Does increasing hydrostatic pressure ("bag squeeze") during flexible cystoscopy improve patient comfort: a randomized, controlled study

Abstract

Objectives: To determine whether increased hydrostatic pressure by simple manual compression ("bag squeeze") of the irrigation solution bag (500 mL of 0.9% saline) during passage of the flexible cystoscope will reduce patient discomfort.

Methods: A total of 151 male patients undergoing diagnostic and review flexible cystoscopies were randomized to "squeeze" (n = 72) or "no squeeze" (n = 79) as the cystoscope was passed from below the external sphincter until after the bladder neck was negotiated. All patients had received 10 mL of 2% lidocaine gel beforehand. A 10-point visual analog pain scale assessing cystoscopy insertion was completed by the patients after the procedure.

Results: The mean pain score was 1.38 (95% confidence interval 0.99-1.77) in the squeeze group and 3.00 (95% confidence interval 2.55-3.46) in the no-squeeze group (P < .001, Mann-Whitney U test). Patient age, procedure indication (diagnostic and review), and grade of clinician performing the cystoscopy had no effect on the findings.

Conclusions: The results of our study have shown that the squeeze technique during insertion of a flexible cystoscope significantly decreases the discomfort of the procedure. It is strongly recommended in all male patients.