Does sodium bicarbonate reduce painful voiding after flexible cystoscopy? A prospective, randomized, double-blind, controlled trial
Wong, L and Huang, JG and Yong, TL and Robertson, I and Brough, SJS, Does sodium bicarbonate reduce painful voiding after flexible cystoscopy? A prospective, randomized, double-blind, controlled trial, British Journal of Urology International, 108, (5) pp. 718-721. ISSN 1464-4096 (2011) [Refereed Article]
Study Type - Therapy (RCT) Level of Evidence 1b Objective To determine if sodium bicarbonate (UralŪ) reduces painful voiding after flexible cystoscopy. Patients and Methods 300 patients over 18 years old undergoing elective flexible cystoscopy were enrolled in a randomized, double-blinded, placebo-controlled trial. Patients with active urinary tract infections, indwelling urinary catheters and/or requiring additional procedures such as biopsy and dilatation were excluded. Painful voiding was quantified using a pain analogue scale from 0 to 10. Pre-existing painful voiding, previous experience with UralŪ and flexible cystoscopy were recorded. Flexible cystoscopy was performed to a standard protocol. Patients were randomised after recruitment to receive UralŪ or placebo (glucose) powder four times a day for two days after the procedure. Trial outcome was assessed by estimating the change in pain incidence and severity from before to two days after by post-procedural questionnaire. Results Painful voiding was present in 84 of the 300 patients post flexible cystoscopy (45 of 160 patients receiving UralŪ; 39 of 140 receiving placebo), but overall mean pain scores were low (1.25; standard deviation 2.4; on a 0-10 scale). Treatment with UralŪ compared to placebo was associated with a non-significant reduction in frequency of pain (28.9% vs 31.3%; incidence rate ratio 0.66; 95% CI 0.29-1.46; P = 0.30) and severity of pain (odds ratio 0.72; 95% CI 0.30-1.74; P = 0.47). Conclusions In the replicable context of low post-cystoscopy pain levels, we believe UralŪ does not reduce painful voiding after flexible cystoscopy.