Feasibility and outcomes of interventions to reduce cystoscopy discomfort: a multi-site pilot study

To investigate the feasibility and effectiveness of interventions aiming to decrease pain and anxiety during cystoscopy.

A prospective study of 190 adults undergoing flexible office cystoscopy was conducted at the University of North Carolina and the University of Texas Southwestern from January to September 2023. Patients were offered 20 mL intraurethral 2% lidocaine with a dwell time of ≤10 or >10 min and either music on headphones or real-time cystoscopy visualisation. Patients declining the offered intervention were provided their requested study intervention. Outcomes included pain (visual analogue scale [VAS], pain intensity) and anxiety. Multivariable regression models controlled for age, sex, prior cystoscopies, bladder cancer surveillance, site, and intervention preferences. Feasibility was evaluated by patient acceptance of interventions.

Of 190 patients, 35% (66/190) declined their assigned intervention, with 8% (7/90) declining visualisation and 59% (59/100) declining music alone. Patients with prior cystoscopy were more likely to decline music (69%) than cystoscopy-naïve patients (31%). Visualisation was associated with lower reported pain on the VAS and anxiety than music. Patients receiving both music and visualisation reported the highest proportion of no-to-mild pain. Lidocaine dwell time did not significantly affect outcomes.

Allowing patients to visualise or listen to music during their office cystoscopy are simple, accessible means of reducing pain and discomfort with the procedure, particularly for cystoscopy-naïve patients.