Original Article 92 GENERAL UROLOGY Turk J Urol 2016; 42(2): 92-6 • DOI: 10.5152/tud.2016.18784 2% Lidocaine gel or plain lubricating gel: Which one should be used in male flexible cystoscopy? Ali Akkoç 1 , Mahir Kartalmış 2 , Cemil Aydın 1 , Ramazan Topaktaş 1 , Selçuk Altın 1 , Aykut Aykaç 3 1 Clinic of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey 2 Clinic of Urology, Selahaddin Eyyubi State Hospital, Diyarbakır, Turkey 3 Clinic of Urology, Orhangazi State Hospital, Bursa, Turkey Submitted: 23.04.2015 Accepted: 10.11.2015 Correspondence: Ali Akkoç E-mail: aliakkoc@gmail.com ©Copyright 2016 by Turkish Association of Urology Available online at www.turkishjournalofurology.com ABSTRACT Objective: To investigate and compare the effects on pain of intraurethral 2% lidocaine gel and plain lubri- cating gel in male patients underwent fexible cystoscopy. Material and methods: The data of 220 male patients who underwent fexible cystoscopy between March 2012 and August 2014 were retrospectively analized. The patients were divided into 2 groups according to using intraurethral gel types. Group I included 120 patients who were underwent fexible cystoscopy with 2% lidocaine gel and Group II was consisted from 100 patients who underwent fexible cystoscopy with plain lubricating gel. The groups were compared according to postprocedure data including pain score, procedure time and age of patients. Results: The mean age of the patients in Group I was 50.02±11.87 years while that in Group II was 52.03±13.37 years (p=0.492). The mean procedure times were 6.02±0.787 and 6.28±0.689 minutes in Group I and Group II respectively (p=0.061). Pain perception scores were not statistically different between the groups (Group I: 3.10±0.980, Group II: 3.34±0.789, p=0.132). Conclusion: Use of intraurethral 2% lidocaine gel has no advantage over plain lubricating gel in regard to pain control during fexible cystoscopy in men. Keywords: Flexible cystoscopy; lidocaine gel; pain; plain lubricating gel. Introduction Office based cystoscopy is an easy, safe, and effective method for the diagnosis of lower urinary tract symptoms (LUTS) and follow-up of urological malignancies. [1] Before the mid 1990s, all cystoscopies used to be done with rigid cystoscope. [2] The first flexible cystos- copy was performed in 1981 by Wilbur using flexible choledochoendoscope and now flex- ible cystoscope is used extensively in many centers. [3,4] Both rigid and flexible cystoscopy is associated with some extent of pain and discomfort to the patient but the flexible cys- toscopy has significantly decreased the pain and discomfort associated with the procedure. In female patients, cystoscopy is generally associated with mild discomfort, and the need for intraurethral anesthesia does not usually arise. Moreover, because of the short female urethra, the efficacy of intraurethral anesthesia by numerous means of topical application is limited and difficult to standardize. In contrast, men may experience more discomfort during cystoscopy due to longer urethra. Cocaine was reported as the first topical anesthetic agent for cystoscopy in 1884. [5,6] Historically, a lubricat- ing gel with 2% lidocaine used as an intraure- thral anesthetic has been a standard of care in men undergoing rigid cystoscopy; however, with introduction of the flexible cystoscope, the need for intraurethral anesthesia in men has been questioned. [7] The primary objective of this study was to determine whether intraurethral lubricating gel containing 2% lidocaine results in lower average pain scores compared with the plain lubricating gel in men undergoing flexible cystoscopy. Material and methods The medical records including ages, type of lubricants, type of procedures, procedure times and the pain score during procedure of 220