Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transl Med. Apr 12, 2015; 4(1): 38-43
Published online Apr 12, 2015. doi: 10.5528/wjtm.v4.i1.38
Modern advances in reducing anxiety and pain associated with cystoscopy: Systematic review
Hossein S Mirheydar, Omer A Raheem, Fuad F Elkhoury, Ramzi Jabaji, Kerrin L Palazzi, Nishant Patel, Rogelio Du, Scott Maroney, Kyoko Sakamoto
Hossein S Mirheydar, Omer A Raheem, Kerrin L Palazzi, Nishant Patel, Kyoko Sakamoto, Department of Urology, UC San Diego Health System, San Diego, CA 92103-8897, United States
Fuad F Elkhoury, Ramzi Jabaji, San Diego School of Medicine, University of California, La Jolla, CA 92103-8897, United States
Rogelio Du, Scott Maroney, Kyoko Sakamoto, VA San Diego Healthcare System, San Diego, CA 92103-8897, United States
Author contributions: Mirheydar HS, Elkhoury FF, Jabaji R, Patel N, Du R, Maroney S and Sakamoto K contributed to conception and design; Palazzi KL contributed to acquisition of data, analysis and interpretation; all authors contributed to drafting the article and final approval; Mirheydar HS, Raheem OA and Sakamoto K contributed to critical revision.
Ethics approval: The study was reviewed and approved by the University of California, San Diego Human Research Protections Program Institutional Review Board (IRB).
Clinical trial registration: This study is registered at University of California, San Diego and the Veterans Administration San Diego Healthcare System. The registration identification number is H120134.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no conflicts of interest.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at email address: kyoko.sakamoto@va.gov. All participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kyoko Sakamoto, MD, Department of Urology, UC San Diego Health System, 200 West Arbor Dr. #8897, San Diego, CA 92103-8897, United States. kyoko.sakamoto@va.gov
Telephone: +1-858-5528585 Fax: +1-619-543-6573
Received: July 23, 2014
Peer-review started: July 23, 2014
First decision: December 17, 2014
Revised: January 23, 2015
Accepted: March 4, 2015
Article in press: March 5, 2015
Published online: April 12, 2015
Processing time: 265 Days and 12.9 Hours
Abstract

AIM: To investigate if music reduces anxiety and pain in the Veterans Affairs population undergoing flexible cystoscopy.

METHODS: This study was reviewed and approved by the University of California, San Diego Human Research Protections Program Institutional Review Board. Patients were prospectively randomized to undergo flexible cystoscopy with or without music. Thirty-eight patients were randomized into either the No Music group (n = 24) or the Music group (n = 14). We used the state-trait anxiety inventory and the visual analog pain scale, respectively. Statistics were generated and compared using an independent t-test and chi-squared tests. P values < 0.05 were considered statistically significant. Outpatient cystoscopy is a safe and useful procedure employed frequently in Urology for diagnosis and evaluation of genitourinary pathologies. However, cystoscopy-related distress cannot be ignored. Three components of outpatient cystoscopy have been evaluated to improve the cystoscopic experience: local anesthetic control, cystoscopic equipment redesign and environmental modification. We reviewed the literature pertaining to these modifications.

RESULTS: The mean age was 65.3 and 67.1 years for men in the No Music and Music groups, respectively. Although, the majority of patients in each group self-identified as Caucasians (66%), African American, Hispanic and other ethnicities represented 13%, 8% and 13% respectively. The majority of patients (68%) reported experiencing hematuria. Thirty-four percent had a history of bladder cancer, and eighteen percent had a history of prostate cancer. Ten patients (26%) admitted to taking antidepressants. Physiologic parameters that correlated to pain and anxiety (systolic blood pressure, diastolic blood pressure, and heart rate) were statistically similar in both groups prior to and after flexible cystoscopy. The median delta anxiety between the No Music and Music groups were not significantly different (0.78 vs -1.46), and the pain scores between the No Music and Music groups (1.5 vs 1.6) were not statistically different (P = 0.28 and P = 0.92, respectively).

CONCLUSION: Preliminary results demonstrate that music does not reduce anxiety or pain associated with flexible cystoscopy.

Keywords: Flexible cystoscopy; Veterans; Anxiety; Music

Core tip: Flexible cystoscopy is a very common in-office procedure performed in urology. There have been several technological advances made in the instrumentation of flexible cystoscopies, however, there have also been advances made in reducing patient pain and anxiety associated with this procedure such as viscous lidocaine jelly and music. We reviewed the literature on effects of modifiable factors on patient pain and anxiety associated with flexible cystoscopy, and also includes preliminary data on a Veterans Affairs randomized prospective trial evaluating the effect of classical music on pain and anxiety associated with flexible cystoscopy.