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

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 4ºC 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 4ºC (LI4ºC). 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 LI4ºC (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 LI4ºC 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 4ºC provides additional analgesic benefit in men undergoing office cystoscopy and increases compliance.