# A Quality Improvement Initiative to Alleviate Pain in Flexible Cystoscopy and Minimize False Passages in Catheterization

## TL;DR

This study improved patient comfort during flexible cystoscopy and catheterization by optimizing urethral lubrication techniques.

## Contribution

The study introduced a quality improvement initiative focused on standardizing lubrication techniques to reduce pain and false passages.

## Key findings

- Inadequate lubrication was commonly observed and linked to higher patient-reported pain.
- Proper lubrication techniques led to significantly lower pain and discomfort levels in patients.
- The initiative is expected to standardize best practices and reduce complications in urological procedures.

## Abstract

Introduction: Flexible cystoscopy is a common diagnostic procedure used to evaluate the urethra, bladder, and prostate by inserting a camera-equipped flexible tube through the urethra. Similarly, urinary catheterization involves the passage of a tube into the bladder for drainage or treatment. Both procedures are known to cause discomfort due to urethral sensitivity and share similar pre-procedural preparation steps. This quality improvement project (QIP) aimed to reduce patient discomfort during flexible cystoscopy by improving urethral preparation techniques, with potential applicability to urinary catheterization to minimize traumatic insertions and false passages.

Methods: A mixed-methods approach was used. Observations were made of healthcare professionals performing pre-procedural urethral preparation to identify variations in lubrication techniques. Patient feedback was collected using the Numeric Pain Rating Scale (NPS) and the Visual Analog Scale (VAS) following flexible cystoscopy. After analyzing the findings, the staff was educated on appropriate lubrication techniques, emphasizing adequate gel application prior to instrumentation.

Results: Initial observations revealed that inadequate lubrication was commonly practiced, contributing to increased discomfort during flexible cystoscopy. Questionnaire data confirmed higher reported pain scores among patients who received suboptimal lubrication. Following implementation of proper lubrication techniques, patients reported lower pain and discomfort levels, indicating improved procedural tolerance and patient satisfaction.

Discussion and conclusion: Optimizing the urethral lubrication technique significantly reduces pain during flexible cystoscopy and may prevent traumatic catheterizations. Based on these findings, an instructional video will be developed for the National Health Service (NHS) Greater Glasgow and Clyde (GGC) to demonstrate correct versus incorrect lubrication methods. This initiative is expected to standardize best practices, enhance patient comfort, and reduce complications during urological procedures.