1 INTRODUCTION
Direct visualization of the anterior and posterior urethra, bladder neck, and bladder can be done with cystourethroscopy. Basic indications for cystourethroscopy are hematuria, bladder cancer and suspicion, and lower urinary tract diseases.1 Cystourethroscopy directly examines the lower urinary tract anatomy, enabling imaging of the macroscopic pathologies and providing an explanation to the clinical picture. The most common indication for cystourethroscopy is the evaluation of macroscopic or microscopic hematuria, and urogenital malignancies are the underlying cause of 10%–26% of cases with microscopic hematuria.2 Moreover, a bladder tumor is a middle-aged disease that requires close and repeated cystoscopy controls. Cystoscopy and transurethral bladder tumor resection in standard practice operations are done under white light. Before cystourethroscopy, active urinary infection of the patient must be known. Hence, the presence of urinary infection should be detected through urinalysis and, if necessary, with urine culture antibiogram treated before operation.
Cystourethroscopy is performed with rigid or flexible cystoscopes of various sizes. While adult-size rigid cystoscopes range in size from 17 to 25 Fr, flexible cystoscopes range from 16 to 17 Fr. Rigid cystoscope provides better image quality compared to the flexible cystoscope.1 While the cystoscopy procedure is mostly performed with flexible cystoscopes in developed countries for the patient’s best comfort, rigid cystoscopy is still mostly preferred in developing or underdeveloped countries due to its cost-effectiveness.
Local anesthetics are drugs that reversibly interrupt nerve conduction. Water-soluble lubricating anesthetic is administered as retrograde from the meatus for local anesthesia during cystoscopy in male patients. The urethral clamp is placed and left for 5–10 min. In this way, contact between the urethral mucosal surface and the anesthetic agent is suggested before each urethral instrumentation. As for female patients, the lubricating anesthetic can be directly applied onto the cystourethroscope or administered to the urethra before the procedure.
Lubricating gels, which are conventionally applied repeatedly in cystoscopic procedures containing lidocaine, do not always provide adequate pain control. As a result, general and regional anesthesia, which is used more frequently today, brings additional burden and cost in this patient group, who may have accompanying diseases, and for the patient and the physician not only because of its long preparation requirement but also possible complications. Levobupivacaine is a long-acting aminoamide local anesthetic, which is the pure S enantiomer of bupivacaine hydrochloride. The higher vasoconstrictor effect of levobupivacaine explains the longer duration of the resulting sensory block and lower central nervous system toxicity.3
Pain is a sensory, unpleasant emotional sensation and a way of behavior in a certain area of ​​the body whether or not due to strong tissue damage and is related to the subjective, primitive protective experiences of people acquired in the past.4Measurement and evaluation of pain is an important step in the diagnosis and treatment of a patient suffering from pain. Pain measurement methods include verbal and visual questioning of pain.5 Among the visual methods, body diagrams, face scales, as well as the 10-cm straight line known as the Visual Analog Scale is widely used.
This study aimed to investigate the effectiveness of locally applied intracavitary levobupivacaine diluted with isotonic solution for reducing the patient’s pain. Consequently, comfort and satisfaction is increased by providing deeper and longer mucosal anesthesia with instillation.