Lidocaine solution vs. lidocaine gel instillation for pain management during intravesical botulinum injections

Most Canadian urologists use lidocaine solution prior to botulinium toxin (BoNT) administration; however, this requires additional time. Our aim was to compare pain scores in patients undergoing office-based BoNT using lidocaine instillation and lidocaine gel vs. lidocaine gel alone.

All patients undergoing office-based intradetrusor BoNT between March 1 and September 1, 2022, were included. Group 1 received intravesical lidocaine solution (20 ml 2% lidocaine solution + 30 ml 0.9% normal saline) instillation for 30 minutes and lidocaine gel. Group 2 received lidocaine gel only. The Verbal Numeric Rating Scale (VNRS) was used to measure pain. Patient demographics were compared with t-test for continuous and Chi-squared for categorical variables. The Mann-Whitney U test was used to compare pain scores.

A total of 79 patients were included (mean age 61 years, 74.7% female, 58.2% with overactive bladder, and 30.4% receiving first treatment). Group 1 had 39 patients and group 2 had 40. There was no significant difference in pain scores between groups: group 1 median VNRS 3.0 (interquartile range [IQR] 2.5) vs. group 2 median VNRS 4.0 (IQR 2.0) (p=0.11). No significant differences in pain scores were noted between groups based on sex, indication for treatment, or number of previous BoNT treatments (p>0.05). Post-procedural complications were low. Treatment failure did not occur.

Lidocaine gel alone may be an acceptable analgesic alternative while improving availability and efficiency of treatment delivery. Our findings are limited by the retrospective nature of the study and the small sample size.