Lidocaine 2% gel versus plain lubricating gel for pain reduction during flexible cystoscopy: a meta-analysis of prospective, randomized, controlled trials.

PURPOSE The current literature shows mixed results for the effectiveness of topical intraurethral lidocaine gel as local anesthesia during flexible cystoscopy. We performed a meta-analysis of randomized, controlled trials of the efficacy of 2% lidocaine vs plain gel for decreasing the pain that male patients incur during flexible cystoscopy. MATERIALS AND METHODS A search of the literature from 1950 to September 2006 yielded 46 applicable articles. Search terms included cystoscopy and pain. Study selection included randomized controlled trials, flexible cystoscopy, males, control groups receiving plain gel and treatment groups receiving 2% lidocaine before cystoscopy. Data extraction was done by 2 of us (ARP and JSJ) who independently reviewed each study and were blinded to identifying features. The primary outcome measured was pain incurred by the patient throughout the entire cystoscopy procedure, as measured using a visual analog score. RESULTS Data from 9 eligible trials on a total of 817 patients in 7 publications were included in the meta-analysis. Using a random effects model the difference between visual analog scale pain scores in patients receiving 2% lidocaine and plain gel was estimated to be -4.61 (approximate 95% CI -9.6, 0.385), indicating no statistically significant difference. CONCLUSIONS Based on a meta-analysis of 9 randomized controlled trials there is no evidence to suggest a statistically significant difference in the efficacy of pain control between lidocaine gel and plain gel lubrication in men during flexible cystoscopy. This supports the conclusion that its benefit is limited to lubrication and any other perceived benefit is consistent with placebo.