Pain perception during outpatient cystoscopy: a prospective controlled study

Abstract

Objective: Rigid cystoscopy is a common diagnostic tool in the assessment of lower urinary tract symptoms, but it is an invasive procedure which can cause distress. Data exist about pain perception during cystoscopy in male patients but only a few data are available in women. The purpose of this study was to investigate pain perception in urogynecologic patients during cystoscopy and compare it with pain perception during urodynamics. We also investigated the difference between anticipated and actual pain perception.

Study design: A cooperative, non-randomized cohort study was performed including 109 women with pelvic floor dysfunction scheduled for outpatient cystoscopy or urodynamic testing. Patients completed a questionnaire and a visual analog scale (VAS, 0-10 cm) before and after examination. Patients were called one day after examination and asked about pain and their general state of health. According to power calculation, a sample size of 52 patients per group was needed to detect a 2 cm difference in pain scores on the VAS - judged as a clinically significant - with 95% power and a two-sided significance level of 0.05.

Results: In 57 patients undergoing cystoscopy versus 52 patients undergoing urodynamics, the main pain scores on VAS were 1.9 cm for cystoscopy and 1.2 cm for urodynamics (p=0.03). Patients in both groups anticipated more pain than they actually experienced: 2.7±2.4 before versus 1.9±1.8 after cystoscopy (p<0.01) and 2.1±2.4 before versus 1.2±1.6 after urodynamics (p<0.01).

Conclusion: Patients experience cystoscopy as more painful than urodynamics. Patients anticipate both cystoscopy and urodynamics to be more painful than they actually are.

Keywords: Cystoscopy; Pain perception; Urodynamic testing; Visual analog scale.