Does visualisation during urethrocystoscopy provide pain relief? Results of an observational study

Abstract

BackgroundTo measure the effects of real-time visualisation during urethrocystoscopy on pain in patients who underwent ambulatory urethrocystoscopy.MethodsAn observational study was designed. From June 2012 to June 2013 patients who had ambulatory urethrocystoscopy participated in the study. In order to measure pain perception we used a numeric rating scale (NRS) 0 to 10. Additional data was collected including gender, reason for intervention, use of a rigid or a flexible instrument and whether the patient had had urethrocystoscopy before.Results185 patients were evaluated. 125 patients preferred to watch their urethrocystoscopy on a real-time video screen, 60 patients did not. There was no statistically relevant difference in pain perception between those patients who watched their urethrocystoscopy on a real-time video screen and those who did not (p = 0.063). However, men who were allowed to watch their flexible urethrocystoscopy experienced significantly less pain, than those who did not (p = 0.007). No such effects could be measured for rigid urethrocystoscopy (p = 0.317). Furthermore, women experienced significantly higher levels of pain during the urethrocystoscopy than men (p = 0.032).ConclusionsVisualisation during urethrocystoscopy procedures in general does not significantly decrease pain in patients. Nevertheless, men who undergo flexible urethrocystoscopy should be offered to watch their procedure in real-time on a video screen. To make urethrocystoscopy less painful for both genders, especially for women, should be subject to further research.

Efficacy of urination in alleviating man’s urethral pain associated with flexible cystoscopy: a single-center randomized trial

“…In addition to the use of lubricants, more attention has been paid to non-pharmacological analgesic methods in recent years, including psychological and behavioral interventions. Patel & Zhang demonstrated that watching the examination process through closed-circuit television relieves urethral pain [6,7], but these findings were refuted in later studies [16,17]. Gunendran and coworkers found that squeezing brine bags significantly reduced pain and recommended the routine application of this procedure in males [18].…”

Efficacy of urination in alleviating urethral pain associated with flexible cystoscopy - a single-center randomized trial

“…In addition to the use of lubricants, more attention has been paid to non-pharmacological analgesic methods in recent years, including psychological and behavioral interventions. Patel & Zhang demonstrated that watching the examination process through closed-circuit television relieves urethral pain [6,7], but these findings were refuted in later studies [15,16]. Gunendran and coworkers found that squeezing brine bags significantly reduced pain and recommended the routine application of this procedure in males [17].…”

Intervenciones no farmacológicas para la disminución del dolor en cistoscopia

“…Como el dolor es un compuesto de una experiencia entera influenciada por muchos factores diferentes, se busca un método de distracción alterno. 13 Patel y asociados., informó que los hombres a quienes se les permitió ver la cistoscopia en el monitor de video, tenían significativamente menor nivel de dolor < 40% que aquellos que no miraron el procedimiento en el monitor. 14 Koenig y asociados, por otro lado, diseñaron un estudio observacional prospectivo para medir el dolor experimentado por el paciente durante la uretrocistoscopía mientras se visualiza el procedimiento en una pantalla de video en tiempo real, comparada con los pacientes que no visualizaron su procedimiento.…”

“…Se concluyó que la visualización en tiempo real por sí sola no hace que la uretrocistoscopía sea menos dolorosa. 13 Esa conclusión fue comparable con el estudio de Erik y asociados realizado en 154 hombres en quienes se realizó la cistoscopia flexible, aleatorizados en dos grupos: aquellos en el grupo 1 (77 personas) se les permitió ver la pantalla de video junto con el urólogo durante el procedimiento; a los del grupo 2 (77 personas), no se les permitió ver el procedimiento en la pantalla. Los resultados no demostraron diferencias en cuanto a la reducción del dolor en la escala EVA.…”

“…14 Lo que genera la necesidad de estudios que avalen si el uso de la música por sí solo genera o no mejoría en la escala del dolor o si requiere el acompañamiento de otros métodos de distracción. 13,14 Aumento de la Presión Hidrostática A pesar del uso del cistoscopio flexible aún se percibe dolor y se cree ocurre principalmente al atravesar el esfínter externo, la próstata y el cuello de la vejiga. Es por ello que se realizó un estudio aleatorizado, simple ciego, en el que se propuso demostrar que el aumento la presión hidrostática "Bolsa Squeeze" durante la cistoscopia flexible, mejora la comodidad del paciente permitiendo así abrir la uretra bulbar y el esfínter urinario externo.…”