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Anxiety, distress, and pain in pediatric urodynamics
Julia B Finkelstein1, Dylan Cahill1, Kelsey Graber2
1Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
Insights
Pediatric urodynamic studies (UDS) can cause anxiety and pain. Sphincter electromyography (EMG) needle insertion and urethral catheterization were most distressing for children undergoing UDS.
Area of Science:
- Pediatric Urology
- Urodynamics
- Pain Management in Children
Background:
- Urodynamic studies (UDS) are crucial for diagnosing pediatric lower urinary tract dysfunction.
- However, the anxiety, distress, and pain associated with UDS in children are not well-characterized.
- Understanding these factors is essential for improving the pediatric UDS experience.
Purpose of the Study:
- To systematically evaluate the child's experience during urodynamic studies (UDS).
- To identify specific UDS steps that elicit the greatest anxiety, distress, and pain in children.
- To inform strategies for mitigating negative reactions during pediatric UDS.
Main Methods:
- Prospective study of children aged 5 and older undergoing UDS.
- Assessment of pre- and post-procedure anxiety using visual analog scales (VAS-A).
- Behavioral distress and pain ratings were collected during key UDS steps, including electromyography (EMG) needle insertion and urethral catheterization.
Main Results:
- A total of 76 UDS procedures were observed.
- Anxiety scores significantly decreased after the procedure (mean VAS-A 2.3 to 0.8, P < .001).
- The highest distress and pain were associated with sphincter electromyography (EMG) needle insertion (31% distress) and urethral catheter insertion (29% distress), with mean pain scores of 3.2 and 2.7, respectively.
Conclusions:
- Sphincter electromyography (EMG) needle insertion and urethral catheter placement are key contributors to pain and distress during pediatric UDS.
- Initial urodynamic testing and lack of patient understanding also correlate with increased negative experiences.
- Addressing these specific elements and improving patient education can enhance the pediatric UDS experience.
Aims:
No one has assessed urodynamic studies (UDS) to determine those steps that elicit the greatest anxiety, distress, and pain in children. We sought to systematically evaluate a child's UDS experience to mollify these reactions.
Methods:
Prospective study involving children aged ≥5 undergoing UDS over a 6-month period (from 10 December 2018 to 22 May 2019). Upon arrival, patients completed a visual analog scale for anxiety (VAS-A, 0-10) about the upcoming procedure. A research assistant assessed the patient's behavior during each major step of UDS using a validated brief behavioral distress scale. Nursing staff also obtained patients' pain ratings (0-10) for these key elements. Immediately after UDS, each child completed a posttest VAS-A along with a survey about the UDS experience.
Results:
A total of 76 UDS were observed; almost half included sphincter needle electromyography (EMG). Mean patient VAS-A scores were 2.3 before UDS, compared to 0.8 afterward (P < .001). The highest proportion of distressful behaviors were observed during EMG needle (31%) and urethral catheter (29%) insertion, in agreement with the highest mean pain scores of 3.2 and 2.7, respectively. Fifty-four percent of children reported not being completely aware of what was going to happen before the procedure and 50% of those patients exhibited at least one interfering or potentially interfering behavior. Similarly, 60% of children with no prior history of UDS exhibited at least one interfering or potentially interfering behavior.
Conclusions:
EMG needle and urethral catheter placement, initial urodynamic testing and not knowing what to expect were associated with greater pain and distress during pediatric UDS.
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