title: Is diagnostic cystoscopy painful? Analysis of 1,320 consecutive procedures.
abstract: OBJECTIVE
  To prospectively evaluate self-reported pain levels associated with diagnostic cystoscopy.
  
  
  METHODS
  Patients who underwent diagnostic cystoscopy and subsequently graded their pain level during the procedure were enrolled. Pain was graded on a Likert visual analog scale (VAS) of 1-10 where 0 = no pain and 10 = excruciating unbearable pain. Local lidocaine gel 2% was used as intraurethral lubricant.
  
  
  RESULTS
  Data from 1320 consecutive cystoscopies (929 males, 391 females, age range 15-93 years) between 6/2009-1/2010 were analyzed. This was the first cystoscopy for 814 patients. The overall mean VAS was 2.74 ± 1.51 (range 0-9) for rigid cystoscopy and 2.48 ± 1.53 (range 0-10) for flexible cystoscopy (P = 0.004). The reported mean pain level for first-time cystoscopy was significantly higher than that for repeat cystoscopy (2.8 ± 1.6 vs. 2.2 ± 1.4, P < 0.001), regardless of gender or type of cystoscope. Men reported significantly higher pain levels than women 2.6 ± 1.5 vs. 2.4 ± 1.4 (P < 0.04). The highest mean pain level was reported by men (3.4 ± 1.6) and women (2.5 ± 1.6) for rigid cystoscopy compared to flexible cystoscopy (2.5 ± 1.4 and 1.1 ± 1.9, respectively, P < 0.001). Pain levels > 5 were reported in 75 (5.7%) cystoscopies.
  
  
  CONCLUSIONS
  Cystoscopy was not associated with distressing levels of pain. Pain levels during first cystoscopies were higher than those for repeated ones. Using a flexible cystoscope is associated with a lower pain level in both men and women and it should be used for both genders.
authors.affiliation: Department of Urology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv.
authors.forename: Alexander
authors.initials: A
authors.lastname: Greenstein
authors.affiliation: Hebrew University Hadassah Medical School, Jerusalem, Israel.
authors.forename: Ithamar
authors.initials: I
authors.lastname: Greenstein
authors.affiliation: Assuta Hashalom Medical Center, Assuta Medical Centers, Tel Aviv, Israel.
authors.forename: Solomon
authors.initials: S
authors.lastname: Senderovich
authors.affiliation: Department of Urology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Mabjeesh
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000627:therapeutic use; D020684:Cystoscopes; D003558:Cystoscopy / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005782:Gels; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement / Q000379:methods*; D057566:Self Report; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D005782:Gels; D008012:Lidocaine