A Prospective Randomized Controlled Trial of Irrigation "Bag Squeeze" to Manage Pain for Patients Undergoing Flexible Cystoscopy.

Determine if "bag-squeeze" technique decreases pain during flexible cystoscopy in men.

A single center, prospective, double-blinded randomized controlled trial recruiting 200 consenting participants who were ambulatory, outpatient males who had undergone a prior cystoscopy and were not expected to require any secondary procedures. Men with prior urethral stricture or bladder neck contracture were excluded. Once eligibility was assessed and consent obtained, participants were randomized to undergo cystoscopy with the "bag-squeeze" (group A) or the sham bag-squeeze procedure (group B). Following the cystoscopy, participants completed a pain questionnaire: visual analogue scale. Differences in mean pain score between groups were evaluated using a Students T test with two-sided alpha of 0.05.

Two hundred patients were randomized and underwent flexible cystoscopy. Ten participants were ineligible because they required secondary procedures. Among the 190 eligible patients, 97 were randomized to bag-squeeze (group A) and 93 to sham bag-squeeze (group B) with mean pain scores of 1.91 and 3.39, respectively. (p<0.005).

This study demonstrated a clinically meaningful decrease in pain for men undergoing flexible cystoscopy when the irrigation "bag-squeeze" technique was employed versus placebo bag-squeeze. Accordingly, this useful, simple and free method to improve patient comfort during flexible cystoscopy should be adopted by clinicians.Patient Summary:Squeezing the irrigation bag during a flexible cystoscopy improves pain perception by males and we recommend this to be the standard of care.

The Journal of urology. 2020 May 12 [Epub ahead of print]

Mohamad Baker Berajoui, Ishan Aditya, JaimeOmar Herrera-Caceres, Yazan Qaoud, Katherine Lajkosz, Khaled Ajib, Zoe Glase, Heidi Wagner, Karen Hersey, Miran Kenk, Robert J Hamilton, Girish S Kulkarni, Alexandre R Zlotta, Jason Y Lee, Nathan Perlis, Antonio Finelli, Neil E Fleshner

Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada., University of Toronto, School of Medicine, Toronto, Ontario, Canada., Department of Neurosciences, Carleton University, Ottawa, Ontario, Canada.