Randomised Controlled Study to Evaluate the Outcomes between Rigid and Flexible Cystoscopy in Men with Lower Urinary Tract Symptoms Undergoing Diagnostic Cystoscopy

BACKGROUND Cystoscopy is a commonly performed routine outpatient procedure and an essential diagnostic tool in urology. It may be performed using either rigid or flexible cystoscopes. From the clinical perspective, it might appear that flexible cystoscopy causes less discomfort than rigid cystoscopy, but remarkably head-to- head comparisons of these two devices are sparse. We wanted to compare rigid cystoscopy with flexible cystoscopy in men with lower urinary tract symptoms (LUTS), in terms of the post-procedure outcomes defined as discomfort / pain experienced by the patient using the visual analogue score (VAS) scoring and duration of the procedure. METHODS A total of 60 male patients with LUTS were randomised to flexible and rigid cystoscopy groups (N = 30 each group). Cystoscopy was done using appropriate rigid and flexible cystoscope. Post procedure, patient was assessed with VAS scaling for pain. The duration of the procedure and any post-procedure discomfort and complication were also noted. RESULTS The mean age of patients of flexible cystoscopy group was comparable to that of a rigid cystoscopy group (39.43 ± 11.45 vs. 41.7 ± 10.8, P = 0.433). The mean duration (minutes) for flexible cystoscopy was significantly less than that of rigid cystoscopy (8.53 ± 1.81 vs. 9.77 ± 2.14, P = 0.019). The mean VAS score for flexible cystoscopy was significantly less than that of rigid cystoscopy (2.57 ± 0.97 vs. 3.97 ± 1.1, P < 0.0001). There was no significant difference between groups in terms of diagnosis (P = 0.796). Post-procedure complications were also comparable between the two groups. CONCLUSIONS Flexible cystoscopy caused less pain and discomfort as compared to rigid cystoscopy. Duration of procedure was also less for the flexible cystoscope. KEY WORDS Cystoscopy, Flexible Cystoscopy, Lower Urinary Tract Symptoms, Pain, Rigid Cystoscopy