How painful are shockwave lithotripsy and endoscopic procedures performed at outpatient urology clinics?

Our aim was to investigate the subjective pain felt by patients during shockwave lithotripsy (SWL) and endoscopic procedures such as cystoscopy, retrograde ureteral stenting, retrograde pyelography (RGP), and ureteroscopic lithotripsy performed in an outpatient clinic, and to identify how severe pain during such procedures is. We estimated subjective pain in 984 patients after SWL (186), cystoscopy (489), retrograde ureteral stenting (127), RGP (97), and ureteroscopic lithotripsy (85) performed by a single expert in an outpatient clinic using a prospective questionnaire with a ten point visual analog scale between January 2001 and December 2003. There was no premedication in any procedure except ureteroscopic lithotripsy for which an intramuscular injection of analgesics (pethidine HCl 50 mg) was used. The pain scale score in SWL was 6.62+/-2.27, the highest among the procedures (P<0.05). Pain scores for endoscopies were 4.48+/-2.07 in retrograde ureteral stenting, 3.81+/-2.06 in ureteroscopic lithotripsy, 3.72+/-1.75 in RGP, and 3.08+/-1.95 in cystoscopy. In this study, we observed that patients feel most pain in SWL without anesthesia, and that pain during ureteroscopic lithotripsy under local anesthesia is not high, compared with other endoscopic procedures.