Modern advances in reducing anxiety and pain associated with cystoscopy: Systematic review

Feasibility and outcomes of interventions to reduce cystoscopy discomfort: a multi-site pilot study

OBJECTIVE

To investigate the feasibility and effectiveness of interventions aiming to decrease pain and anxiety during cystoscopy.

PATIENTS AND METHODS

A prospective study of 190 adults undergoing flexible office cystoscopy was conducted at the University of North Carolina and the University of Texas Southwestern from January to September 2023. Patients were offered 20 mL intraurethral 2% lidocaine with a dwell time of ≤10 or >10 min and either music on headphones or real-time cystoscopy visualisation. Patients declining the offered intervention were provided their requested study intervention. Outcomes included pain (visual analogue scale [VAS], pain intensity) and anxiety. Multivariable regression models controlled for age, sex, prior cystoscopies, bladder cancer surveillance, site, and intervention preferences. Feasibility was evaluated by patient acceptance of interventions.

RESULTS

Of 190 patients, 35% (66/190) declined their assigned intervention, with 8% (7/90) declining visualisation and 59% (59/100) declining music alone. Patients with prior cystoscopy were more likely to decline music (69%) than cystoscopy-naïve patients (31%). Visualisation was associated with lower reported pain on the VAS and anxiety than music. Patients receiving both music and visualisation reported the highest proportion of no-to-mild pain. Lidocaine dwell time did not significantly affect outcomes.

CONCLUSIONS

Allowing patients to visualise or listen to music during their office cystoscopy are simple, accessible means of reducing pain and discomfort with the procedure, particularly for cystoscopy-naïve patients.

A Randomized Controlled Trial on the Effect of Music Listening on Procedural Pain, Anxiety and Comfort Levels during Cystoscopy

This study aimed to determine the effect of music listening on procedural pain intensity, anxiety, and comfort levels in patients during cystoscopy. This study was a prospective, randomized controlled trial. Study participants were randomly assigned to either a control or music group. The outcome measures were assessed using the Visual Analogue Scale, State Anxiety Scale, and General Comfort Questionnaire. A total of 36 patients in each group completed the study. The mean scores of pain in the music and control groups immediately after cystoscopy were 3.22 (SD, 1.72) and 5.22 (SD, 1.92), respectively. A statistically significant difference (between-group effect) was found, indicating that pain scores in the music group were significantly lower than those of the control group (group: F = 15.756, p < .001). However, no statistically significant difference was noted between the two groups regarding anxiety and comfort scores 20 min after cystoscopy (t₁ = 1.156, p = .526; t₁ = -0.586, p = .560, respectively). Music listening is a safe, economical, and effective method in pain management in patients undergoing cystoscopy.

Music reduces patient-reported pain and anxiety and should be routinely offered during flexible cystoscopy: Outcomes of a systematic review

Objective: To conduct a systematic review of the literature to assess whether music reduces the use of analgesics and anxiolytics during flexible cystoscopy.

Methods: The systematic review was performed in line with the Cochrane guidelines and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The databases searched included the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, the Excerpta Medica dataBASE (EMBASE), Cochrane library, Google Scholar, and Web of Science from inception of the databases to February 2020. The primary outcome measure was the effect of music on pain and anxiety, and secondary outcome measures were patient heart rate and blood pressure.

Results: The initial search yielded 234 articles and after going through titles and abstracts, four studies (399 patients, 199 in the music group and 200 in no music group) were included for the final review. There were three randomised controlled trials and one prospective study published between 2014 and 2017. These studies were done in China, the USA and Italy, with the study duration between 9 and 24 months. All patients had 2% topical lignocaine jelly given per-urethra before the procedure. The choice of music was classical in three studies and a mixture of different music types in one study. Three of the four studies showed significantly reduced pain and anxiety with the use of music for flexible cystoscopy procedures. Heart rate was noted to be higher for the no music group, reflecting a higher pain perceived by these patients.

Conclusion: The present review showed that listening to music was associated with reduced anxiety and pain during flexible cystoscopy. Listening to music is therefore likely to increase procedural satisfaction and willingness to undergo the procedure again, considering repeated flexible cystoscopy is often needed for surveillance. As music is simple, inexpensive and easily accessible, it should be routinely offered to patients for outpatient and office-based urological procedures.

Abbreviations: IQR: interquartile range; NRS: numerical rating scale; PTSD: post-traumatic stress disorder; RCT: randomised control trial; STAI: State–trait Anxiety Inventory; VAS: visual analogue scale