To determine whether increased hydrostatic pressure by simple manual compression (“bag squeeze”) of the irrigation solution bag (500 mL of 0.9% saline) during passage of the flexible cystoscope will reduce patient discomfort.

A total of 151 male patients undergoing diagnostic and review flexible cystoscopies were randomized to “squeeze” (n = 72) or “no squeeze” (n = 79) as the cystoscope was passed from below the external sphincter until after the bladder neck was negotiated. All patients had received 10 mL of 2% lidocaine gel beforehand. A 10-point visual analog pain scale assessing cystoscopy insertion was completed by the patients after the procedure.

The mean pain score was 1.38 (95% confidence interval 0.99-1.77) in the squeeze group and 3.00 (95% confidence interval 2.55-3.46) in the no-squeeze group (P < .001, Mann-Whitney U test). Patient age, procedure indication (diagnostic and review), and grade of clinician performing the cystoscopy had no effect on the findings.

The results of our study have shown that the squeeze technique during insertion of a flexible cystoscope significantly decreases the discomfort of the procedure. It is strongly recommended in all male patients.