Discussion
A lot of studies have evaluated the adverse effects of cystoscopy in the
literature. However, most of them have investigated the management of
pain and discomfort in the patients who underwent cystoscopy(10-12). A few studies have compared between rigid and
flexible cystoscopies but the diameters of the cystoscopes in these
studies were not equal (5,6). Cicione et al also
reported the lack of studies regarding comparison of these cystoscopies
in literature (13). In a multi-center prospective
study, Seklehner et al performed rigid cystoscopy for 150 patients and
flexible cystoscopy for other 150 patients (5). They
reported that the patients undergoing flexible cystoscopy were more
frequently free of pain than the patients undergoing rigid cystoscopy.
Consequently, they suggested that flexible instrument for diagnostic
cystoscopy caused less pain than rigid instrument in male patients.
However the most important limitations of their study were that the
study was multi-institutional and the diameters of rigid cystoscopes
(17.7 and 16 Fr) were bigger than flexible ones (16.5, 16 and 15.5 Fr).
The two limitations might influence the results of the study regarding
the negative effect of rigid cystoscopy on the pain of the patients. The
present study was single-institutional and the cystoscopies were
performed by the same surgeon. Also the diameters of rigid and flexible
cystoscopes were equal. The result of our study showed that the mean VAS
values of the patients undergoing the first rigid cystoscopies were
statistically similar to the patients undergoing the first flexible
ones. The second cystoscopies were performed using cross sectional
design of the instruments. There was no statistically difference between
the VAS values of the patients in the second cystoscopies (Table 2).
There was also no difference between the mean VAS values of all patients
in the first and second cystoscopies. Overall, the findings of our study
showed that the pain levels of patients during cystoscopy were not
affected by type of instrument or the cystoscopy experience of patient.
The other study compared between rigid (n=60) and flexible (n=60)
cystoscopies in the male patients with bladder cancer(6). The results of this study indicated that flexible
cystoscopy was less pain procedure and better tolerated than rigid
cystoscopy by men with bladder cancer. However the different diameter
instruments were used for cystoscopy in this study. Diameters of rigid
and flexible cystoscopes were 20 and 15Fr, respectively. The most
important limitations of previous two studies were that diameters of
instruments were not equal and cystoscopies did not performed by the
same surgeon. Our study was a prospective randomized cross-sectional
single blind study and cystoscopy procedures were performed by the same
urologist. LUTS, quality of life and erectile function as well as pain
of male patients after rigid cystoscopy were compared with male patients
undergoing flexible cystoscopy. After the second cystoscopies all of the
patients were asked which instrument they preferred. While 22 patients
preferred flexible instrument, the other 19 patients preferred rigid one
(p=0.42). When the patients were divided into two groups according to
the instrument using the first cystoscopy, there were no statistically
differences between the choices of the patients.
Sexual functions of the patients in our study were evaluated by using
IIEF form. The mean IIEF total and EF scores of the patients in the two
groups before the both first and second cystoscopies were statistically
similar to the scores after the cystoscopies (Table 3). These findings
showed that cystoscopies using flexible or rigid instruments did not
influence the erectile function of patients. LUTS of the patients were
evaluated as two different groups including “voiding” and
“incontinence” by using ICIQ-MLUTS form. The mean voiding and
incontinence scores of the patients before and after the both first and
second cystoscopies were statistically similar independently of
cystoscope type (Table 3). The findings regarding quality of life were
similar to the results associated with LUTS and erectile function.
Overall, the results of our study indicated that flexsible or rigid
cystoscopies did not effect adversely the LUTS, quality of life and
erectile function of the patients.
Finally, when all parameters of the present study including age, quality
of life scores, LUTS and sexual function scores of the groups, and type
of cystoscopy were analyzed by using multivariate tests, no
relationships between types of cystoscopy and other parameters were
found. A limitation of our study was small sample size. Further large
sample studies should confirm the finding of the present study.