Instillation of anesthetic gel is no longer necessary in the era of flexible cystoscopy: a crossover study.

Abstract

Whether urethral injection of anesthetic and lubricating gel prior to outpatient flexible cystoscopy is worthwhile with regard to pain tolerance has been investigated only in a parallel randomized study. A crossover study was thus designed for further elucidation. Each of 33 male patients underwent three flexible cystoscopic examinations with intraurethral instillation of 11 mL of cold anesthetic gel (group 1), plain lubricating gel (group 2), or no gel (group 3). In every examination, 2% lidocaine gel was applied to the cystoscope. Although the cystoscopy was performed by two urologic surgeons, each patient underwent the three consecutive examinations with the same urologist. All the patients separately recorded pain levels during gel instillation, cystoscope insertion, and intravesical observation on a 100-mm visual analog scale after every cystoscopy. From the median scores, the degree of pain resulting from gel injection was 77.0% and 98.0% of those for cystoscope insertion and intravesical observation, respectively. For each group stratified by anesthetic method, there was no significant difference in the pain score during either cystoscope insertion or intravesical observation. The pain caused by intraurethral gel instillation is significant compared with that from cystoscope insertion and intravesical observation. Anesthetic gel instillation appears to have no significant advantage over anesthesia-free flexible cystoscopic examinations.