Effects of Topical Lidocaine During Urodynamic Testing In Women

Kristine Zinkgraf

Status: Completed

Conditions: Urinary Stress Incontinence; Pain

Treatments: Drug: lidocaine 2% gel; Drug: water soluble lubricant

Study type: Interventional

Funder types: Other

Identifiers

NCT03881293

IRB#12-09

Details and patient eligibility

About

Urodynamic testing is used to help diagnose causes of urinary incontinence and voiding dysfunction. The purpose of the urodynamic test is to gain insight into the patient's urinary symptoms and assist in making a diagnosis. Catheter insertion and manipulation during the test can be uncomfortable for the patient. Lidocaine gel has not been used routinely during urodynamic testing. However, it is used routinely during outpatient cystoscopy and with any urethral catheterization. The investigators proposed that lidocaine numbing gel could be used without compromising test findings.

The study included 110 adult women. The purpose was:

1. Determine whether the use of topical lidocaine during urodynamic testing decreases patient discomfort during the procedure.
2. Evaluate whether the use of topical lidocaine affects the urodynamic results.

Full description

Topical Lidocaine For Urodynamic Testing: A Double Blinded Randomized Control Trial

Hypothesis / aims of study

Determine whether the use of topical lidocaine during urodynamic testing decreases patient discomfort during the procedure. Evaluate whether the use of topical lidocaine affects the urodynamic results.

Study design, materials and methods The hospital IRB approved the study. Women with symptoms of stress urinary incontinence (SUI) scheduled for a urodynamic study (UDS) were eligible to participate. Women presenting with predominant overactive bladder symptoms were excluded. Participants were randomized on the day of the procedure using Random Allocation Software Version 1.0. All were blinded to the study arms until completion of final data analysis. Participant randomization assignment was known only to an independent research nurse and the dispensing pharmacist. The study consisted of transurethral administration of 5 ml lidocaine 2% gel or surgilube gel, in the study and control arms, respectively, 10 minutes before catheter insertion. Prior to testing, a 24 hour bladder diary and the Pelvic Floor Distress Inventory - Short Form 20 were completed. During the UDS participants were asked for sensory information including desire to void and maximal cystometric capacity (MCC). Urethral pressure profiles were obtained at an infused volume of 200 ml. Provocative measures were performed to assess SUI. Using a Likert scale, pain was assessed prior to and after catheter insertion, after performing the urethral pressure profile, and at the completion of the study. The primary outcome; pain after urethral pressure profile (UPP), was compared between the two groups. Comparisons of the bladder diary and UDS results were made between study and control arms individually and in-between groups.

Statistical methods The effect of lidocaine on patient pain as reported during multiple time-points during the UDS was evaluated using repeated measures analysis via mixed effects regression with a random patient-specific intercept. This approach allows the evaluation of the overall pain experience, as well as baseline-adjusted comparison at individual time-points. Comparisons were done using t-tests for continuous variables, Chi-squared test for categorical variables, Wilcoxon rank-sum test, Lin's Concordance Correlation Coefficient (CCC), and a z-test. The CCC provides a generalization of Pearson's correlation coefficient that measures how well the data align with the diagonal representing equal values for the two measurements (as opposed to any straight line). Agreement is stronger than correlation. Specifically, the agreement between mean void volume and volume at strong desire, as well as between maximum void volume and volume at MCC were computed separately for each study group. The CCC values were compared between the study groups using a z-test. Power calculations determined a total sample size of 110 participants was needed to detect significant differences between the groups with at least 94% statistical power.

Enrollment: 110 patients

Sex: Female

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

Women with complaint of stress urinary incontinence who were scheduled for a urodynamic test Patients with symptomatic pelvic organ prolapse if they also had stress incontinence symptoms.

Community dwelling elderly patients who were able to provide their own history and were able to sign for themselves

Exclusion criteria

Patients who were unable to provide their own consent Patients who are allergic to lidocaine Children and pregnant patients

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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110 participants in 2 patient groups, including a placebo group

Placebo Lubricant Gel

Placebo Comparator group

Description:

5 ml water-soluble gel instilled transurethrally ten minutes prior to catheter insertion

Treatment:

Drug: water soluble lubricant

Lidocaine 2% Gel

Active Comparator group

Description:

5 ml lidocaine 2% gel instilled transurethrally ten minutes prior to catheter insertion

Treatment:

Drug: lidocaine 2% gel