Factors Predictive of Pain During Cystoscopy: A Prospective Study

Aim: To determine the patient characteristics and surgical conditions which is associated with patient pain and discomfort during cystoscopic procedures.Material and Method: Consecutive patients who had a cystoscopy for cancer-related and benign indications were included. Patients were randomized to undergo either rigid or flexible cystoscopy. Procedures were performed in a teaching setting that included residents and attending physicians to assess the impact of experience on pain/discomfort. Patients were further subdivided into the groups that were received detailed verbal explanation during the cystoscopy and allowed to watch the video screen together with the urologist during the procedure or not. Patients were asked to assess their pain on a 10-mm VAS after the procedure the location of the pain was noted. Results: A total of 146 outpatient cystoscopies (99 rigid, 47 flexible) were evaluated. There was no correlation between patients age and VAS scores. Mean VAS during flexible cystoscopy was lesser than rigid one. Univariate analysis showed that lower BMI, real time detailed verbal explanation by the physician, lesser physician experience and initial cystoscopies were significantly associated with painful cystoscopies. Lineer regression analysis confirmed that type of instrument, detailed verbal information, physicians experience-more than 3 years and history of previous cystoscopy were independent factors related to VAS scores. The most painful localizations were lidocaine injections during flexible cystoscopy whereas visualization of the side wall of the bladder for rigid technique. Discussion: Instrument type (flexible or rigid), explaining the procedure, experience of the physician, number of previos cystoscopies may have an effect on the amount of pain and discomfort during cystoscopy