Pilot study of the feasibility of in-office bladder distention using electromotive drug adminstration (EMDA)

Cystoscopic bladder distention is an important tool in the diagnosis and treatment of interstitial cystitis (IC). We investigated the feasibility of performing bladder distention in the office using two different anesthetic strategies: simple instillation of alkalized lidocaine and electromotive drug administration (EMDA) of lidocaine.

Patients presenting with urinary frequency, urgency, and bladder pain were recruited for an office evaluation protocol which included bladder distention under local anesthesia. An initial group of 10 patients underwent bladder distention after instillation of 5 mg/kg alkalized lidocaine. A second group of 11 patients had lidocaine EMDA anesthesia prior to distention.

In the alkaxlized lidocaine group, 6 of the 10 distentions were aborted after less than 5 minutes at only 40 cm H(2)O. In the EMDA group, 7 of 11 of the distentions were completed using 60 cm H(2)O for 7 minutes. EMDA afforded a more effective distention as manifest by a greater percent increase in distention capacity over cystometric capacity compared to alkalized lidocaine (135% vs. 70%). Despite the lower pressure used in the alkalized lidocaine group, the median distention time was only 3 minutes compared to 7 minutes using EMDA.

These results represent the first study of the efficacy of EMDA as local anesthesia for bladder distention compared to another method of anesthesia. Lidocaine EMDA is superior to alkalized lidocaine in that it allows for a greater distention of the bladder for a longer period of time but does not eliminate the pain of bladder distention.