EAU 2019: A Randomized Controlled Trial of Modified Cystoscopy Technique to Decrease Patient’s Pain and Anxiety

Barcelona, Spain (UroToday.com) Peak end theory is a psychological principle in which patients judge their experiences based upon how they felt at its peak and end, rather than the sum or average of the experience.  In this abstract, the group felt that patients may associate pain, anxiety, and embarrassment with ambulatory, outpatient, cystoscopy.  They hypothesized that if the end of the cystoscopic procedure was improved, the patient's perception of pain and anxiety would improve as well.

This study randomized patients undergoing first-time ambulatory flexible cystoscopy into a control (standard cystoscopy) into an intervention arm.  Patients in the intervention arm had the cystoscope left in the bladder for an additional two minutes after the standard cystoscopy was complete without further manipulation.  Primary outcomes were pain and anxiety using the visual analogue scale.

The baseline demographics in both groups were similar, including male to female ratio, mean age, BMI, and pre-cystoscopy anxiety score.  In these preliminary results, post cystoscopy pain scores did not differ in both arms and did not demonstrate differences when subtyped by sex.  Post cystoscopy anxiety scores also did not generate significant improvement.  However, when subtyped by sex, males treated with the intervention arm demonstrated a statistically significant improvement in post cystoscopy anxiety score (p=0.013).

While we await the results and final analysis after full accrual, this preliminary data has some thought-provoking results.  Although there was no significant improvement in pain, men did have an improvement in anxiety with this newer, and longer technique.  However, an additional two minutes of cystoscopy time per patient may negatively influence workflow, clinic time, or scope turnover, especially in locations where clinic time, cystoscopes, physicians are highly in need.  It will be interesting to see how this group chooses to use its data to influence patient care in the future.

Presented by: Khalil Hetou, MD, Department of Urology, University of Western Ontario, London, Canada

Written by: David B. Cahn, DO, MBS, Fox Chase Cancer Center, Philadelphia, Pennsylvania, Twitter:@dbcahn at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.