A Randomized Controlled Trial of a Modified Cystoscopy Technique

Introduction Pain, anxiety and embarrassment are well documented feelings in patients undergoing ambulatory diagnostic cystoscopy. In this study, we explored utilizing Peak-end theory in improving pain perception in patients undergoing diagnostic cystoscopy. Materials and Methods We conducted a randomized clinical trial at the London Health Sciences Center for patients undergoing an ambulatory diagnostic cystoscopy for the first time. Males and females as well as allocation ratios were 1:1. The control arm received a standard cystoscopy. In the intervention arm the cystoscope was left for additional 2 minutes without further manipulation in the bladder before scope removal. The primary outcome was VAS pain scores after cystoscopy in both arms. Results We present the preliminary results of 54 patients out of 61 patients recruited thus far in this ongoing study after exclusion of 7 patients. Baseline characteristics were balanced between the two arms. Mean VAS scores were lower in the intervention arm but not statistically significant (17.2 mm vs. 12.0 P=0.30). Post-cystoscopy anxiety scores were lower in the intervention group but were only statistically significant in the males’ subgroup (3.4 vs. 0.96, P= 0.013). Conclusions: Utilizing the tenets of the Peak-end theory in modifying an unpleasant ambulatory procedure like diagnostic cystoscopy showed a potential improvement in post-procedure pain and anxiety perception scores even at the preliminary and under-powered analysis. An interim-analysis will be performed after inclusion of 79 patients