Reduction of Pain during Flexible Cystoscopy: A Systematic Review and Meta-Analysis

No AccessJournal of UrologyAdult Urology1 Dec 2019Reduction of Pain during Flexible Cystoscopy: A Systematic Review and Meta-Analysis Dima Raskolnikov, Benjamin Brown, Sarah K. Holt, Andrea L. Ball, Yair Lotan, Seth Strope, Florian Schroeck, Ralph Ullman, Robert Lipman, Angela B. Smith, and John L. Gore Dima RaskolnikovDima Raskolnikov *Correspondence: Department of Urology, University of Washington School of Medicine, 1959 NE Pacific, Box 356510, Seattle, Washington 98195 telephone: 206-685-1982; E-mail Address: [email protected] Department of Urology, University of Washington School of Medicine, Seattle, Washington , Benjamin BrownBenjamin Brown School of Medicine, University of Washington, Seattle, Washington , Sarah K. HoltSarah K. Holt Department of Urology, University of Washington School of Medicine, Seattle, Washington , Andrea L. BallAndrea L. Ball School of Medicine, University of Washington, Seattle, Washington , Yair LotanYair Lotan Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas , Seth StropeSeth Strope Department of Urology, Baptist MD Anderson Cancer Center, Jacksonville, Florida , Florian SchroeckFlorian Schroeck Section of Urology, White River Junction VA Medical Center, Vermont Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire , Ralph UllmanRalph Ullman Patient Representatives, Bladder Cancer Advocacy Network, Bethesda, Maryland , Robert LipmanRobert Lipman Patient Representatives, Bladder Cancer Advocacy Network, Bethesda, Maryland , Angela B. SmithAngela B. Smith Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina , and John L. GoreJohn L. Gore Department of Urology, University of Washington School of Medicine, Seattle, Washington View All Author Informationhttps://doi.org/10.1097/JU.0000000000000399AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The BCAN (Bladder Cancer Advocacy Network) Patient Survey Network identified pain during intravesical procedures as a research priority for patients. Although intraurethral lidocaine is the standard of care in this setting, evidence of its use is equivocal. We systematically reviewed studies of interventions to reduce discomfort during cystoscopy and intravesical therapy of bladder cancer. We performed a meta-analysis of interventions using available randomized, controlled trials. Materials and Methods: Search terms derived from the key questions were incorporated into the literature search constructed by a research librarian and the English medical literature from 1990 to 2017 was accessed. The initial search yielded 626 potential studies and the final review incorporated 62. We combined 12 trials into a meta-analysis with a random effects model of the efficacy of intraurethral lidocaine vs plain lubricant to reduce pain during flexible cystoscopy as measured on a 10-point visual analogue scale. Results: Data from 12 randomized controlled trials in a total of 1,549 patients were included in the final intraurethral lidocaine meta-analysis. The standardized mean difference between visual analogue scale pain scores in patients who underwent flexible cystoscopy with intraurethral lidocaine and plain lubricant was –0.22 (95% CI –0.39–−0.05). Evidence was insufficient to evaluate other interventions to mitigate the discomfort of invasive bladder procedures. Conclusions: Intraurethral lidocaine provides statistically significant pain reduction in men who undergo flexible cystoscopy, particularly with a longer dwell time. The evidence was insufficient for other tested interventions. A prospective study is needed to further clarify interventions to decrease patient discomfort during cystoscopy and other intravesical procedures in a diverse population. References 1. : Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol 2016; 196: 1021. Link, Google Scholar 2. : A new small-calibre diagnostic flexible cystoscope. BJU Int 2002; 89: 194. Google Scholar 3. : Flexible and rigid cystoscopy in women. JSLS 2009; 13: 135. Google Scholar 4. : Lidocaine 2% gel versus plain lubricating gel for pain reduction during flexible cystoscopy: a meta-analysis of prospective, randomized, controlled trials. J Urol 2008; 179: 986. 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Google Scholar 30. : Effects on pain and anxiety of patients viewing their cystoscopy in addition to a detailed explanation: a controlled study. BJU Int 2003; 92: 751. Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported in part by a Urology Care Foundation Residency Research Award, the Russell Scott, Jr., MD Urology Research Fund and PCORI (Patient-Centered Outcomes Research Institute) Contract 1089. Supplementary references 31 to 42 for this article can be obtained at https://www.jurology.com. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byOverland M, Leva N, DiSandro M and Copp H (2022) Feasibility of Awake Intravesical Botulinum Toxin Injection in Pediatric Neurogenic BladderJournal of Urology, VOL. 208, NO. 3, (702-710), Online publication date: 1-Sep-2022.Smith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 202, NO. 6, (1069-1070), Online publication date: 1-Dec-2019. Volume 202Issue 6December 2019Page: 1136-1142Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordslidocainecystoscopyproceduraladministrationintravesicalurinary bladder neoplasmspainAcknowledgmentJudy Mayer-Connery assisted with patient comfort during cystoscopy at our institution. BCAN Patient Centered Outcomes and Policy Working Group key informants assisted with study KQ and PICOTS iterative development, including Drs. Kamal Pohar, Department of Urology, Ohio State University, Columbus, Ohio; Karim Chamie, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California; Matthew Nielsen, Department of Urology, University of North Carolina, Chapel Hill, North Carolina; and Scott Gilbert, Department of Urology, H. Lee Moffitt Cancer Center, Tampa, Florida.MetricsAuthor Information Dima Raskolnikov Department of Urology, University of Washington School of Medicine, Seattle, Washington *Correspondence: Department of Urology, University of Washington School of Medicine, 1959 NE Pacific, Box 356510, Seattle, Washington 98195 telephone: 206-685-1982; E-mail Address: [email protected] More articles by this author Benjamin Brown School of Medicine, University of Washington, Seattle, Washington More articles by this author Sarah K. Holt Department of Urology, University of Washington School of Medicine, Seattle, Washington More articles by this author Andrea L. Ball School of Medicine, University of Washington, Seattle, Washington More articles by this author Yair Lotan Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas More articles by this author Seth Strope Department of Urology, Baptist MD Anderson Cancer Center, Jacksonville, Florida More articles by this author Florian Schroeck Section of Urology, White River Junction VA Medical Center, Vermont Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire More articles by this author Ralph Ullman Patient Representatives, Bladder Cancer Advocacy Network, Bethesda, Maryland More articles by this author Robert Lipman Patient Representatives, Bladder Cancer Advocacy Network, Bethesda, Maryland More articles by this author Angela B. Smith Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author John L. Gore Department of Urology, University of Washington School of Medicine, Seattle, Washington More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported in part by a Urology Care Foundation Residency Research Award, the Russell Scott, Jr., MD Urology Research Fund and PCORI (Patient-Centered Outcomes Research Institute) Contract 1089. Supplementary references 31 to 42 for this article can be obtained at https://www.jurology.com. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement PDF downloadLoading ...