Diclofenac vs placebo in men undergoing dj stent removal- a randomized double-blinded study

Introduction: Double J (DJ) stent removal requires local anesthesia and is done using rigid cystoscope. Patients experience significant pain during and after the procedure. We assessed the efficacy of preemptive oral diclofenac in analgesia for patients undergoing DJ stent removal by rigid cystoscopy compared to placebo. Methods: Only male patients undergoing DJ stent removal under local anesthesia between March 2017 and July 2018 were enrolled. Patients were randomized to receive 50 mg oral diclofenac (Group A) or placebo (Group B) 1 hour before procedure by randomization. Intraurethral 2% lignocaine gel (25 ml) was used in both groups. Pain during rigid cystoscopy, pain at the first void, and at 1 day after cystoscopy was assessed using visual analog scale (VAS) (0–100). Adverse reactions to diclofenac and episodes of acute urinary retention, if any, were assessed. Results: Totally 121 males (Group A [n = 62]; Group B [n = 59]) underwent stent removal. The median (Interquartile range) VAS during the procedure in Group A was 30 (30) and Group B was 60 (30) (P< 0.001), at first void was 30 (30) and 70 (30) (P< 0.001) and at 24 h postoperatively was 20 (20) and 40 (20) (P< 0.001). The incidence ofside effects was comparable in the two groups (P> 0.05). Conclusions: A single oral dose of diclofenac 1 h before DJ stent removal using rigid cystoscope under intra-urethral lignocaine anesthesia decreases pain significantly during and upto one day after the procedure,with minimal side effects.