title: Male flexible cystoscopy: does waiting after insertion of topical anaesthetic lubricant improve patient comfort?
abstract: What's known on the subject? and What does the study add? Flexible cystoscopy is commonly performed. Several studies show that topical anaesthetic lubricant reduces patient discomfort, particularly with long lubricant retention times (15-25 min). No studies have specifically addressed whether a short, clinically manageable retention time provides any benefit over immediate cystoscopy. Our study demonstrates that delay by a 3-min interval provides no benefit to patients and a more expedient approach can be justified without compromising patient comfort. LAY-TERM SUMMARY: This prospective comparative trial randomizes 50 men to undergo flexible cystoscopy with insertion of local anaesthetic lubricant either immediately prior to cystoscope insertion or after a 3-min interval. Patients then report discomfort on a visual analogue scale. We show that there is no benefit to delay and therefore a more expedient approach can be justified.
  
  
  OBJECTIVE
  • To determine whether a short, clinically manageable time delay between lubrication with topical local anaesthetic and insertion of the flexible cystoscope, vs immediate insertion, reduces discomfort in male patients.
  
  
  METHODS
  • This was a prospective comparative trial. • Male patients undergoing simple flexible cystoscopy were randomized to undergo cystoscope insertion either immediately after lubrication with topical lignocaine gel or after a 3-min delay. • Patient-reported pain of the procedure was recorded on a visual analogue scale and data were statistically analysed.
  
  
  RESULTS
  • Fifty male patients were randomized to cystoscope insertion either immediately following lubrication or after a 3-min delay. • Mean pain score in the immediate insertion group was 11.94 mm (95% confidence interval [CI] 7.53-16.36) compared with 10.52 mm (95% CI 6.24-14.80) in the 3-min delay group. • The mean difference between the two groups was 1.42 mm (95% CI -4.57 to 7.41, P= 0.64).
  
  
  CONCLUSIONS
  • Findings show that patient comfort is similar between the two groups and therefore there is no benefit in delaying insertion by a 3-min interval. • Flexible cystoscopy is a well tolerated outpatient procedure.
authors.affiliation: Department of Urology, Christchurch Hospital, Christchurch, New Zealand. g.losco@xtra.co.nz
authors.forename: Giovanni
authors.initials: G
authors.lastname: Losco
authors.forename: Stefan
authors.initials: S
authors.lastname: Antoniou
authors.forename: Stephen
authors.initials: S
authors.lastname: Mark
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage*; D003558:Cystoscopy / Q000379:methods*; D004338:Drug Combinations; D005782:Gels; D006417:Hematuria / Q000209:etiology; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D054327:Lubricants / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D005782:Gels; D054327:Lubricants; C008129:chlorhexidine gluconate, lidocaine drug combination; D008012:Lidocaine; D002710:Chlorhexidine