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.