Efficacy of the Act of Urination to Relief the Pain During Flexible Cystoscopy Procedure.

This research is about modification during routine cystoscopy (scope in the bladder) procedure [ experimental research ]. The goal of the study is to evaluate patient experience with cystoscopy by using procedural modification to reduce pain perception. The investigator aim for quality improvement of the current methods of cystoscopy to achieve a better patient experience.

Study Area -Department of Urology, Hospital Universiti Sains Malaysia. Study population. -Patient who is required for flexible cystoscopy procedure attending Urology Unit in Hospital USM Participants Inclusion Criteria : • Adult (>18 years old) Exclusion criteria: Analgesic use within 24hours History of stricture ,urinary tract infection, existing urethral pain Secondary procedure(example stent, stone removal, fulguration) Withdrawal Criteria Change of mind Found to be outside the parameters of inclusion criteria, and inside the parameters of exclusion criteria Breach of Protocol

Cystoscopy procedure will be done based on cystoscopy protocol. During scope procedure patient will not giving instruction to urinate during the procedure.

Cystoscopy procedure will be done based on cystoscopy protocol. During scope procedure, patient will be ask to urinate and this will lead to contraction of urinary bladder and relaxation of external urethral sphincter. Scope will then pass through external urethral sphinter and go to the urinary bladder

Cystoscopy procedure will be done based on cystoscopy protocol. During scope procedure, patient will be ask to urinate and this will lead to contraction of urinary bladder and relaxation of external urethral sphincter. Scope will then pass through external urethral sphinter and go to the urinary bladder

1)To determine the efficacy of the act of urination in reducing patient urethral pain during flexible cystoscopy procedure.

To determine the efficacy of the act of urination , we will use visual analogue score (VAS) , subjective assessment for assessing the patient pain score.

2)To determine the association between the act of urination with relaxation of external urethral sphincter during flexible cystoscopy procedure.

We will use electromyography (EMG) as objective assessent to determine association between act of urination and relaxation of external urethral sphinter.

Inclusion Criteria: age more 18 years old Exclusion Criteria: Analgesic use within 24hours History of stricture ,urinary tract infection, existing urethral pain Secondary procedure(exp stent, stone removal, fulguration)