Randomized controlled trial of the effect of environment on patient embarrassment and anxiety with urodynamics.

INTRODUCTION AND HYPOTHESIS: In previous survey studies, women undergoing urodynamic testing (UDT) have reported bother and embarrassment and have provided suggestions for improving the experience. The suggestions include audio distraction and increased privacy, neither of which have been prospectively examined. We report a prospective randomized controlled trial to evaluate the hypothesis that an improved ambience can decrease UDT-related embarrassment and anxiety. METHODS: A total of 60 participants were recruited to achieve an 80% power to detect a conservative 20-point difference with a significance level of 0.05. Eligible participants were randomized to one of two conditions: dim lighting with light instrumental music (modified group, 30 patients), or no music and standard lighting (standard group, 30 patients). The aim of the dim lighting and music was to provide an increased sense of privacy and audio distraction based on participant feedback in previous studies. RESULTS: The study was complete with 60 participants. Patients in both groups reported less embarrassment after UDT. However, patients in the modified group showed a greater decrease in embarrassment scores (9.72 mm) than patients in the standard group (1.3 mm; p = 0.33). Although the study was under-powered, the difference found approached clinical significance. CONCLUSIONS: Simply dimming the lights and providing music during UDT resulted in a decrease in embarrassment scores of almost ten points. This low-cost and simple measure improved patient experience.

Provision of information leaflet before urodynamic study reduces the pre-examination anxiety level.

AIMS: To find out if information leaflets reduce anxiety levels before urodynamic studies (UDS). METHODS: One hundred and four patients (age 60 ± 15 years) who were referred for multichannel UDS were prospectively recruited and randomized into 2 groups: (1) received a leaflet containing detailed information regarding the examination; (2) did not receive a leaflet. Patients who were unable to complete the questionnaire due to mental disorders and patients who had previously undergone UDS were excluded. The leaflets were mailed to the patients in group 1 one month before the examination. This leaflet included information on how the examination would be performed, its purpose, recommended preparation, potential complications, and common events that might occur in association with the examination, such as incontinence. Emotional distress was measured by the State Anxiety Inventory (SAI)-a validated questionnaire composed of 20 items measuring anxiety. These measures are divided into two psychological domains: (1) positive well being; (2) psychological distress. Patients filled out the SAI immediately before entering the examination room. RESULTS: Demographics and clinical and psychological co-morbidities were similar between the groups. The "psychological distress" score was significantly lower in group 1 (13.1 ± 2.9 vs. 24.8 ± 5.8, P < 0.001), whereas there was no difference in the "positive well being" score. CONCLUSIONS: We recommend providing patients with an information leaflet on UDS since it significantly reduces anxiety levels. Neurourol. Urodynam. 35:805-808, 2016. © 2015 Wiley Periodicals, Inc.

Patient perceptions of physical and emotional discomfort related to urodynamic testing: a questionnaire-based study in men and women with and without neurologic conditions.

OBJECTIVE: To determine predictors of physical and emotional discomfort associated with urodynamic testing in men and women both with and without neurologic conditions. METHODS: An anonymous questionnaire-based study was completed by patients immediately after undergoing fluoroscopic urodynamic testing. Participants were asked questions pertaining to their perceptions of physical and emotional discomfort related to the study, their urologic and general health history, and demographics. Logistic regression was performed to determine predictors of physical and emotional discomfort. RESULTS: A total of 314 patients completed the questionnaire representing a response rate of 60%. Half of the respondents (50.7%) felt that the examination was neither physically nor emotionally uncomfortable, whereas 29.0% and 12.4% of respondents felt that the physical and emotional components of the examination were most uncomfortable, respectively. Placement of the urethral catheter was the most commonly reported component of physical discomfort (42.9%), whereas anxiety (27.7%) was the most commonly reported component of emotional discomfort. Presence of a neurologic problem (odds ratio, 0.273; 95% confidence interval, 0.121-0.617) and older age (odds ratio, 0.585; 95% confidence interval, 0.405-0.847) were factors associated with less physical discomfort. There were no significant predictors of emotional discomfort based on our model. CONCLUSION: Urodynamic studies were well tolerated regardless of gender. Presence of a neurologic condition and older age were predictors of less physical discomfort. These findings are useful in counseling patients regarding what to expect when having urodynamic procedures.

Patient and family impact of pediatric genitourinary diagnostic imaging tests.

PURPOSE: The impact of diagnostic genitourinary imaging on patients and families is poorly understood. We measured patient and family reaction to commonly performed genitourinary imaging studies using a standardized measurement tool. MATERIALS AND METHODS: We surveyed families undergoing genitourinary imaging (renal ultrasound, voiding cystourethrography, radionuclide cystogram, static renal scintigraphy and diuretic renal scintigraphy) using a Likert scaled 11-item survey to assess impact across 4 domains (pain, anxiety, time, satisfaction). Survey scores were analyzed using ANOVA and linear regression. RESULTS: A total of 263 families were surveyed (61 renal ultrasound, 52 voiding cystourethrogram, 55 radionuclide cystogram, 47 mercaptoacetyltriglycine dynamic renal scintigraphy, 48 dimercaptosuccinic acid static renal scintigraphy). Mean patient age was 2.1 years old. Of the patients 45% were male and 77% were white. Patient age, gender and prior genitourinary imaging experience varied by study type. Study type was significantly associated with total and weighted scores on the genitourinary imaging survey (both p <0.0001). Renal ultrasound was scored as better and mercaptoacetyltriglycine dynamic renal scintigraphy was worse than voiding cystourethrogram, radionuclide cystogram and dimercaptosuccinic acid static renal scintigraphy, which did not differ from each other. Other factors associated with worse total scores included patient age 1 to 3 years (p <0.001) and nonwhite race (p = 0.04). Gender, prior testing history, wait time and parent education were not associated with total scores. In the multivariate model renal ultrasound remained the best and mercaptoacetyltriglycine dynamic renal scintigraphy the worst (p <0.0001). In a direct comparison dimercaptosuccinic acid static renal scintigraphy and voiding cystourethrogram total scores did not differ (p = 0.59). CONCLUSIONS: There were significant differences among genitourinary imaging studies regarding the patient/family experience, but there was no overall difference between dimercaptosuccinic acid static renal scintigraphy and voiding cystourethrogram. These findings may be useful to aid decision making when considering genitourinary imaging for children.

[Effect of an urodynamic study on women with urinary incontinence]. / Impacto do estudo urodinâmico em mulheres com incontinência urinária.

OBJECTIVE: The purpose was to evaluate tolerance of patients with urinary incontinence undergoing an urodynamic study. METHODS: Forty nine patients with lower urinary tract symptoms submitted to an urodynamic study were evaluated... Prior to and immediately after the procedure each patient completed a self-administered questionnaire about several emotional variables, including anxiety, pain and shame. Answers about pain were given on a visual analog scale. Mean values of continuous variables were compared using a paired t-test, whereas categorical variables were compared using the chi-square test. RESULTS: The mean age was 49.5 (23-84) years. Pain score pre-procedure was 4.29 +/-3 and after procedure was 2.7+/-2.9 (p=0.001). CONCLUSION: The urodynamic study is well tolerated by female patients and a low morbidity was found. Previous orientation can decrease anxiety.

Prevalence of interstitial cystitis in a primary care setting.

In this article, we report a study that assessed the prevalence of interstitial cystitis (IC) in a primary care office using symptom-based and improved diagnosis-based assessment modalities. Over the course of 1 year, all patients > or = 18 years of age who presented for a primary care office visit were administered the Pelvic Pain and Urgency/Frequency (PUF) questionnaire. Patients with potential IC as indicated by PUF score were selected for further interview and, when appropriate, a Potassium Sensitivity Test (PST) or Anesthetic Bladder Challenge (ABC). Those given the PST were queried afterward regarding the tolerability of the test. Of 3883 patients initially surveyed, 13.1% (n +/- 509) reported PUF scores suggestive of probable IC, including 17.5% (357 of 2043) of women and 8.3% (152 of 1840) of men. Overall, 4.3% (168 of 3883) of patients in this primary care population was diagnosed with IC on the basis of history, PUF score, patient interview, and results of the PST or ABC. The PST was found to be comparable to, and in most cases less painful than, several standard office-based procedures. IC is a prevalent disease in the general primary care population. The PUF questionnaire represents an easy-to-use approach for IC symptom screening, and the PST and the ABC are useful and relatively noninvasive adjuncts in the diagnosis of IC.

Impacto do estudo urodinâmico em mulheres com incontinência urinária / Effect of an urodynamic study on women with urinary incontinence

OBJETIVO: Avaliar a tolerabilidade das pacientes com incontinência urinária submetidas ao estudo urodinâmico (EUD). MÉTODOS: Foram avaliadas 49 pacientes com queixas do trato urinário inferior submetidas ao estudo urodinâmico. Por meio de um questionário, as pacientes respondiam sobre seus anseios em relação ao exame a que iriam se submeter (medo, vergonha, ansiedade) e a expectativa de dor, por meio de uma escala visual analógica. Imediatamente após o estudo, as mesmas perguntas eram repetidas. Os resultados foram comparados antes e após a realização do EUD. A análise estatística das variáveis contínuas foi feita pelo teste t pareado, e as variáveis qualitativas foram comparadas pelo teste do Qui-quadrado. Fixou-se em 5 por cento a hipótese de nulidade. RESULTADOS: A média de idade foi de 49,5 (23-84) anos, sendo que 55 por cento estavam no menacme e 45 por cento na pós-menopausa. O principal sentimento antes do exame foi ansiedade, presente em 28 pacientes. A expectativa de dor foi de 4,29 ± 3 (antes do exame) e 2,7 ± 2,9 (após a realização do EUD) (p=0,001). CONCLUSÃO: O EUD apresenta baixa morbidade e desconforto psíquico. A informação prévia ao exame pode diminuir a ansiedade.

OBJECTIVE: The purpose was to evaluate tolerance of patients with urinary incontinence undergoing an urodynamic study. METHODS: Forty nine patients with lower urinary tract symptoms submitted to an urodynamic study were evaluated... Prior to and immediately after the procedure each patient completed a self-administered questionnaire about several emotional variables, including anxiety, pain and shame. Answers about pain were given on a visual analog scale. Mean values of continuous variables were compared using a paired t-test, whereas categorical variables were compared using the chi-square test. RESULTS: The mean age was 49.5 (23-84) years. Pain score pre-procedure was 4.29 ± 3 and after procedure was 2.7 ± 2.9 (p=0.001). CONCLUSION: The urodynamic study is well tolerated by female patients and a low morbidity was found. Previous orientation can decrease anxiety.