Physicians' Perception About Patient Pain in Flexible Cystoscopy With Local Anesthesia

Cystoscopy is one of the most frequently performed procedures in the field of urology. Its widespread application, the impracticality of administering general anesthesia to all patients, and advancements in medical technology have led to the development of devices that enable cystoscopy to be performed with local or intraurethral anesthesia. As a result, cystoscopy under local anesthesia is commonly utilized for the follow-up of bladder cancer, evaluation of hematuria, assessment of urethral strictures, and examination of the lower urinary tract. Both rigid and flexible cystoscopes can be used for this purpose, with flexible instruments generally offering greater comfort for procedures involving local anesthesia.

In patients undergoing cystoscopy with local anesthesia, the standard approach includes the intraurethral administration of a local anesthetic or lubricant prior to the procedure to enhance patient comfort. While some patients tolerate the procedure well, others may exhibit heightened sensitivity and limited tolerance. Even in cases where the procedure is completed, the pain experienced and the resistance demonstrated by the patient may pose challenges for both the patient and the physician. Occasionally, a mismatch is observed between the patient's reported pain and the resistance displayed. The physician's perception of the patient's pain may also differ from the pain reported by the patient.

Previous studies have explored factors that can influence and reduce the perception of pain during cystoscopy performed under local anesthesia. However, data are lacking regarding the relationship between patients' pre-procedural anxiety and depression levels and the pain experienced during the procedure, as well as the physician's perception of that pain. The primary aim of the study is to compare the pain score reported by the patient with the pain level perceived by the physician. A secondary objective is to evaluate patients' pre-procedure anxiety and depression scores, along with their pain scores during the procedure, in the context of flexible cystoscopy performed under local anesthesia.

The study will include male patients aged 18 years and older who are undergoing cystoscopy due to urological complaints. Exclusion criteria include patients with known urethral strictures or those diagnosed with strictures during cystoscopy, individuals with allergies to the local anesthetic used, and patients with cardiopulmonary conditions that preclude the procedure.

Participants will be asked to complete the Hospital Anxiety and Depression Scale (HADS) for the assessment of general anxiety and depression, as well as the Visual Analog Scale (VAS) for pain and anxiety, at the time of admission. All patients will receive standard intraurethral local anesthesia 15 minutes prior to the procedure. Following cystoscopy, participants will complete the VAS for anxiety and pain again, 15 minutes after the procedure, to evaluate their intra-procedural experience. In addition, the physician performing the procedure will complete the VAS for anxiety and pain based on their perception of the patient's experience.

Patients will be randomized into four groups based on the experience level of the physician performing the procedure: a physician with more than five years of experience, a physician with less than five years of experience, a second-year resident under supervision, and a fourth-year resident. A total of 30 patients will be included in each group. The physician will remain blinded to the forms completed by the patient before and after the procedure and will independently assess the patient's condition.

• Diagnostic procedures (Procedure), also known as Flexible Cystoscopy: Diagnostic Flexible Cystoscopy
• Flexible Cystoscopy (Procedure), also known as Cystoscopy: Diagnostic Flexible Cystoscopy

Primary outcomes

• Physicians' Perception about Patient Pain in Flexible Cystoscopy with Local Anesthesia [Immediately after the procedure, upon completion of the diagnostic flexible cystoscopy (15 minutes post-procedure).]: The study will examine the differences in the perception of pain scores in patients according to the years of experience of physicians. Scale Used: Visual Analog Scale (VAS) for Pain Minimum Value: 0 (No pain) Maximum Value: 10 (Worst possible pain) Interpretation: Higher scores indicate worse pain perception.

Secondary outcomes

• Association between patients' pre-procedure HAD score and pain [Pre-procedure (baseline), immediately after the procedure (15 minutes post-procedure).]: Depression and anxiety levels in the pre-procedure HAD scores and VAS pain scores during the procedure will be compared.

Sex: Male, ages: 18 Years to any

Minimum Age: 18 Years Maximum Age: Not Applicable Sex: Male Gender Based: Yes Male patients over 18 years of age who need cystoscopy due to urologic complaints will be included in the study.

Accepts Healthy Volunteers: No

Inclusion Criteria:

Male patients

Over 18 years of age

Patients for whom diagnostic cystoscopy is indicated for a urologic reason

Exclusion Criteria:

Female patients

Patients younger than 18 years of age

Patients with known urethral stricture

Patients with urethral stricture detected during cystoscopy

Patients who cannot tolerate flexible cystoscopy with local anesthesia

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• Haydar Kamil Cam, Professor Doctor, Study chair, Marmara University, School of Medicie, Department of Urology