title: Prospective multi-institutional study analyzing pain perception of flexible and rigid cystoscopy in men.
abstract: OBJECTIVE
  To evaluate pain perception in men undergoing flexible or rigid diagnostic cystoscopy.
  
  
  METHODS
  This is a prospective multi-institutional analysis of men undergoing cystoscopy in 4 European departments of urology. Pain perception was assessed with an 11-point numeric rating scale. Pain categories were as follows: no (0 points), mild (1-3), moderate (4-6), and severe pain (7-10). Assessment of pain was before, during cystoscopy, and at days 1, 4, and 7 of follow-up.
  
  
  RESULTS
  A total of 300 cystoscopies were analyzed (150 rigid and 150 flexible). Men undergoing flexible cystoscopy were more frequently free of pain (58.7% vs 24%; P <.0001). Mild pain (54% vs 30.7%; P <.0001) and moderate pain (18.7% vs 9.3%; P = .02) were more common with rigid devices. No significant differences were prevalent in severe pain perception (3.3% vs 1.3%; P = .25). Patients, who had previous experience with cystoscopy reported similar pain levels as patients naïve to cystoscopy, regardless if rigid (P = .92) or flexible (P = .26) devices were used. Pain decreased to the baseline during the 1-week follow-up after both, flexible and rigid cystoscopy. In multivariate regression analyses, rigid cystoscopy was an independent predictor for not being pain free (odds ratio [OR] = 0.15; confidence interval [CI] = 0.08-0.28; P <.0001), for experiencing mild pain (OR = 2.57; CI = 1.57-4.19; P <.0001), and for moderate pain (OR = 2.39; CI = 1.13-5.07; P = .02). Severe pain was seldom with both devices, and thus, no statistical difference was found.
  
  
  CONCLUSIONS
  Flexible diagnostic cystoscopy caused less pain than rigid cystoscopy in men. Patient's previous experience with cystoscopy did not influence pain sensation. The type of cystoscope itself was identified as an independent risk factor of pain perception.
authors: Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria. Electronic address: st.seklehner@gmx.net.
authors: Stephan
authors: S
authors: Seklehner
authors: Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria.
authors: Mesut
authors: M
authors: Remzi
authors: Department of Urology, Universitätsklinikum Sankt Pölten, Sankt Pölten, Austria; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors: Harun
authors: H
authors: Fajkovic
authors: Department of Urology, Klinički Bolnički Centar Split, Split, Croatia.
authors: Zana
authors: Z
authors: Saratlija-Novakovic
authors: Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria.
authors: Matthias
authors: M
authors: Skopek
authors: Department of Urology, Universitätsklinikum Sankt Pölten, Sankt Pölten, Austria.
authors: Irene
authors: I
authors: Resch
authors: Department of Urology, Klinički Bolnički Centar Split, Split, Croatia.
authors: Mario
authors: M
authors: Duvnjak
authors: Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors: Stephan
authors: S
authors: Hruby
authors: Department of Urology, Klinički Bolnički Centar Split, Split, Croatia.
authors: Davor
authors: D
authors: Librenjak
authors: Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria.
authors: Wilhelm
authors: W
authors: Hübner
authors: Department of Urology, Universitätsklinikum Sankt Pölten, Sankt Pölten, Austria.
authors: Eckart
authors: E
authors: Breinl
authors: Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria.
authors: Claus
authors: C
authors: Riedl
authors: Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria.
authors: Paul F
authors: PF
authors: Engelhardt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D020684:Cystoscopes / Q000009:adverse effects*; D003558:Cystoscopy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000145:classification / Q000209:etiology*; D010147:Pain Measurement; D058748:Pain Perception; D011446:Prospective Studies
chemical_list: D000700:Analgesics