Intravesical analgesia for ambulatory urologic procedures: a histopathological study

Background and objective: Local anesthetics and morphine have been reported to be useful for painful diagnostic procedures in the bladder. Tramadol has the potential for use as an intravesical analgesic. However, intravesical use of tramadol has not been described widely. Methods: This study was approved by the Animal Ethical Committee of Akdeniz University and performed with standard guidelines for care and use of laboratory animals. In this study we tested the histopathological effects of intravesical tramadol versus saline in 20 adult rats. The control group received intravesically 1 ml saline. Tramadol 50 mg (1 ml) was administered intravesically in the other group. Two hours later, all animals were sacrificed and their bladders were excised. Tissue samples were evaluated macroscopically and microscopically. The data were analyzed with χ² and Fisher’s χ² tests. Results: In all the specimens in the control group epithelial edema was seen. This finding may be explained by insertion of intravesical catheter and tissue trauma. Haemorrhagic necrosis of epithelium was observed in four cases only in the tramadol group. This finding demonstrated severe epithelial destruction. However, there was no statistically significant difference when compared with the control group. Conclusion: The technique of topical tramadol anesthesia may be very simple, useful and safe for bladder biopsies and cautery in many cases. However, the number of cases examined in this preliminary study after bladder instillation of tramadol was small. For this reason, the results obtained in this study regarding the histopathological effects of tramadol on the bladder, should be further investigated.