Does office-based flexible cystoscopy provide better pain perception than rigid cystoscopy: a systematic review and meta-analysis.

BACKGROUND The aim of our study is to determine whether flexible cystoscopy (FC) leads to less pain perception than rigid cystoscopy (RC). METHODS Eligible studies were identified through three common databases, including PubMed, the Cochrane Library and Embase. We systematically reviewed studies comparing FC to RC, and extracted data from randomized trials from December 1, 1984 to January 12, 2021, with no language restrictions. Methodological rigor, and risk of bias were evaluated by two independent reviewers using Cochrane Collaboration's tools. The analysis was completed via STATA version 14.2. RESULTS We initially identified 463 studies, and four articles met the criteria for inclusion. Overall, we did not observe a significant difference between FC and RC regarding pain perception [standard mean difference (SMD): -1.19; 95% CI: -2.69 to 0.32], and there was significant heterogeneity among studies (I2=97.6%, P<0.001). This was consistent with the results stratified by gender (male patients, SMD: -0.96, 95% CI: -2.50 to 0.59; female patients, SMD: -1.42; 95% CI: -4.49 to 1.64). CONCLUSIONS Our study revealed that RC is a tolerable procedure, and FC may not be more comfortable than RC. However, further larger well-designed trials are warranted to demonstrate our findings, and explore whether FC is more beneficial to patient sexual function, anxiety, quality of life, and lower urinary tract symptoms than RC.