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Date of last update: 8/13/2017.

Forum Name: Urology Topics

Question: General anaesthesia during cystoscopy?

 MysticFusion - Thu Jun 24, 2010 5:18 am

Dear Sir/Madam, let me first congratulate you for providing this oppurtunity for common people to ask questions! I'm a relatively healthy male of 38 years old. I have nocturia (combined with heavy nightly sweating) for as long as I can remember. Now since a few days I'm sure I have some form of prostatitis: mild pain in testicles and penis as well as perineal area, mild pain and burning sensation in lower abdomen area, very frequent urination (not painful) etc. The GP took a urine dipstick test and that was completely negative (except for miniscule amount of blood). Even a 24-hours lab test proved negative. That's why I'm considering a abacterial chronic prostatitis (possibly related to/combined with pelvic floor tension myalgia).

The main issue is now, I have a HUGE fear of doctors, needles, examinations, related pain etc. etc You have no idea how bad that is. If I needed to go to a urologist and they would suggest a cystoscopy, I would refuse (even if they tell me the cream would numb my genital area). Even if the situation would be life-threatening! However, if they provide general anaesthesia, I would consider it, maybe. Is this common or is this something rare but accepted?

Thank you so much for your time!
 Dr.M.Aroon kamath - Thu Jul 01, 2010 12:11 pm

User avatar Hi,
Most urologists would discuss with the patient regarding the type of anesthesia and explain the pros and cons of each one of them.Decision is taken only aftr such a discussion.

The anesthetic technique may involve
- local anesthetic (topical) alone,
- local anesthetic (topical) + sedation, or
- a general anesthetic.

In 'local anesthetic (topical) alone' situation, a local anesthetic gel (lignocaine) is squeezed(rather than 'injected') into the urethra & massaged in to facilitate even spread.This is then allowed to act for about 15-30 minutes.Procedure may then begin.

Similar procedure along with an anxiolytic/sedative occurs in the case of local anesthetic (topical) + sedation.To comprehend, this needs some explaining.

American Society of Anesthesiologists' definition of levels of sedation is as follows.

Level 1- Minimal sedation (anxiolysis): a drug-induced state during which a patient responds normally to verbal commands.

Level 2- Moderate sedation/analgesia (conscious sedation): a drug-induced depression of consciousness during which a patient responds purposefully to verbal commands, either alone or with light tactile stimulation.

Level 3- Deep sedation/analgesia: a drug-induced depression of consciousness during which a patient can't be easily aroused, but responds purposefully following repeated or painful stimuli.

Level 4- Anesthesia: includes general anesthesia and spinal or major regional anesthesia but not local anesthesia. General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even while painful stimuli are applied.

If the procedure is done in an out-patient setting, the anesthesiologist may prefer to use levels 1 or 2.
If the procedure is performed in the operating room, the preferred levels may be
3 or 4.

Thus, the ultimate decision on the choice of sedation rests with the anesthesiologist.
Best wishes!
 MysticFusion - Mon Jul 05, 2010 4:02 am

Okay, not the answer I was hoping for, but thank you very much for taking the time to answer!
 Dr.M.Aroon kamath - Sun Jul 25, 2010 5:06 am

User avatar Hi MysticFusion,
Thank you for keeping in touch. You are at liberty to discuss with your urologist and the anesthesiologist about your preferences. If, after examining you and going through your past history etc, there is a chance they may accede to your preference.Generally, a patient's preferences regarding anesthetic preferences are sympathetically listened to and even accepted if the anesthesiologist is satisfied about the safety aspect.
Best wishes!

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