Randomized trial of 10 mL and 20 mL of 2% intraurethral lidocaine gel and placebo in men undergoing flexible cystoscopy

Purpose: To determine if 20 mL of 2% intraurethral lidocaine gel is superio r to 10 mt of 2% lidocaine or sterile lubricant for flexible cystoscopy in men. Patients and Methods: A randomized, double-blind, placebo-controlled trial was conducted. Sixty men scheduled to undergo diagnostic flexible cystoscop y were randomized to receive either 20 mt of placebo gel (Group I), 10 mt o f 2% lidocaine gel (Group II) or 20 mt of 2% lidocaine gel (Group III). A p enile clamp was applied for 15 minutes to ensure consistent indwelling time in all patients. Patients recorded their pain on a 10cm non-graphical visu al analog scale prior to cystoscopy as a baseline, during the procedure, an d immediately after the procedure. Patients also recorded their pain and wi llingness to have the same anesthetic on a 4-point descriptive scale. Heart rate and mean arterial blood pressure (MAP) were recorded at specific inte rvals throughout the procedure, and increases in mean arterial pressure wer e considered objective evidence of patient pain. Results: Pain perception was not statistically different in the groups (Gro up I 4.65, Group II 3.93, Group III 3.57; P = 0. 406). Pain assessment and willingness to have the same anesthetic also did not differ statistically a mong the groups. Similarly, differences in the increases in MAP were not st atistically significant between groups. Conclusion: Instillation of 20 mt or 10 mt of 2% lidocaine gel has no advan tage over plain lubricant in providing anesthesia for flexible cystoscopy i n men.