Pain and satisfaction during rigid cystoscopic ureteral stent removal: A preliminary study

Background: Cystoscopy evokes discomfort and pain, especially in males. The cystoscopic retrograde approach is standard in the removal of ureteral stents. However the satisfaction and degree of pain during the procedure according to the use of several pain controlling methods are unclear. Methods: This is a cross-sectional survey of 60 patients who underwent cystoscopic ureteral stent removal under intravenous analgesics (group 1, n = 20), midazolam induction (group 2, n = 20), and propofol (group 3, n = 20). Procedural pain and post-procedure satisfaction were determined, and cost differences between the approaches were clarified. Results: Group 2 and 3 showed significantly less pain than group 1 (P ≤ 0.001) and significantly higher satisfaction rate than group 1 (P ≤ 0.001). Comparison of groups 2 and 3 revealed showed significantly less pain and higher satisfaction rate in group 3 (P ≤ 0.001 for both). In Group 1, 17 (85.0%) patients wanted other treatment modalities, compared to eight group 2 patients (40.0%) and no group 3 patients. Conclusions: Considering the potential pain and dissatisfaction of rigid cystoscopic ureteral stent removal, procedures utilizing moderate sedation with midazolam or general anesthesia using propofol without muscle relaxation should be considered.