chlorhexidine-gluconate--lidocaine-drug-combination and Urinary-Bladder-Neoplasms

What's known on the subject? and What does the study add? Flexible cystoscopy is commonly performed. Several studies show that topical anaesthetic lubricant reduces patient discomfort, particularly with long lubricant retention times (15-25 min). No studies have specifically addressed whether a short, clinically manageable retention time provides any benefit over immediate cystoscopy. Our study demonstrates that delay by a 3-min interval provides no benefit to patients and a more expedient approach can be justified without compromising patient comfort. LAY-TERM SUMMARY: This prospective comparative trial randomizes 50 men to undergo flexible cystoscopy with insertion of local anaesthetic lubricant either immediately prior to cystoscope insertion or after a 3-min interval. Patients then report discomfort on a visual analogue scale. We show that there is no benefit to delay and therefore a more expedient approach can be justified.. • To determine whether a short, clinically manageable time delay between lubrication with topical local anaesthetic and insertion of the flexible cystoscope, vs immediate insertion, reduces discomfort in male patients.. • This was a prospective comparative trial. • Male patients undergoing simple flexible cystoscopy were randomized to undergo cystoscope insertion either immediately after lubrication with topical lignocaine gel or after a 3-min delay. • Patient-reported pain of the procedure was recorded on a visual analogue scale and data were statistically analysed.. • Fifty male patients were randomized to cystoscope insertion either immediately following lubrication or after a 3-min delay. • Mean pain score in the immediate insertion group was 11.94 mm (95% confidence interval [CI] 7.53-16.36) compared with 10.52 mm (95% CI 6.24-14.80) in the 3-min delay group. • The mean difference between the two groups was 1.42 mm (95% CI -4.57 to 7.41, P= 0.64).. • Findings show that patient comfort is similar between the two groups and therefore there is no benefit in delaying insertion by a 3-min interval. • Flexible cystoscopy is a well tolerated outpatient procedure.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anesthetics, Local; Chlorhexidine; Cystoscopy; Drug Combinations; Gels; Hematuria; Humans; Lidocaine; Lubricants; Male; Middle Aged; Pain; Pain Measurement; Prospective Studies; Time Factors; Urinary Bladder Neoplasms

Flexible cystoscopy is routinely performed under local anaesthetic. The aim of this study was to compare the outcomes of using an anaesthetic gel and a non-anaesthetic gel in the same patient.. Men undergoing 3-monthly check cystoscopies were recruited to this prospective, randomized, double-blind, crossover trial. Primary outcome measures were visual analogue scale scores for pain and the incidence of infection. A total of 51 men were randomized to receive 11 ml of either a non-anaesthetic gel or Instillagel as a lubricant on their first visit; they then crossed over to the other agent on their next visit. A nurse who was blinded to the type of lubricant used recorded post-procedural visual analogue scale scores for pain and contacted the patients 48 h postoperatively to check the incidence of infection.. The median difference in pain score (non-anaesthetic minus anaesthetic) was 0 (range -5.3 to 7.5) and the mean difference 0.24 (SD 2.3), with no evidence of a 'time period effect' between instillations, i.e. the sequence of instillation with Instillagel followed by aqueous gel or aqueous gel followed by Instillagel in an individual did not have a significant effect. One patient had a urinary tract infection after using each type of gel. A non-inferiority test gave strong evidence that the mean difference in pain score was < 1 (p = 0.011).. Our study suggests that the pain experienced with the non-anaesthetic gel is no greater than that experienced with the anaesthetic gel. The non-anaesthetic gel is as effective as the anaesthetic gel and its regular use should be advocated in routine practice.

Topics: Administration, Topical; Aged; Aged, 80 and over; Ambulatory Care; Analgesics; Anesthesia, Local; Chlorhexidine; Cross-Over Studies; Cystoscopy; Double-Blind Method; Drug Combinations; Follow-Up Studies; Gels; Humans; Lidocaine; Lubricants; Male; Middle Aged; Pain Measurement; Prospective Studies; Treatment Outcome; Urinary Bladder Neoplasms

Topics: Administration, Intravesical; Anesthetics, Local; Chlorhexidine; Cystoscopy; Diathermy; Drug Combinations; Humans; Lidocaine; Neoplasm Recurrence, Local; Pain; Urinary Bladder Neoplasms

The result of our examinations was that instillagel has a desinfecting effect in the urethra. This result is mathematically secured by means of the 2 I-test and highly significant. 95% of the preoperatively infected urethras were germ-free immediately after operation. This effect could not be proved in nifucin-gel-medicain as well as in urocomb. Using these lubricants all preoperatively infected urethras were also infected immediately after operation.

Topics: Anti-Infective Agents, Urinary; Bacterial Infections; Chlorhexidine; Drug Combinations; Electrosurgery; Humans; Lidocaine; Lubrication; Male; Nitrofurazone; Piperidines; Postoperative Complications; Propiophenones; Prostatic Hyperplasia; Prostatic Neoplasms; Tetracaine; Urethra; Urinary Bladder Neoplasms; Urinary Tract Infections