2 MATERIALS AND METHODS
The study included 100 male patients with previous transurethral
resection operation for a bladder tumor and who were followed up with
cystoscopy. Patients who were female, who would undergo cystoscopy under
local anesthesia for the first time, known to have a urethral stricture,
a history of allergy to local anesthesia, uncontrolled hypertension,
uncontrolled cardiac disease, and uncontrolled chronic obstructive with
lung disease were not included in the study. Necessary explanations
about the study were made to all patients, and their detailed consents
were obtained. Ethics committee approval was obtained from the local
clinical research ethics committee for the study.
Residual urine amount was checked with ultrasound before cystoscopy, and
bladder drainage was performed to those with postvoiding residual urine
by using a 12F feeding tube lubricated with sterile vaseline. The
patients were randomized into five groups . In the first, second, third,
and fourth groups, 4, 6, 8, and 10 mL of levobupivacaine HCl were mixed
with 26, 24, 22, and 20 mL of isotonic solution, respectively. Hence,
the total mixture was 30 mL for each group. The fifth group was the
control group. In this group, the standard method commonly used in most
clinics was utilized. That is, a gel containing Cathejell-2% lidocaine
was applied 20 min before cystoscopy. Meanwhile, levobupivacaine
instillation was used 30 min before cystoscopy in the experimental
groups.
Cystoscopy procedures were performed by a single surgeon with a 17.5 Fr
rigid cystoscope and applied with 0°, 30°, and 70° lens. Patients were
enabled to watch the procedure from the video endoscopy system. For the
control group, the gel containing only 2% lidocaine preparation was
instilled 30 min before the procedure. The VAS was presented to the
patients with a diagram to describe “0” and “10” on a 10-cm straight
line. Pain was evaluated with VAS during cystoscopy and 30 min after the
procedure. Patient satisfaction was assessed after the procedure.