Anxiety and depression analyses of patients undergoing diagnostic cystoscopy.

PURPOSE: To prospectively assess anxiety and depression in patients undergoing diagnostic cystoscopy. METHODS: Patients presenting for outpatient diagnostic cystoscopy were recruited from four European urological departments. Anxiety and depression were assessed with the 'Hospital Anxiety and Depression Scale' (HADS) before cystoscopy and after 1 week. Statistical analyses, including the Chi-square test, univariate, and multivariate logistic regression analyses, were carried out with SPSS v. 21 (IBM Corp., Armonk, NY). RESULTS: Prior to cystoscopy, 30.2 % of patients were anxious and 24.8 % depressive (n = 442). In the post-examination period, anxiety declined to 24.5 %, while depression was unchanged (24.4 %). Pre-cystoscopy anxiety was significantly more common in women (41.8 vs. 24.5 %, p < 0.0001), patients aged <65 years (34.9 vs. 25.9 %, p = 0.04), and in those being examined with rigid cystoscopes (35.7 vs. 23.9 %, p = 0.007). In multivariate regression analyses, female gender (OR 2.6, p < 0.0001), <65 years of age (OR 1.7, p = 0.03), and coexistence of depression (OR 7.8, p < 0.0001) were independently associated with elevated pre-cystoscopy anxiety. Anxious (OR 2.1, p = 0.03) and depressive (OR 2.1, p = 0.01) patients had higher odds of experiencing moderate or severe pain during cystoscopy. Bladder cancer diagnosis did not significantly change patient's anxiety (p = 0.23) or depression (p = 0.7) during the 1 week of follow-up. CONCLUSIONS: Women, patients aged <65 years, depressive patients and those being examined with rigid devices had higher rates of anxiety prior to cystoscopy. Anxious and depressive patients experienced more pain during cystoscopy. Bladder cancer diagnosis seems to have a minor effect on anxiety and depression during the first week after diagnosis.

Prospective, multi-institutional pain assessment of 150 women undergoing diagnostic cystoscopy.

BACKGROUND: The aim of this study was to prospectively assess women's pain during rigid and flexible diagnostic cystoscopy and afterwards during a one-week follow-up. METHODS: Prospective, multi-institutional trial analyzing numeric rating scales (NRS) of women undergoing diagnostic cystoscopy. Pain categories: no (0 points), mild (1-3), moderate (4-6) and severe pain (7-10). Assessing of pain before, during cystoscopy, and at day 1, 4 and 7 of follow-up. RESULTS: A total of 150 women undergoing rigid (N.=85) or flexible (N.=65) diagnostic cystoscopy were analyzed. Women undergoing flexible cystoscopy were more frequently pain-free (64.6% vs. 40%, P=0.003) and experienced mild pain less frequently (27.7% vs. 52.9% vs. P=0.002). No significant differences were noted among moderate (6.2% vs. 5.9%, P=0.95) and severe pain (1.5% vs. 1.2%, P=0.85). Patients undergoing their first (P=0.14) and repeat cystoscopy (P=0.08) had similar pain perception. In multivariate logistic regression analyses, women undergoing flexible cystoscopy had a 2.6 increased chance of being pain-free (OR=2.6, CI: 1.28-5.11, P=0.08) and their odds of experiencing mild pain were significantly lower (OR=0.34, CI: 0.17-0.71, P=0.004). The likelihood of experiencing moderate (OR=1.1, CI: 0.28- 4.4, P=0.83) or severe pain (OR=2.42, CI: 0.11-51.79, P=0.57) differed insignificantly. CONCLUSIONS: Rigid and flexible cystoscopies were well-tolerated by most women. However, flexible cystoscopy was associated with a higher likelihood of being pain-free and lower chances of experiencing mild pain. Patients' previous experience with cystoscopy did not influence pain perception.

Prospective multi-institutional study analyzing pain perception of flexible and rigid cystoscopy in men.

OBJECTIVE: To evaluate pain perception in men undergoing flexible or rigid diagnostic cystoscopy. METHODS: This is a prospective multi-institutional analysis of men undergoing cystoscopy in 4 European departments of urology. Pain perception was assessed with an 11-point numeric rating scale. Pain categories were as follows: no (0 points), mild (1-3), moderate (4-6), and severe pain (7-10). Assessment of pain was before, during cystoscopy, and at days 1, 4, and 7 of follow-up. RESULTS: A total of 300 cystoscopies were analyzed (150 rigid and 150 flexible). Men undergoing flexible cystoscopy were more frequently free of pain (58.7% vs 24%; P <.0001). Mild pain (54% vs 30.7%; P <.0001) and moderate pain (18.7% vs 9.3%; P = .02) were more common with rigid devices. No significant differences were prevalent in severe pain perception (3.3% vs 1.3%; P = .25). Patients, who had previous experience with cystoscopy reported similar pain levels as patients naïve to cystoscopy, regardless if rigid (P = .92) or flexible (P = .26) devices were used. Pain decreased to the baseline during the 1-week follow-up after both, flexible and rigid cystoscopy. In multivariate regression analyses, rigid cystoscopy was an independent predictor for not being pain free (odds ratio [OR] = 0.15; confidence interval [CI] = 0.08-0.28; P <.0001), for experiencing mild pain (OR = 2.57; CI = 1.57-4.19; P <.0001), and for moderate pain (OR = 2.39; CI = 1.13-5.07; P = .02). Severe pain was seldom with both devices, and thus, no statistical difference was found. CONCLUSION: Flexible diagnostic cystoscopy caused less pain than rigid cystoscopy in men. Patient's previous experience with cystoscopy did not influence pain sensation. The type of cystoscope itself was identified as an independent risk factor of pain perception.