Introduction
Cystoscopy is one of the most common outpatient procedures of urologic practice that provides to evaluate lower urinary tract diseases such as various pathologies of urethra, prostate and bladder(1). A Flexible instrument used cystoscopy was first introduced by Tsuchida and Sugawara in 1973. They reported that flexible cystoscopy was a potentially less painful technique than rigid cystoscopy, especially in male patients (2). Since then flexible cystoscopy has been performed routinely in many urology clinics and European Association of Urology guidelines recommend flexible instruments for cystoscopy, particularly in men(3). The guidelines report that flexible cystoscopy with local anesthetic instillation results in better compliance compared to rigid cystoscopy. However the meta-analysis regarding this recommendation do not compare between rigid and flexible cystoscopies. It compares only flexible cystoscopies with and without topical intra urethral anesthetic instillations (4).
Only two studies have compared pain and tolerability of male patients during flexible and rigid cystoscopies (5,6). The results of these studies showed that flexible cystoscopy was better tolerated and it caused less pain than rigid cystoscopy by male patients. However the most important limitation of the both studies is that the different diameter instruments were compared. The diameters of the rigid cystoscopes were bigger than the diameters of the flexible cystoscopes in the both studies. The aim of the present study was to compare lower urinary tract symptoms (LUTS), sexual functions and quality of life as well as pain and tolerability between flexible and rigid cystoscopies which had the same diameter in male patients with non-muscle invasive bladder cancer (NMIBC).