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Flexible And Rigid Cystoscopy In Women

Main Category: Urology / Nephrology
Also Included In: Women's Health / Gynecology
Article Date: 26 Oct 2009

UroToday.com - In this single blinded, prospective study, 36 women requiring cystoscopy were randomized to either rigid or flexible cystoscopy; all patients were placed in the dorsal lithotomy position and were given 2% local lidocaine urethral jelly. Questionnaires were completed prior, just after, and one week after the cystoscopy.

While no statistically significant differences were recorded, it is of note that the overall median pain scores for flexible (1.4) vs. rigid (1.8) cystoscopy were 22% less and one week later the median recall of pain was 0.8 vs. 1.15, respectively, 30% less. Among the 10 patients who had previously undergone rigid cystoscopy, 4 preferred the flexible, 5 noted no difference, and 1 preferred the rigid endoscope.

To my mind, this study reveals a trend favoring flexible cystoscopy in the office, but is too underpowered with only 18 patients in each group. Of note, there were no stated differences among the surgeons in ease of use or diagnostic abilities. No cost analysis or time analysis was done - while they note that flexible endoscopes are more costly than rigid endoscopes, the absence of a need to use lidocaine jelly and the time/inconvenience saved by not having to put the patient into a dorsal lithotomy position should also be considered.

In my office, the rigid endoscope has not made an appearance for over 20 years for either male or female cystoscopy. I do believe that if this study were properly powered to determine differences of at least 20% (i.e. likely entering at least 100 patients into each arm), some of these trends favoring female flexible cystoscopy may well have become significant. However, as this article now stands, both rigid and flexible female cystoscopy remain acceptable.

Gee JR, Waterman BJ, Jarrard DF, Hedican SP, Bruskewitz RC, Nakada SY
JSLS. 2009 Apr-Jun;13(2):135-8

Written by UroToday.com Medical Editor Ralph V. Clayman, MD

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