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Medical Forum / Diseases and Disorders / Prostate BPH / February 2006anesthesia for cystoscopy?
I am on my way to pvp. Urodynamics was quite painful when the tubing hit the constriction. Therefore, it seems reasonable to assume that cystoscopy -- which uses a larger diameter tubing -- will be even more painful (tho my urologist says that being able to see where he is going, plus flushing out with water during the procedure will work in my favor.) Because of certain rigidities in the system, the urologist plans to do cystoscopy without anesthesia, except for perhaps 10 mg of Valium by mouth. Do people on this list have relevant experience/expertise? What other means would be available to lessen pain during this procedure? Jesse A major question needing an answer is whether your URO plans to do a flexible or rigid cystoscopy? I have had 2 flexible cystoscopies and in each case, anesthetic jell was injected into the urethra and allowed to work for 15 minutes before the cystoscopy was done. The first cystoscopy was done before mt TUMT was done. I had been given Ativan to take one hour before the procedure. On the second cystoscopy, the anesthetic jell was injected into the urethra before the procedure and allowed to work for 15 minutes before the procedure. There was some discomfort, but not unbearably so in my opinion. I understand that if a rigid cystoscopy is done, generally the patient is put under general anesthesia. When I was taken into surgery for my PVP, I was given 10 mg of Valium and I was perfectly comfortable until the general anesthesia was administered. > I am on my way to pvp. Urodynamics was quite painful when the tubing > hit the [quoted text clipped - 14 lines] > > Jesse Jesse...My first one was done in 1995 by an old timer using a rigid scope (he had it from WWII), and it damn near killed me (I was screaming curse words at the top of my lungs) and had to be equivalent to childbirth or a kidneystone. My second one was done in 2005 with the more modern flexible scope (which is all they use today), and that hurt like a son of a bitch also but not as bad as the first :-) . I may consider anesthesia next time, but being awake helps them get feedback when they inject water into your bladder (pertaining to pain from distending your bladder). "Hydrodistensions" of the bladder are always done under anesthesia, since they pressurize your bladder and hold it that way for 8 minutes (so I've read - I've never had that done). In my opinion the local they put in your urethra isn't worth a sh.t. When the scope goes through your external sphincter, I believe it will hurt (even with the flexible scope). And it hurts for several minutes while he is searching around in your bladder, etc. Ask your uro. Just thought I would give you a little more info. I guess some people can tolerate pain better than others, but I don't consider myself to be a pussy. It hurts...Pete PS - And valium wouldn't do sh.t for me - maybe 100 mg of demerol, but my uro's never even asked :-) . Also I wonder why your message was all grayed out, like it was a sig being stripped. Was not a problem for me and I was very apprehensive. Doctor offered valium but I would have had to get a ride home so I took his word that it wouldn't be painful. A little burning while tube entered the prostate but nothing remotely unbearable. Jim W. >I am on my way to pvp. Urodynamics was quite painful when the tubing > hit the [quoted text clipped - 14 lines] > > Jesse > Was not a problem for me and I was very apprehensive. Doctor offered > valium but I would have had to get a ride home so I took his word > that it wouldn't be painful. A little burning while tube entered the > prostate but nothing remotely unbearable. Jim W. Interesting Jim...I had a lot of pain, but no burning. I had a myelogram once and it took the damn radiologist over a half an hour to get the damn needle through my scar tissue in my between L4/L5, and I was screaming like a banshee the whole time. And guess how many times I was being burned with the damn fluoroscope. Take care...Pete >> I am on my way to pvp. Urodynamics was quite painful when the tubing >> hit the [quoted text clipped - 14 lines] >> >> Jesse I had no pain whatsoever, just a very slight burn when peeing the next day - it's kind of cool to see on the screen. It is also very quick, over before you know it. > I am on my way to pvp. Urodynamics was quite painful when the tubing > hit the [quoted text clipped - 14 lines] > > Jesse People's pain thresholds do seem to vary quite a lot - so I guess reference back to relevant previous personal experiences (with dentists, for example) is useful. For me, flexible cystoscopies have been fine with just anesthetic gel in the urethra. It does seem customary to do rigid cystoscopies (which are still used for some purposes) under general anesthesia. Interestingly, though, I have had two rigid cystoscopies done by my PVP urologist using local anesthesia only, within the last few years. Not least as a result of things I'd read on the net, I had considerable misgivings the first time when I realised (quite late) that he was planning to use a local only and no sedation at all, but in fact both were quite tolerable - certainly no worse than having a tooth drilled (and, of course, there were no anesthesia aftereffects and recovery time was minimal, which I regarded as a definite bonus). Maybe the horror stories refer to older-type cystoscopes with a larger bore - or maybe my urologist is just unusually skilled at 'driving' the scope! Richard Slessor People's pain thresholds do seem to vary quite a lot - so I guess reference back to relevant previous personal experiences (with dentists, for example) is useful. For me, flexible cystoscopies have been fine with just anesthetic gel in the urethra. It does seem customary to do rigid cystoscopies (which are still used for some purposes) under general anesthesia. Interestingly, though, I have had two rigid cystoscopies done by my PVP urologist using local anesthesia only, within the last few years. Not least as a result of things I'd read on the net, I had considerable misgivings the first time when I realised (quite late) that he was planning to use a local only and no sedation at all, but in fact both were quite tolerable - certainly no worse than having a tooth drilled (and, of course, there were no anesthesia aftereffects and recovery time was minimal, which I regarded as a definite bonus). Maybe the horror stories refer to older-type cystoscopes with a larger bore - or maybe my urologist is just unusually skilled at 'driving' the scope! Richard Slessor I don't want to know anything when they are working down there so both times I have been sedated. No problems whatsoever. Buford >I am on my way to pvp. Urodynamics was quite painful when the tubing >hit the [quoted text clipped - 14 lines] > >Jesse Thanks very much for these replies. Pete, are you saying that if you had another cystoscopy you would ask for anesthesia, and if so, what kind of anesthesia would you consider adequate? I notice that the 2002 PDR Nurses Drug Handbook, p 869 lists among the uses for oral Demerol "diagnostic procedures such as cystoscopy." What do people think of this? All: what would you recommend to handle pain after cystoscopy? Thanks. Jesse PS to Pete, On my copy my posting isn't "grayed out... like... a sig." Can you explain what this looks like? > Thanks very much for these replies. > Pete, are you saying that if you had another cystoscopy you would ask > for anesthesia, and if so, what kind of anesthesia would you consider > adequate? Jesse...most of the procedures today by the gastro's (egd's and colonoscopies) and by the uro's for surgery have an anesthesiologist who uses propofil via IV (great drug - fast recovery and no hangover). Ask your uro what his anesthesiologists uses. They used to do a thing called conscious sedation (my current gastro - old timer - still does) and he injects "versed" into my IV and that knocks me out completely (you sure aren't conscious) and has a bigger hangover than the propofil (plus he gives his patients 100 mg of demerol to relax them before the procedure even though he is going to knock you out with the versed - lol). He says the anesthesiologist is overkill and an added expense (and another bill - I agree). Only the old time doctor's would be interested in saving the patient money. I used to have procedures in the 90's where you were semi conscious (egd's, colonoscopies) and no anesthesiologists were required (doc did injection - don't know what they used back then). But they have all gone to the propofil today and you go to sleep (at least in Maryland). > I notice that the 2002 PDR Nurses Drug Handbook, p 869 lists among the > uses for oral Demerol "diagnostic procedures such as cystoscopy." > What do people think of this? The gastro I mentioned above has the nurse give 100 ml of demerol by injection (before the versed like I said, which is very rare) so it work in minutes. The pills would take longer and I bet the standard is only 50 mg, which would be kind of like 10 mg of valium for me, which does nothing. The people in here say 10 mg of valium has helped them, but maybe they wouldn't have had the pain without it. Hope I've help shed some light on this...Pete > All: what would you recommend to handle pain after cystoscopy? > [quoted text clipped - 4 lines] > PS to Pete, On my copy my posting isn't "grayed out... like... a sig." > Can you explain what this looks like? Pete, Talking about that Versed, when I had my second PVP, they came into preop and told me they were going to give me some Versed in my IV and that would put me in la-la land. The nurse came back to me in about 20 minutes and said you do not look like the Versed has affected you. I told her I could not tell any difference. She said she was going to ask if she could give me another one. She came back and gave me another one and checked on me about 10 minutes later and said "You still don't feel like you have had anything?". I said "No". She said that was all she could give me. Well, they finally wheeled me back into surgery and I her them tell the anesthesist that I had received Versed times 2 with no result. He said "well, we better cure that one." He put a mask over my face with a terrible smell and that is the last I remember. Buford >> Thanks very much for these replies. >> Pete, are you saying that if you had another cystoscopy you would ask [quoted text clipped - 38 lines] >> PS to Pete, On my copy my posting isn't "grayed out... like... a sig." >> Can you explain what this looks like? > Thanks very much for these replies. > Pete, are you saying that if you had another cystoscopy you would ask > for anesthesia, and if so, what kind of anesthesia would you consider > adequate? Jesse...I answered your question about the types of anesthesia at length in my last post. But I forgot to tell you what I would do if I have another cysto. I live by myself and don't have anyone to help me except for one person and it's like pulling teeth, even though I pay her. So I probably would endure the pain again (even though its the flexible scope). If I had family or people to help me, I would definitely go with the propofil. Although I mentioned earlier, being awake does give the uro some feedback from the water he instills in your bladder (i.e. did it cause pain, etc. - the uro put 500 ml of water in me). I just wanted to complete my answer, since I always try to address everything in a persons message...Pete > I notice that the 2002 PDR Nurses Drug Handbook, p 869 lists among the > uses for oral Demerol "diagnostic procedures such as cystoscopy." [quoted text clipped - 8 lines] > PS to Pete, On my copy my posting isn't "grayed out... like... a sig." > Can you explain what this looks like? For a flex cysto you need nothing more than a little lidocaine gel in the urethra. It is the same as getting a cath put in your bladder and you do not need meds for that. After the procedure you need no pain meds. 99.9% f people do just fine. A rigid cysto being done in the OR for some reason (a bladder tumor or bladder biopsy) gets you a little "sleepy" meds. Just how much depends on what the doc is doing. ME On 2/3/06 2:49 PM, in article 11u7gfcr1kles37@corp.supernews.com, "Pete" <pete@nospam.net> wrote: >> Thanks very much for these replies. >> Pete, are you saying that if you had another cystoscopy you would ask [quoted text clipped - 24 lines] >> PS to Pete, On my copy my posting isn't "grayed out... like... a sig." >> Can you explain what this looks like? Jesse, Can you share more info on the urodynamic study? I think I am headed that way and want to know more about it. Thanks. Buford R >I am on my way to pvp. Urodynamics was quite painful when the tubing >hit the [quoted text clipped - 14 lines] > >Jesse Jesse, Also, I cannot figure out why they would recommend urodynamic study if it is to determine a weak bladder. As I understand it, there is nothing they can do if it is indeed a weak bladder so why have the tests? Am I missing something? Buford R >Jesse, > [quoted text clipped - 8 lines] >> >>Jesse Jesse, My experience with cystoscopies has been varied. I have had 5 done in the past decade by 5 different uros, all using flexible equipment and with only anesthetic gel in the urethra. Two have been painful followed by burning and bleeding for a few days. One was uncomfortable but not painful and two were a breeze. In my case the difference was due to the skill and compassion of the uro. The better uros gave the anesthetic gel more time to do its work, 15-30 minutes. They also understood how to ease the cystoscope gently through the sphincters, which is the uncomfortable part. My first urologist inserted the scope seconds after the gel and it was very painful. I shall never allow that again. Best, Dave |
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