title: Prospective randomized crossover trial of lubricant gel against an anaesthetic gel for outpatient cystoscopy.
abstract: OBJECTIVE
  Flexible cystoscopy is routinely performed under local anaesthetic. The aim of this study was to compare the outcomes of using an anaesthetic gel and a non-anaesthetic gel in the same patient.
  
  
  METHODS
  Men undergoing 3-monthly check cystoscopies were recruited to this prospective, randomized, double-blind, crossover trial. Primary outcome measures were visual analogue scale scores for pain and the incidence of infection. A total of 51 men were randomized to receive 11 ml of either a non-anaesthetic gel or Instillagel as a lubricant on their first visit; they then crossed over to the other agent on their next visit. A nurse who was blinded to the type of lubricant used recorded post-procedural visual analogue scale scores for pain and contacted the patients 48 h postoperatively to check the incidence of infection.
  
  
  RESULTS
  The median difference in pain score (non-anaesthetic minus anaesthetic) was 0 (range -5.3 to 7.5) and the mean difference 0.24 (SD 2.3), with no evidence of a 'time period effect' between instillations, i.e. the sequence of instillation with Instillagel followed by aqueous gel or aqueous gel followed by Instillagel in an individual did not have a significant effect. One patient had a urinary tract infection after using each type of gel. A non-inferiority test gave strong evidence that the mean difference in pain score was < 1 (p = 0.011).
  
  
  CONCLUSIONS
  Our study suggests that the pain experienced with the non-anaesthetic gel is no greater than that experienced with the anaesthetic gel. The non-anaesthetic gel is as effective as the anaesthetic gel and its regular use should be advocated in routine practice.
authors.affiliation: Department of Urology, Norfolk & Norwich University Hospital & School of Medicine Health Policy and Practice, Norwich, UK. chitalenorwich@aol.com
authors.forename: Sudhanshu
authors.initials: S
authors.lastname: Chitale
authors.forename: May
authors.initials: M
authors.lastname: Hirani
authors.forename: Louise
authors.initials: L
authors.lastname: Swift
authors.forename: Edwin
authors.initials: E
authors.lastname: Ho
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D000772:Anesthesia, Local / Q000379:methods*; D002710:Chlorhexidine / Q000008:administration & dosage*; D018592:Cross-Over Studies; D003558:Cystoscopy / Q000379:methods*; D004311:Double-Blind Method; D004338:Drug Combinations; D005500:Follow-Up Studies; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D054327:Lubricants / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*
chemical_list: D000700:Analgesics; D004338:Drug Combinations; D005782:Gels; D054327:Lubricants; C008129:chlorhexidine gluconate, lidocaine drug combination; D008012:Lidocaine; D002710:Chlorhexidine