Cooled (4°C) lidocaine during office cystoscopy improves patient satisfaction and comfort: A prospective, randomized, double-blind, controlled study

Abstract

Introduction: Office-based flexible cystoscopy is often associated with considerable discomfort in male patients. We devised this study to prospectively evaluate the efficacy of cooling intraurethral lidocaine jelly to 4°C prior to use in office-based cystoscopy in an effort to reduce male patient discomfort.

Methods: A total of 600 male patients scheduled for office diagnostic cystoscopy were enrolled and randomized into three groups for a prospectively controlled, double-blind study. Each group received one of the three methods of intraurethral lubrication: plain room temperature lubricant (control) (CON), room temperature lidocaine (LI), or lidocaine at 4°C (LI4°C). Perceived pain was recorded on a Likert visual analog scale (VAS) of 1-10 where 0=no pain and 10=excruciating pain. Kruskal-Wallis test assessed the efficacy of cooling lidocaine compared to room temperature lidocaine and control. Subjective pain reporting was corroborated with instantaneous objective pulse rate recording eliminating perception bias.

Results: There was no significant difference in cystoscopy duration between all groups. Mean pain scores (mean ± standard deviation) were 4.05±0.91, 2.74±1.01, and 1.8±0.84, respectively, for groups CON, LI, and LI4°C (p=0.02). There was a 32.34% reduction in the mean pain score of LI and a further reduction of 34.3% was achieved in LI4°C when compared to CON. Body mass index (BMI) and prostate weight had a significant positive correlation with pain score, whereas no such correlation was found with age.

Conclusions: Cooling lidocaine to 4°C provides additional analgesic benefit in men undergoing office cystoscopy and increases compliance.

Fig. 1

CONSORT diagram of the study. CON: plain lubricant at room temperature; GAD: generalized anxiety disorder score; LI: lidocaine at room temperature; LI4°C: lidocaine gel cooled to 4°C; VAS: visual analog scale.

Fig. 2

The used visual analog scale.

Fig. 3

Distribution of pain scores across three groups. CON: plain lubricant at room temperature; LI: room temperature lidocaine gel; LI4°C: lidocaine gel cooled to 4°C.

Fig. 4

Scatterplots between body mass index and pain scores in each group with added regression line. CON: plain lubricant at room temperature; LI: room temperature lidocaine gel; LI4°C: lidocaine gel cooled to 4°C.

Fig. 5

Scatterplots between prostate weight and pain scores in each group with added regression line. CON: plain lubricant at room temperature; LI: room temperature lidocaine gel; LI4°C: lidocaine gel cooled to 4°C.

Fig. 6

Scatterplots between age and pain scores in each group with added regression line. CON: plain lubricant at room temperature; LI: room temperature lidocaine gel; LI4°C: lidocaine gel cooled to 4°C.