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.