranous urethra. Neurourol Urodyn. 2010. 29:592–5.
Article
6.Haines JS., Grabstald H. Xylocaine; a new topical anesthetic in urology. J Urol. 1949. 62:901.
Article
7.Brekkan E., Ehrnebo M., Malmström PU., Norlén BJ., Wirbrant A. A controlled study of low and high volume anesthetic jelly as a lubricant and pain reliever during cystoscopy. J Urol. 1991. 146:24–7.
Article
8.Ho KJ., Thompson TJ., O'Brien A., Young MR., McCleane G. Lignocaine gel: does it cause urethral pain rather than prevent it? Eur Urol. 2003. 43:194–6.
Article
9.Henry R., Patterson L., Avery N., Tanzola R., Tod D., Hunter D, et al. Absorption of alkalized intravesical lidocaine in normal and inflamed bladders: a simple method for improving bladder anesthesia. J Urol. 2001. 165:1900–3.
Article
10.Choong S., Whitfield HN., Meganathan V., Nathan MS., Razack A., Gleeson M. A prospective, randomized, double-blind study comparing lignocaine gel and plain lubricating gel in relieving pain during flexible cystoscopy. Br J Urol. 1997. 80:69–71.
Article
11.Akkoç A., Kartalmış M., Aydın C., Topaktaş R., Altın S., Aykaç A; A. 2% Lidocaine gel or plain lubricating gel: which one should be used in male flexible cystoscopy? Turk J Urol. 2016. 42:92–6.
12.Cano-Garcia Mdel C., Casares-Perez R., Arrabal-Martin M., Merino-Salas S., Arrabal-Polo MA. Use of lidocaine 2% gel does not reduce pain during flexible cystoscopy and is not cost-effective. Urol J. 2015. 12:2362–5.
13.Kobayashi T., Nishizawa K., Mitsumori K., Ogura K. Instillation of anesthetic gel is no longer necessary in the era of flexible cystoscopy: a crossover study. J Endourol. 2004. 18:483–6.
Article
14.Rodríguez-Rubio F., Sanz G., Garrido S., Sánchez C., Estudillo F. Patient tolerance during outpatient flexible cystoscopy—a prospective, randomized, double-blind study comparing plain lubrication and lidocaine gel. Scand J Urol Nephrol. 2004. 38:477–80.
15.Li HW., Wong CY., Lo SS., Fan SY. Effect of local lignocaine gel application for pain relief during suction termination of first-trimester pregnancy: a randomized controlled trial. Hum Reprod. 2006. 21:1461–6.
Article
16.Guney M., Oral B., Bayhan G., Mungan T. Intrauterine lidocaine infusion for pain relief during saline solution infusion sonohysterography: a randomized, controlled trial. J Minim Invasive Gynecol. 2007. 14:304–10.
Article
17.Gooran S., Pourfakhr P., Bahrami S., Fakhr Yasseri AM., Javid A., Behtash N, et al. A randomized control trial comparing combined glandular lidocaine injection and intraurethral lidocaine gel with intraurethral lidocaine gel alone in cystoscopy and urethral dilatation. Urol J. 2017. 14:4044–7.
18.Qiu Y., Hu AM., Liu J., Du GZ. Dorsal penile nerve block for rigid cystoscopy in men: study protocol for a randomized controlled trial. Trials. 2016. 17:147.
Article
19.Greenstein A., Greenstein I., Senderovich S., Mabjeesh NJ. Is diagnostic cystoscopy painful? Analysis of 1,320 consecutive procedures. Int Braz J Urol. 2014. 40:533–8.
Article
Full Text Links
  • UTI
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr