Our quasi-randomized trial is by far the largest performed so far (404 patients recruited, versus 185, the second largest one). In this trial we tried hard to include all relevant variables, incorporating the strengths of previous similar trials and avoided the criticisms received by prior studies.
We believe that previous trials have shown a benefit because the number of previous cystoscopies has not been taken into account. In the next table, you can appreciate that all patients irrespective from the group (self-visualization or not) have a lower visual analog scale (VAS) score at their third (or more) cystoscopy. Probably meaning that patients have less anxiety and improved tolerance to the test be the mere fact of having had prior exposure to the procedure.
Some benefit was found in female patients with 3 or more cystoscopies and self-visualization, yet the sample is quite limited with only 42 females patients having a history of 3 or mores cystoscopies.
While this trial was practically negative, hopefully, this will trigger a search for other interventions which may diminish the perception of pain during cystoscopy and continue to improve our patient’s experience. Finally, we would recommend urologists to allow the patient to choose whether they want to see or not the screen, leaving the decision up to them.
Written by: Daniel A González-Padilla, MD, Department of Urology, University Hospital, Madrid, Spain
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