The Bladder Cancer Advocacy Network (BCAN) Patient Survey Network identified pain during intravesical procedures as a research priority for patients. Although intraurethral lidocaine is standard of care in this setting, evidence for its use is equivocal. We performed a systematic review of studies evaluating interventions to reduce discomfort during cystoscopy and intravesical therapies for bladder cancer. We performed a meta-analysis for interventions with available randomized-controlled trials.

Search terms derived from the Key Questions were incorporated into the literature search constructed by a research librarian and accessed English medical literature from 1990-2017. Initial search yielded 626 potential studies. Final review incorporated 62 studies. We combined 12 trials into a meta-analysis with a random-effects model of the efficacy of intraurethral lidocaine versus plain lubricant for reducing pain during flexible cystoscopy as measured by a 10-point Visual Analog Scale (VAS).

Data from 12 randomized-controlled trials on 1,549 patients were included in the final intraurethral lidocaine meta-analysis. The standardized mean difference between VAS pain scores in patients undergoing flexible cystoscopy with intraurethral lidocaine and plain lubricant was -0.22 (95% CI -0.39 to -0.05). The evidence was insufficient to evaluate other interventions for mitigating discomfort from invasive bladder procedures.

Intraurethral lidocaine provides a statistically significant reduction in pain among men undergoing flexible cystoscopy, particularly with longer dwell times. The evidence was insufficient for other tested interventions. A prospective study is needed to further clarify interventions to decrease patient discomfort during cystoscopy and other intravesical procedures in a diverse population.

The Journal of urology. 2019 Jun 20 [Epub ahead of print]

Dima Raskolnikov, Benjamin Brown, Sarah K Holt, Andrea L Ball, Yair Lotan, Seth Strope, Florian Schroeck, Ralph Ullman, Robert Lipman, Angela B Smith, John L Gore

Department of Urology, University of Washington School of Medicine , Seattle , WA., School of Medicine, University of Washington , Seattle , WA., Department of Urology, University of Texas Southwestern Medical Center , Dallas , TX., Department of Urology, Baptist MD Anderson Cancer Center , Jacksonville , FL., Section of Urology, White River Junction VA Medical Center, VT, and Dartmouth-Hitchcock Medical Center , Lebanon , NH., Patient Representatives, Bladder Cancer Advocacy Network., Department of Urology, University of North Carolina at Chapel Hill , Chapel Hill , NC.