Interventions to decrease pain and anxiety in patients undergoing urodynamic testing: A randomized controlled trial

The Effect of Different Education Methods Before Invasive Urodynamics on Patients' Anxiety, Pain, Readiness and Satisfaction Levels: Randomized Controlled Clinical Trial

BACKGROUND

Urodynamic testing is an invasive procedure that causes pain and anxiety. Patient education is an evidence-based nursing intervention that relieves pain and anxiety and increases patient satisfaction.

AIMS

This study was carried out to compare the effects of different education methods utilized before a urodynamic testing procedure on patients' pain, anxiety, readiness for the procedure, and satisfaction.

METHODS

The study is a randomized controlled clinical trial. Participants (n = 80) were randomly assigned to four groups. While patients in the control group were provided with routine clinical information, patients in the intervention group were given education with brochures, videos, and brochure-supported videos. The research data were collected by using a Data Collection Form with items about participants' descriptive characteristics, the Visual Analog Scale, and the State Anxiety Inventory.

RESULTS

It was determined that pain expectation before urodynamics and the severity of pain during urodynamics were lower in intervention groups than in the control group. Pain expectation before urodynamics was lower in the brochure-supported video education group than in the brochure education group. Anxiety levels were lower and satisfaction levels were higher in the video education and brochure-supported video education groups than in the control and brochure education groups.

CONCLUSIONS

Of the methods utilized, it was determined that the most effective one was brochure-supported video education as it affected all parameters positively.

The Effect of Running Water Sound Listened to Patients During Urodynamics on Anxiety and Urodynamic Parameters

PURPOSE

This study was conducted to determine the effect of listening to the sound of running water during urodynamics on the patient's anxiety and parameters in the pressure-flow study.

METHODS

The population of the study, which was planned in the nonrandomized experimental study design, consisted of patients who will undergo urodynamics in the Urology Department of a city hospital in Istanbul between September 2022 and January 2023, and the sample consisted of 60 patients, 30 of which were in the experimental group and 30 in the control group. During the pressure-flow study, the patients in the experimental group listened to the sound of running water from a smartphone, while the patients in the control group did not undergo any intervention during urodynamics. The level of anxiety in both groups before, during and after urodynamics was evaluated with the visual analogue scale. During the pressure-flow study, it was evaluated whether the patients emptied on command, and the maximum flow rate (Qmax) and the detrusor pressure at the maximum flow rate (PdetQmax) were measured. Bladder outlet obstruction index (PdetQmax-2Qmax) and bladder contractility index (Pdetqmax+5Qmax) were calculated using these values.

RESULTS

During the pressure-flow study, in the experimental group patients who listened to the sound of running water from a smartphone; anxiety level mean scores during and after urodynamics were found to be statistically significantly lower than the control group patients (P < 0.001). The mean bladder contractility index score in the experimental group patients was statistically significantly higher than the control group patients (P < 0.001), and the cases of urinating with a catheter during the pressure-flow study were statistically significantly higher than the control group patients (P < 0.001).

CONCLUSION

Listening to the sound of running water during urodynamics had a positive effect on reducing anxiety in patients and micturating during pressure-flow study.

Acceptability and perceived value of urodynamics from the patient perspective: A narrative review

Background

The value and application of urodynamic evaluation (UDS) have been a controversial topic in recent years. Gaining robust data on the patient viewpoint in this area is important since, even when UDS findings do not change the management plan, the objective diagnostic information gained from UDS may be valued by patients. Moreover, insights from UDS may empower treating physicians to counsel patients more effectively and manage their expectations regarding treatment outcomes.

Objective

This expert narrative review aims to analyze the findings of published studies in this area, looking at two topics in turn: (a) the tolerability and acceptability of the UDS procedure itself from the patient perspective and (b) patient perceptions of the clinical value of insights provided by UDS.

Design, Setting, Participants, and Outcome Measurements

An evidence assessment was conducted using selected articles from the literature reporting data on patients' perspectives on the tolerability, acceptability, utility, and value of the urodynamic investigation.

Results and Limitations

Although pain, discomfort, and infection risks are frequently used as a rationale to skip UDS when initial management fails, there is good evidence that, from the patients' perspective, the procedure is very well tolerated in most cases. There are only a few articles available that assess patient perceptions of the usefulness of UDS, but those that do exist appear to demonstrate that the insights gained from UDS are widely welcomed by patients in the interest of receiving a more tailored and personalized treatment approach.

Conclusion

From the patient perspective, UDS appears to be a well‐accepted and well‐tolerated diagnostic tool in patients with lower urinary tract symptoms, particularly when an appropriate explanation is provided before the examination. Our review also highlights that patients value the objective information provided by UDS and that this outweighs the temporary invasiveness of the test. This information is particularly relevant in light of the relative lack of evidence in the literature about patient expectations of specialist care in functional urology, which may have hindered progress with quality of care.

Periurethral Lidocaine Does Not Decrease Pain After Urodynamic Testing in Women: A Double-Blinded Randomized Control Trial

OBJECTIVE

Urodynamic testing of women is a common procedure to evaluate lower urinary tract symptoms but may cause discomfort. The objective of our study was to determine the effect of externally applied periurethral 2% lidocaine gel on pain scores after complex urodynamic testing in women.

METHODS

This prospective, double-blinded, placebo-controlled randomized trial compared 2% lidocaine gel to water-based lubricant applied to the periurethral area before urodynamic testing in women. Discomfort was measured using a visual analog pain scale (VAS) ranging from 0 to 100. The primary outcome was the difference in VAS from baseline to 4 to 6 hours after urodynamic testing. Secondary outcomes included: VAS difference from baseline to immediately postprocedure and 24 hours after urodynamic testing; VAS scores: at baseline, immediately postprocedure, after 4-6 hours, and after 24 hours; urodynamic testing results; and any adverse events. Sixty-four women per group were needed to provide a power of 80% to detect a 10-mm difference on a 100-point VAS.

RESULTS

From January 2018 to March 2019, 134 subjects were randomized, 6 subjects were excluded, which resulted in 64 subjects in both the water-based lubricant group and 2% lidocaine gel group. There was no difference in baseline demographics. There was no significant difference in the change in VAS from baseline to 4 to 6 hours after UDT (0, 0 P = 0.88). No difference in secondary outcomes was noted.

CONCLUSIONS

Topically applied 2% lidocaine gel does not decrease pain compared with water-based lubricant. For most women, complex urodynamic testing is not associated with any significant pain.Clinical Trial Registration:www.ClinicalTrials.gov,-NCT03390790, "Lidocaine for Pain After Urodynamic Testing".

Analysis of pain perception associated with urodynamic testing in children over 3 years old

OBJECTIVE

To measure the tolerance of urodynamic testing (UDT) in the pediatric patient by means of the Visual Analog Scale (VAS). To analyze which clinical and UDT-related variables influence pain perception.

MATERIAL AND METHODS

Cross-sectional study of 139 pediatric patients undergoing UDT (December 2013 - May 2018).

INCLUSION CRITERIA

understanding and expressing their experience after UDT (preschool and school age). No adolescents were included. Measurement instrument Visual Analog Scale (0-10). Other clinical and UDT-associated variables were obtained.

STATISTICAL ANALYSIS

Mann-Whitney U test, Kruskal Wallis test. Spearman's rank correlation analysis (rs). Multivariate analysis through ordinal logistic regression. Significance p < 0.05.

RESULTS

Mean age 7.7 years (SD 2.4), median VAS score, 2 (2-6). In 41% (n = 57), the score was ≥ 4 (moderate pain). Multivariate analysis. Explanatory variables for obtaining a high VAS score: high APUDT score (identifying patient anxiety prior to UDT), sensory-motor alteration in the lower limbs, difficult bladder catheterization and the appearance of pain during the filling phase. Age and duration of the UDT have not influenced the VAS score.

CONCLUSIONS

Although the UDT has resulted in 40% of the pediatric patients in our study expressing discomfort or pain, it is a well-tolerated test. The variables that have influenced on pain perception were patient's anxiety prior to UDT, a sensory-motor alteration located in the lumbosacral metameres, difficult bladder catheterization and the appearance of pain during bladder filling.

Lavender Aromatherapy for Anxiety and Pain During Multichannel Urodynamics: A Randomized Controlled Pilot Trial

OBJECTIVE

Our objective was to determine if there is a difference in anxiety during urodynamics in women given lavender aromatherapy (lavender) versus placebo.

METHODS

This was a randomized, controlled trial of women scheduled for urodynamic testing with baseline anxiety. Participants rated their anxiety and pain immediately before the examination and then were randomized to lavender or placebo. Anxiety and pain were assessed immediately after catheter placement and 15 minutes after termination of the study.

RESULTS

Data for 40 women who received lavender and 38 women who received placebo were available for analysis. Decrease in anxiety from baseline to catheter placement (-2 vs -0.5, P = 0.01) and 15 minutes post procedure was significantly greater in the lavender group. Postprocedure anxiety was lower in the lavender group compared with controls (0 vs 0.5, P = 0.001). No differences were seen in pain.

CONCLUSIONS

Lavender aromatherapy reduces anxiety during urodynamics.

A Telephone Call to Decrease Patient Anxiety Before Urodynamic Testing: A Randomized Controlled Trial

OBJECTIVE

The aim of this study was to determine if a telephone call before undergoing urodynamic study (UDS) would decrease test-related anxiety compared with standard care.

METHODS

We performed a randomized controlled trial at a single practice from April 2016 to June 2017. Patients at least 18 years old with lower urinary tract dysfunction and undergoing UDS for the first time were eligible. All participants received standard counseling; participants randomized to the intervention group also received a telephone call before their UDS appointment to answer any questions regarding their upcoming test. All participants completed surveys before and after testing to assess anxiety, preparedness, and satisfaction. The primary outcome was anxiety level immediately before UDS. Secondary outcomes included self-reported patient preparedness, pain, and satisfaction with counseling. Data were compared using χ, Fisher exact, and Wilcoxon rank sum tests.

RESULTS

One hundred two participants were included in this as-treated analysis: 52 in the intervention group and 50 in the standard care group. The 2 groups were similar in age, ethnicity, and the proportion seeking additional information before testing. There were no statistically significant differences between groups with respect to overall anxiety, anxiety regarding specific elements of the test, or anticipated pain (all P ≥ 0.19). Participant satisfaction with pre-UDS counseling was significantly higher in the intervention group (80.8%) compared with the standard care group (54.0%; P = 0.002).

CONCLUSIONS

Our study showed that a telephone call before undergoing UDS did not decrease anxiety compared with standard care; however, the telephone call was associated with higher satisfaction with pre-UDS counseling.

Audiovisual stimulus during urodynamics to provoke detrusor overactivity: A randomized trial

OBJECTIVE

This study estimated the effect of adding an audiovisual (AV) intervention during urodynamic evaluation (UDE) on increasing detrusor contractions (DO) versus routine UDE testing without AV cues.

METHODS

A randomized trial was conducted of women with overactive bladder (OAB) undergoing UDE with and without AV intervention. The AV intervention was a 1-minute video on continuous loop showing common OAB triggers. A continuous running waterfall provided auditory stimulation. The primary outcome was the proportion of patients who had DO on UDE, interpreted by masked clinicians. Secondary outcomes included the number, amplitude, and duration of DO and urinary leakage associated with DO. A sample size of 109 per group was calculated to have 80% power to detect a 20% difference with a significance level of 0.05.

RESULTS

In all, 109 women each were randomized to standard UDE and to the AV intervention. There was no difference in the proportion of patients with DO on UDE between the intervention and control groups (35% vs 32%, respectively; P = 0.8). Furthermore, there were no differences between the intervention and control groups in leakage with DO on UDE (24% vs 21%, respectively), mean duration of detrusor contractions (23.9 vs 25.3 s, respectively), or mean maximum detrusor pressure during involuntary contractions (18.1 vs 20.6 cm H₂ O, respectively). Clinical severity of OAB symptoms was not associated with the detection of DO or other UDE parameters.

CONCLUSIONS

Addition of AV intervention during UDE did not increase the finding of detrusor contractions. The relationship between OAB triggers, urge incontinence, and urodynamic findings remains unclear.

Standardizing music characteristics for the management of pain: A systematic review and meta-analysis of clinical trials

PURPOSE

To evaluate if music characteristics like tempo, harmony, melody, instrumentation, volume, and pitch, as defined by musical theory, are described in randomized clinical trials (RCTs) evaluating the effects of music-listening on the quantified pain perception of adults, and if these characteristics influence music's overall therapeutic effect.

METHODS

A systematic review and meta-analysis of RCTs evaluating music-listening for pain management on adults was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. The databases Pubmed, Scopus, SCIELO, SpringerLink, Global Health Library, Cochrane, EMBASE, and LILACS were searched. Studies published between 2004 and 2017 with quantified measurements of pain were included. Quality was evaluated using the Scottish Intercollegiate Guidelines Network methodology checklist for RCT, and effect sizes were reported with standardized mean differences.

RESULTS

A total of 85 studies were included for qualitative analysis but only 56.47% described at least one music characteristic. Overall meta-analysis found a significant effect, with high heterogeneity, of music for pain management (SMD -0.59, I2 = 85%). Only instrumentation characteristics (lack of lyrics, of percussion or of nature sounds), and 60-80 bpm tempo were described sufficiently for analysis. All three instrumentation characteristics had significant effects, but only the lack of lyrics showed an acceptable heterogeneity.

CONCLUSIONS

Results show that music without lyrics is effective for the management of pain. Due to insufficient data, no ideal music characteristics for the management of pain were identified suggesting that music, as an intervention, needs standardization through an objective language such as that of music theory.

Trained and dedicated staff appears to be the main factor in decreasing anxiety and improving overall satisfaction during urodynamic testing: A prospective, randomized trial

INTRODUCTION

We sought to determine whether listening to patient-selected music during urodynamic study (UDS) reduced pain and anxiety while increasing overall patient satisfaction and willingness to repeat the procedure.

METHODS

Fifty-one (51) patients who underwent UDS from March to July 2014 were randomized into two groups: Group 1 with patient-selected music during the procedure (n=27) and Group 2 without music (n=24). Standard multichannel filling cystometry was performed. Anxiety was self-assessed using the State Trait Anxiety Inventory, while overall pain, satisfaction, and willingness to undergo the procedure again were self-measured using a visual analogue scale.

RESULTS

Demographic characteristics and reasons for testing were similar between the two groups. The state score for Groups 1 and 2 were 27.04 and 29.5, respectively (p=0.3225) and 31.78 and 33.86, respectively (p=0.4970) for the trait score. The mean pain scores were 1.04 and 1.57, respectively (p=0.2047); the mean satisfaction scores were 0.65 and 0.52, respectively (p=0.8169); and the scores for willingness to undergo the procedure again were 0.77 and 0.74, respectively (p=0.9442). While there were no significant differences between the two groups in anxiety and satisfaction scores, pain, and willingness to undergo the procedure again, both groups commented on the nurse as the most important factor in their overall comfort.

CONCLUSIONS

Music during UDS did not appear to lower pain and anxiety, nor increase overall satisfaction and willingness to repeat the procedure. The most important aspect in alleviating patients' pain and anxiety was the person actually performing the testing, highlighting the importance of having trained and dedicated staff.