Efficacy and safety of intravesical alkalinized lignocaine for cystoscopy: a retrospective analysis

To study the effect of intravesical instillation of alkalinized lignocaine (AL) solution on pain scores and patient tolerance in patients undergoing cystoscopy. Bladder distension, trigonal irritation, and bladder neck irritation during cystoscopy under local anesthesia contribute significantly to patient discomfort.

This was a retrospective case-control study performed at a single center from January 2023 to July 2023 (Institutional Ethics Committee approval: T/IM-NF/Urol/23/194). Prior to cystoscopy, patients in control group (Group A) (LG group) received only 10 ml of 2% lignocaine HCl gel (LG) per-urethrally, while intervention group (Group B) (AL group) also received 30 ml of AL solution intravesically (20 min prior). Postoperative pain scores were compared using visual analog scale (VAS). The patient tolerance, postoperative hematuria, experience with the procedure, persistent LUTS, and incidence of UTI after 1 week were also compared.

The study included 50 male patients in each group undergoing cystoscopy for LUTS under evaluation, unexplained hematuria and check cystoscopy for Ca bladder; the median age was comparable between the groups. The VAS scores at 0 h [2(2-3) vs. 5(4-5); p < 0.001], 1 h [1(1-2) vs. 3(3-4); p < 0.001], and 2 h [0 vs. 1(1-1); p < 0.001] were better in Group B. Patient tolerance and experience with the procedure, assessed 1 week postoperatively, were significantly better in Group B. Postoperative clinical features and incidence of LUTS at 1 week postoperatively were significantly less in Group B.

Using intravesical AL solution significantly reduces pain and improves patient tolerance and satisfaction during cystoscopy; also, it is safe and well-tolerated.