Listening to Music during Outpatient Cystoscopy Reduces Pain and Anxiety and Increases Satisfaction: Results from a Prospective Randomized Study.

BACKGROUND: This study investigates the effect of classical music, music of patients' own choice, or no music on pain reduction during elective cystoscopy. OBJECTIVES: The aim of the study was to describe the effect of listening to classical music, music of patients' own choice, or no music on patient's pain and satisfaction rates when carrying out an elective cystoscopy and the effect on the assessment capability of the performing urologist. DESIGN, SETTING, AND PARTICIPANTS: This randomized trial included 127 patients undergoing elective cystoscopy at the Urological Department of the University Clinic of Munich between June 2019 and March 2020. Outcome Measurements and Statistical Analysis: Patients were assigned randomly to 3 groups: group I: listening to standardized classical music (n = 35), group II: listening to music according to the patients' choice (n = 34), and control group III: no music (n = 44). Prior to cystoscopy, anxiety levels were assessed by the Beck Anxiety Inventory (BAI). The Visual Analog Scale (VAS, range 1-100) was used for a self-assessment of pain, discomfort, and satisfaction. Statistical analysis was done with Spearman's rank correlation and t-tests. RESULTS AND LIMITATIONS: The median age was 63 (range 27-91) years. The duration of cystoscopy was 5.7 (1-30) min. Patients had undergone a median of 2.3 cystoscopies in the past. Between giving informed consent and cystoscopy, patients had to wait for a median of 64 (0-260) min. The median VAS pain score was significantly lower in group I at 1.7 and group II at 2.3 versus 5.2 in the control group III (p < 0.001). The control group III had significantly worse pain and patient satisfaction rates compared with groups I and II. Group I had a significant lower VAS pain score than groups II and III (p < 0.001). Classical music also increased the assessment capability of the preforming urologist. CONCLUSIONS: Listening to music during elective cystoscopy significantly reduces pain and distress and leads to higher patient and surgeon satisfaction. We recommend listening to classical music or music chosen by the patients during outpatient flexible/rigid cystoscopy in daily clinical routine. Patient Summary: In this study, we found that patients who listened to classical music or music of their own choice while undergoing a cystoscopy showed significant reduction of pain and distress.

Mixed-methods approach to exploring patients' perspectives on the acceptability of a urinary biomarker test in replacing cystoscopy for bladder cancer surveillance.

OBJECTIVES: To determine the minimal accepted sensitivity (MAS) of a urine biomarker that patients are willing to accept to replace cystoscopy and to assess qualitatively their views and reasons. PATIENTS AND METHODS: Patients were part of a prospective multicentre observational study recruiting people with bladder cancer for a urine biomarker study (DETECT II; ClinicalTrials.gov: NCT02781428). A mixed-methods approach comprising (1) a questionnaire to assess patients' experience with cystoscopy and patients' preference for cystoscopy vs urinary biomarker, and (2) semi-structured interviews to understand patient views, choice and reasons for their preference. RESULTS: A urine biomarker with an MAS of 90% would be accepted by 75.8% of patients. This was despite a high self-reported prevalence of haematuria (51.0%), dysuria/lower urinary tract symptoms (69.1%) and urinary tract infection requiring antibiotics (25.8%). There was no association between MAS with patient demographics, adverse events experienced, cancer characteristics or distance of patients' home to hospital. The qualitative analysis suggested that patients acknowledge that cystoscopy is invasive, embarrassing and associated with adverse events but are willing to tolerate the procedure because of its high sensitivity. Patients have confidence in cystoscopy and appreciate the visual diagnosis of cancer. Both low- and high-risk patients would consider a biomarker with a reported sensitivity similar to that of cystoscopy. CONCLUSION: Patients value the high sensitivity of cystoscopy despite the reported discomfort and adverse events experienced after it. The sensitivity of a urinary biomarker must be close to cystoscopy to gain patients' acceptance.

The use of a heating pad to reduce anxiety, pain, and distress during cystoscopy in female patients.

INTRODUCTION AND HYPOTHESIS: This study evaluated the effects of using a heating pad during cystoscopy on anxiety, pain, and distress in female patients. METHODS: Seventy-four female patients who underwent rigid cystoscopy between January 2017 and August 2017 were randomized to either the experimental group using a heating pad (n = 37) or the control group using a pad without heat (n = 37). In the experimental group, a heating pad was applied to the patient's sacrum during cystoscopy. All patients completed the State-Trait Anxiety Inventory-S (STAI-S, 20-80) before and after the procedure and assessed their degree of pain and distress after the procedure using a visual analog scale (0-10). Systolic and diastolic blood pressure and pulse rate were also measured before and after the procedure. RESULTS: Demographic characteristics, mean age, procedure duration, and pre- and post-procedural systolic and diastolic blood pressures and pulse rate were statistically similar between the experimental and control groups. The mean STAI-S score of the experimental group was significantly lower than that in the control group (33.1 ± 10.1 vs 48.2 ± 11.1, p < 0.001). The experimental group had significantly lower pain and distress scores (visual analog scale, 3.8 ± 1.6 and 3.8 ± 1.8 respectively,) than the control group (6.4 ± 1.9 and 6.3 ± 2.1 respectively, both p < 0.001). CONCLUSIONS: Using a heating pad during cystoscopy significantly reduced female patients' anxiety, pain, and distress. We found this to be a safe, simple, and effective tool to use during cystoscopy.

Prospective randomised controlled trial of written supplement to verbal communication of results to patients at the time of flexible cystoscopy.

PURPOSE: This trial assessed if written information on procedural findings and subsequent treatment improved understanding and reduced anxiety among patients undergoing day case flexible cystoscopy (FC). METHODS: Participants completed pre- and post-procedure questionnaires self-rating anxiety and feeling well informed on 5-point Likert scales. Supplemental written information was provided after FC to half the patients on a standardized template, according to randomized allocation. Comparisons between the groups were undertaken using the Wilcoxon test. RESULTS: Two hundred patients were recruited, with 171 evaluable questionnaires (83 from written group). The distribution of age, sex and prior FC, as well as the pre-procedure self-assessment of anxiety and understanding, was similar between the two groups. Patients receiving written information reported feeling better informed, with median (range) Likert score of 5 (4-5) compared to 4 (1-5) out of 5 (p < 0.0001) and less anxious (score 1 [1-4] compared to 2 [1-5] out of 5, p < 0.005), although all except four patients had an accurate understanding of the information provided (p = NS). CONCLUSIONS: Written information at the time of FC leads to patients feeling better informed and less anxious, although verbal information alone appears to lead to an adequate understanding. CLINICAL TRIAL REGISTRATION NUMBER: ACTRN12616000288426.

Hand-Holding during Cystoscopy Decreases Patient Anxiety, Pain, and Dissatisfaction: A Pilot Randomized Controlled Trial.

OBJECTIVE: Often a sick or an anxious person can experience pain or anxiety relief if another person holds his or her hand. In this study, we conducted investigations to determine whether hand-holding during cystoscopy decreases patient anxiety, pain, and dissatisfaction while at the same time increasing patient comfort and tolerance during the procedure. PATIENTS AND METHODS: Eighty-six male patients who underwent flexible cystoscopy between November 2015 and March 2017 were randomized as follows: hand-holding (group I, n = 43) or non-hand-holding (group II, n = 43) during the procedure. Before flexible cystoscopy, lidocaine gel was instilled in the urethra. Patients' anxiety levels were quantified using the State-Trait Anxiety Inventory. A visual analog scale (0-10) was used for self-assessment of satisfaction, discomfort, and willingness to undergo repeat cystoscopy. RESULTS: Demographic characteristics, mean age, procedure duration, procedure indications, and preprocedural analyses did not differ significantly between the 2 groups. In group I, the postprocedural mean anxiety level, pain score, heart rate, and systolic blood pressure were significantly lower compared with those in group II (p = 0.009, p = 0.003, p = 0.022, and p = 0.014, respectively). In group I, postprocedural mean satisfaction score were higher, and patients were more likely to undergo a repeat cystoscopy, compared with those in group II (p = 0.001 and p = 0.004, respectively). CONCLUSIONS: Hand-holding during cystoscopy significantly reduced patients' feelings of anxiety, pain, discomfort, and dissatisfaction. Hand-holding served as a simple, inexpensive, and effective adjunct to sedation during cystoscopy.

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.

The effect on pain experienced by male patients of watching their office-based flexible cystoscopy.

OBJECTIVE: To confirm the recently published positive effect on visual analogue pain (VAS) scale levels for men watching their flexible cystoscopy. PATIENTS AND METHODS: From June 2007 to September 2007, 154 men had a flexible cystoscopy for various indications, all carried out by one urologist. Patients were randomized into two groups; those in group 1 were allowed to watch the video screen together with the urologist during the procedure; those in group 2 were not allowed to watch the procedure on the video screen. All patients received the same real-time explanation during the cystoscopy. After the cystoscopy procedure the patients were asked to record their experience of pain on the 100 mm VAS as soon as they left the room. The two groups were further stratified by the number of previous cystoscopies experienced to evaluate the possible modifying effect of their previous experience. RESULTS: Although the results suggested a small decrease in perceived pain there were no statistically significant differences between the groups, regardless of cystoscopy experience. CONCLUSIONS: Our results show that, in contrast to an earlier report, the pain experienced by men undergoing a first or repeated flexible cystoscopy is not strongly influenced by watching the procedure.

Patients' perceived burden of cystoscopic and urinary surveillance of bladder cancer: a randomized comparison.

OBJECTIVE: To compare, in patients with non-muscle-invasive low-grade (pTa/pT1, G1/G2) urothelial cell carcinoma of the urinary bladder, the perceived burden of flexible cystoscopy or surveillance by microsatellite analysis (MA) in voided urine, as such patients are normally recommended to adhere to regular cysto-urethroscopic surveillance (CUS). PATIENTS AND METHODS: In all, 220 participants of a randomized trial comparing CUS and surveillance by MA were asked to complete questionnaires 1 week after cystoscopy or urine sample collection. We assessed the discomfort and pain reported during CUS, experiences with MA, and physical symptoms, medical consumption and general functioning in the week after CUS/urine sampling. RESULTS: We analysed data from 732 questionnaires (197 patients) completed after CUS and 184 (67 patients) after collecting urine. The introduction of the cystoscope was reported to cause discomfort in 39% and pain in 35% of the responses to the questionnaires; the waiting time for the results of MA was reported as burdensome in 19%. Painful micturition was significantly more frequent in the week after CUS than after MA (30% and 12%, respectively). The frequency of fever (1% and 2%) and haematuria (7% and 6%) was similar in both groups. Older patients reported significantly less pain and discomfort from cystoscopy, and this was not related to having more previous cystoscopies. CONCLUSION: CUS caused pain and discomfort in about a third of patients. The burden of MA appeared fully attributable to the waiting time for the test result. The present results are a further motivation in the search for less invasive surveillance tests.

What a signature adds to the consent process.

BACKGROUND: "Consent is a process by which a patient is informed and becomes a participant in decisions regarding their medical management." It is argued, however, that providing a signature to a form adds little to the quality of this process. METHODS: Views regarding the consent ritual of nonselected patients undergoing endoscopy (cystoscopy or sigmoidoscopy) were prospectively studied together with those of the attending staff. Patient volunteers were randomly assigned to one of two groups and given verbal explanation before the procedure, either alone (group A) or with a request to sign a form in addition (group B). A standardized questionnaire regarding preferences then was applied. RESULTS: A total of 37 patients (22 men) were studied along with seven staff members. Most surveyed felt that signing a consent form helped to empower the patient (group A, 84%; group B, 83%; staff, 100%). Although the patients mainly believed that it functioned primarily to protect the hospital and doctor (group A, 89%; group B, 67%), only one patient (3% of total) felt that such a formality undermined the patient-doctor relationship. Most staff members favored signing a form (86%). The majority of patients either favored it (group A, 47%; group B, 78%) or expressed no strong preference (group A, 32%; group B, 11%). Interestingly, more women than men preferred signing (73 vs. 55%; p = 0.25), perhaps because more women believed that it functioned to preserve autonomy (93 vs. 77% of men). Age was no particular determinant of perspective. CONCLUSION: Although it may be viewed as primarily serving to protect the doctor and hospital, the formal process of signing written consent forms appeals to patients and staff.

Does Listening to Music During Office-Based Flexible Cystoscopy Decrease Anxiety in Patients: A Prospective Randomized Trial.

PURPOSE: To validate the effect of listening to music on perceived anxiety and pain during office-based flexible cystoscopy using the State-Trait Anxiety Inventory (STAI) and the Visual Analog Scale (VAS), in a well-matched North American veteran patient population in a prospective, randomized fashion. PATIENTS AND METHODS: A total of 137 veteran patients receiving routine urologic care in a North American Veterans Affairs (VA) healthcare system were recruited over a 2-year period (June 2011 to June 2013). All patients were prospectively randomized to undergo office-based flexible cystoscopy with or without music. The music group consisted of 73 patients who listened to the same excerpt of classical music at the time of flexible cystoscopy; the nonmusic group consisted of 64 patients. RESULTS: The median postprocedural STAI anxiety scores between the music and nonmusic groups were statistically significantly different: 30 (range 23-39) and 35 (range 28-49), respectively (P=0.0017). The median postprocedural pain VAS score between the music and nonmusic groups reached statistical significance: 0 (range 0-1) and 2 (range 1-2), respectively (P<0.0001). The median delta STAI anxiety score was statistically significantly different between the music and nonmusic groups: 0 (range -3-0) and 2 (range 0-4), respectively (P<0.0001). CONCLUSIONS: This study demonstrates that listening to music decreases anxiety and pain associated with flexible cystoscopy in a North American VA patient population. We recommend incorporating music as an effective adjunct to other maneuvers used at the time of flexible cystoscopy to reduce anxiety and pain.

Patient experiences and preferences with ureteral stent removal.

PURPOSE: Ureteral stent removal is a source of patient morbidity. We surveyed 599 patients to evaluate their experiences and identify the preferred method of stent removal. MATERIALS AND METHODS: Visitors to a kidney stone website were invited to participate. Respondents were asked how their ureteral stent was removed? Pain during and after the procedure, patient experiences, and preferences regarding stent removal were queried. Chi-square and ANOVA tests were used to identify significant differences among removal methods. RESULTS: Five hundred seventy-one respondents were included in the study. The majority of stents (44%) were removed by office cystoscopy while 39% had their stents removed by string. Mean pain during stent removal was 4.8 out of 10 with 57% reporting moderate-to-severe pain levels of 4 or more. Removal by office cystoscopy resulted in the highest experienced pain (5.3). Thirty-two percent reported delayed severe pain after stent removal, including 9% who returned for emergency care. Removal by string resulted in more emergency room visits when compared to cystoscopy. Willingness to undergo the same removal technique was lowest for those who underwent office cystoscopy and highest for operating room cystoscopy. Being informed of why a stent was placed and the removal process was of high priority for respondents. CONCLUSIONS: The majority of patients report moderate-to-severe pain with stent removal and a third report delayed significant pain after stent removal. Variations exist in the patient experience with stent removal based on the method used. More research is needed to identify effective ways to prevent or manage stent-removal-related adverse events.

Pre-procedural antibiotics for endoscopic urological procedures: Initial experience in individuals with spinal cord injury and asymptomatic bacteriuria.

OBJECTIVE: The objective of this study was to compare the safety, efficacy, quality-of-life impact, and costs of a single dose or a longer course of pre-procedural antibiotics prior to elective endoscopic urological procedures in individuals with spinal cord injury and disorders (SCI/D) and asymptomatic bacteriuria. DESIGN: A prospective observational study. SETTING: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA. PARTICIPANTS: Sixty persons with SCI/D and asymptomatic bacteriuria scheduled to undergo elective endoscopic urological procedures. INTERVENTIONS: A single pre-procedural dose of antibiotics vs. a 3-5-day course of pre-procedural antibiotics. OUTCOME MEASURES: Objective and subjective measures of health, costs, and quality of life. RESULTS: There were no significant differences in vital signs, leukocytosis, adverse events, and overall satisfaction in individuals who received short-course vs. long-course antibiotics. There was a significant decrease in antibiotic cost (33.1 ± 47.6 vs. 3.6 ± 6.1 US$, P = 0.01) for individuals in the short-course group. In addition, there was greater pre-procedural anxiety (18 vs. 0%, P < 0.05) for individuals who received long-course antibiotics. CONCLUSION: SCI/D individuals with asymptomatic bacteriuria may be able to safely undergo most endoscopic urological procedures with a single dose of pre-procedural antibiotics. However, further research is required and even appropriate pre-procedural antibiotics may not prevent severe infections.

Postoperative course after papilloma resection: effects of written disclosure of the experience in subjects with different alexithymia levels.

OBJECTIVE: The aim of the investigation was to assess the effects on postoperative course after bladder papilloma resection of a technique for the written disclosure of traumatic events in interaction with individual differences in alexithymia. METHODS: Forty subjects were administered a general questionnaire and the Toronto Alexithymia Scale (TAS-20) the second day after admittance. Twenty subjects were asked to write for 3 days, 20 minutes a day, about their experience of being in the hospital, following instructions developed by J. W. Pennebaker and coworkers. The postoperative course was assessed objectively by the duration of stay in hospital and subjectively by subjects completing the Symptom Check List 90 (SCL-90) the day before leaving the hospital. RESULTS: Subjects who wrote stayed fewer days in hospital and had lower SCL-90 scores. The same effect was shown by low alexithymia levels. Study of interactions showed that the effect of writing was apparent only in subjects high in alexithymia, whereas subjects low in alexithymia showed a favorable course independent of writing. CONCLUSIONS: Writing about one's thoughts and feelings about being in hospital for a surgical operation has beneficial effects on postoperative course. This holds particularly true for high alexithymic subjects, who obtain through writing the same outcome as low alexithymic subjects.

Adverse effects of cystoscopy and its impact on patients' quality of life and sexual performance.

BACKGROUND: Cystoscopy, the principal means of diagnosis and surveillance of bladder tumors, is invasive and associated with unpleasant side effects. OBJECTIVES: To determine the early complications of rigid cystoscopy and the impact on patients' quality of life and sexual performance. METHODS: One hundred consecutive patients undergoing diagnostic rigid cystoscopy filled in questionnaires that included anxiety and pain levels (0-5 visual analogue scale), adverse events, Short-Form Health Survey, International Prostate Symptom Score, and functional sexual performance. Questionnaires were administered before, immediately after, and 1, 2 days, 2 and 4 weeks following cystoscopy. RESULTS: The pre-cystoscopy anxiety level was 2.01. The average pain during the examination was 1.41. SF-36 score was not affected by cystoscopy. The subjective impact on patients' quality of life was 0.51. The mean IPSS increased following cystoscopy (6.75 vs. 5.43, P = 0.001) and returned to baseline 2 weeks later. A decline in libido was reported by 55.6% (25/45) and 50% (3/6) of the sexually active men and women, respectively. Cystoscopy was associated with a decreased Erectile Dysfunction Intensity Score, from 15.6 to 9.26 during the first 2 weeks (P = 0.04). The overall complication rate was 15% and included urethrorrhagia and dysuria, None of the patients had fever or urinary retention and none was hospitalized. The complication rate was higher in patients with benign prostatic hyperplasia (24% vs. 9.7%, P = 0.001). CONCLUSIONS: Rigid cystoscopy is well tolerated by most patients and has only a minor impact on quality of life. However, cystoscopy transiently impairs sexual performance and libido. The early complications are mild and correlate with a diagnosis of BPH.

Test or trauma? The voiding cystourethrogram experience of young children.

Many diagnostic procedures, while necessary and appropriate, may be experienced by a child as a trauma. Health care professionals often perceive invasive procedures such as surgery and needle biopsies as more painful and threatening to the child than "test" such as voiding cystourethrograms (VCUGs). However, clinical experience indicates that the VCUG is often perceived by children as more highly distressing than other procedures. Success and a sense of competence (or shame and doubt) in mastering challenging life experiences, such as medical procedures, contribute to a child's evolving self-concept (Harter, 1983). These memories and successful behaviors can be applied to future similar situations. Health care professionals are challenged to help the child and the parents through the procedure with minimal distress in an effective and efficient manner. A series of vignettes illustrating parents' and children's experiences with a VCUG procedure highlight the impact of the VCUG on children's coping ability and adjustment. Recommendations for developmentally appropriate clinical practice standards of care related to the VCUG procedure in young children also are presented. Preparation as an ongoing partnership process among children, parents, and health care professionals.

Office based flexible cystoscopy may be less painful for men allowed to view the procedure.

PURPOSE: An experienced urology nurse observed that patients seemed to tolerate the procedure better when allowed to see the monitor in real time during office based cystoscopy. We assessed the impact of this on visual analog scale pain scores. MATERIALS AND METHODS: A total of 100 consecutive male patients underwent flexible cystoscopy, as performed by a single surgeon during the study period. Patients were randomized into 2 groups. Patients in group 1 were allowed to visualize the video screen with the surgeon, while patients in group 2 had the screen positioned so that only the surgeon could visualize the procedure. Water soluble lubricant was used on all endoscopes and all men received 10 cc 2% viscous lidocaine intraurethral before cystoscopy. No sedatives or analgesics were administered. All patients provided consent before the procedure and they were asked to record their pain experience on a 100 mm visual analog pain scale as soon as the surgeon left the room. RESULTS: Men who were allowed to visualize the cystoscopy had lower visual analog scale pain scores than those who were unable to visualize the screen (14 vs 23, Wilcoxon rank sum test p=0.02). CONCLUSIONS: To our knowledge no study has shown the impact of distraction of cystoscopic findings on procedure pain levels. Men viewing cystoscopy on the video monitor experienced an approximately 40% decrease in the pain level compared to those who did not view the procedure on the monitor. We encourage office urologists to incorporate this useful point of technique during flexible cystoscopy.

Patients' experiences at home after day case cystoscopy.

AIM: To determine patients' problems with day case cystoscopy and their problem solving ways and patients' self-care at home. BACKGROUND: Day surgery has become increasingly common in the last 20 years. Cystoscopic procedures are increasingly being carried out as a diagnostic and therapeutic procedures. DESIGN AND METHOD: This descriptive/prospective study comprised 50 patients undergoing day case cystoscopic procedures in the university hospital of Turkey. The data were collected using telephone interview three days after the procedure. The two questionnaire used were Symptom Measurement Questionnaire and Symptom Management Questionnaire. Discharge information and written instruction was given to all patients. RESULTS: It was found in the investigation that the most common problems experienced by the patients were tiredness, haematuria, dysuria, pain over bladder and difficulty in voiding after flexible cystoscopy in first day. Generally, urinary elimination problems were experienced by majority of the patients. At second day, these problems were also common. The mean score for all problems decreased after three days. The patients stated that they were able to deal with their symptoms either independently or to a lesser extent with assistance of a carer. But they were unable to deal with problems such as especially haematuria. CONCLUSION: Problems experiences by the patients at home after cystoscopy influenced some daily living activities. The problems related to voiding are more frequently observed after cystoscopy. Although some these problems are related to the procedures, some were present previously. RELEVANCE TO CLINICAL PRACTICE: This findings indicate that patient-centred care should be strengthened at home in urological day surgery.

Brief report: Optimizing children's memory and management of an invasive medical procedure: the influence of procedural narration and distraction.

OBJECTIVE: To evaluate the influence of two interventions on children's memory of and distress during a voiding cysto-urethrogram (VCUG, X-ray of the kidneys). METHODS: Sixty-two children (aged 2.5-7.5 years) were allocated to one of three conditions. In one (CI + D), they received complete procedural information during the VCUG, with a cartoon video. In a second (PI + D), children received limited procedural information, with a cartoon video. In a third (standard care, PI), they received limited procedural information. VCUGs were videotaped and distress was coded using the CAMPIS-R. To assess memory, children were interviewed 1 week later. RESULTS: Relative to the PI condition, children in the CI + D condition recalled more information, appraised the VCUG as less painful, and were less distressed. There were no differences between the PI + D and PI conditions. CONCLUSIONS: An inexpensive, theoretically driven intervention can enhance children's memory and reduce distress during an invasive procedure.

Evaluation of pain caused by urethrocystoscopy in patients with superficial bladder cancer: a perspective of quality of life.

AIM: The aim of this study is to evaluate patients' tolerance to pain caused by urethrocystoscopy (UCS) in both diagnosis and the period of follow-up in patients with superficial bladder cancer, and to evaluate these results with respect to quality of life. PATIENTS AND METHODS: Between March 2003 and October 2004, 66 patients with bladder cancer or hematuria underwent UCS and recorded their overall pain level. RESULTS: The mean age was 60.4 (range 26-83) years. UCS was done only one time in 22 patients for the diagnosis of etiology of hematuria and was done 4 times in 44 patients every 3 months for bladder cancer follow-up. The mean pain scores on first, second, third, and fourth UCS were 4.3+/-2.2, 4.7+/-2.5, 4.68+/-2.45, and 5.1+/-2.5, respectively. Statistically significant differences were found among mean pain scores of patients on first, third, and forth cystoscopic examinations (p < 0.05). No correlation was found between age and pain scores in this study group (p > 0.05). CONCLUSION: UCS is a painful surgical procedure and pain tolerance was not observed on repeated UCS. Therefore urologists need to use more effective anesthetic methods to provide better patients' tolerance to pain and quality of life during the endoscopic procedure.