Flexible Cystoscopy Patient Experience: Comparative Effects of Irrigation Techniques on Comfort and Satisfaction

Aim: Flexible cystoscopy under local anesthesia is frequently associated with pain and discomfort, and irrigation delivery may influence patient experience. The aim of this study was to compare three irrigation techniques with respect to pain, patient satisfaction, and willingness to repeat (WtR) during flexible cystoscopy. Methods: This single-center retrospective comparative cohort study included 283 men who underwent flexible cystoscopy under local anesthesia between October 2023 and June 2024. Patients were allocated to patient-controlled pressurized irrigation with a sphygmomanometer cuff (Group 1, n=73), operator-controlled manual pressurized irrigation (Group 2, n=126), or non-squeeze irrigation (Group 3, n=84). The primary outcome was intraoperative pain assessed by a 0-10 visual analog scale (VAS). Secondary outcomes were postprocedural VAS, WtR (0-10), satisfaction (5-point Likert scale), and complications. Groups were compared using Kruskal-Wallis and chi-square or Fisher’s exact tests (two-sided; p<0.05). Results: Age and body mass index were similar across groups. Intraoperative VAS differed significantly across groups (Group 1: 3.07±1.07; Group 2: 3.64±1.26; Group 3: 4.88±1.58; p<0.001), with both pressurized techniques associated with less pain than non-squeeze irrigation. Postprocedural VAS scores were also lower with pressurized irrigation (2.63±0.96 and 2.98±1.32 vs. 3.73±1.20; p<0.001). Willingness to repeat was highest in Group 2 and lowest in Group 3 (7.79±1.63 vs. 6.71±1.74; p<0.001). Satisfaction was higher in the pressurized groups (4.34±0.58 and 4.30±0.68 vs. 3.71±0.84; p<0.001). Complication rates were low and comparable (6.8%, 6.3%, and 3.6%; p=0.610). Conclusion: Pressurized irrigation during flexible cystoscopy under local anesthesia was associated with less pain and greater patient satisfaction than non-squeeze irrigation, without an increase in complications. Operator-controlled pressurization showed a modest advantage in WtR.