Modern advances in reducing anxiety and pain associated with cystoscopy:Systematic review

AIM:To investigate if music reduces anxiety and pain in the Veterans Affairs population undergoing flexible cystoscopy. METHODS:This study was reviewed and approved by the University of California,San Diego Human Research Protections Program Institutional Review Board. Patients were prospectively randomized to undergo flexible cystoscopy with or without music. Thirty-eight patients were randomized into either the No Music group(n = 24) or the Music group(n = 14). We used the state-trait anxiety inventory and the visual analog pain scale,respectively. Statistics were generated and compared using an independent t-test and chi-squared tests. P values < 0.05 were considered statistically significant. Outpatient cystoscopy is a safe and useful procedure employed frequently in Urology for diagnosis and evaluation of genitourinary pathologies. However,cystoscopy-related distress cannot be ignored. Three components of outpatient cystoscopy have been evaluated to improve the cystoscopic experience:local anesthetic control,cystoscopic equipment redesign and environmental modification. We reviewed the literature pertaining to these modifications. RESULTS:The mean age was 65.3 and 67.1 years for men in the No Music and Music groups,respectively.Although,the majority of patients in each group selfidentified as Caucasians(66%),African American,Hispanic and other ethnicities represented 13%,8% and 13% respectively. The majority of patients(68%) reported experiencing hematuria. Thirty-four percent had a history of bladder cancer,and eighteen percent had a history of prostate cancer. Ten patients(26%) admitted to taking antidepressants. Physiologic parameters that correlated to pain and anxiety(systolic blood pressure,diastolic blood pressure,and heart rate) were statistically similar in both groups prior to and after flexible cystoscopy. The median delta anxiety between the No Music and Music groups were not significantly different(0.78 vs-1.46),and the pain scores between the No Music and Music groups(1.5 vs 1.6) were not statistically different(P = 0.28 and P = 0.92,respectively).CONCLUSION:Preliminary results demonstrate that music does not reduce anxiety or pain associated with flexible cystoscopy.

Fundamentals of prosthetic urology

The field of prosthetic urology demonstrates the striking impact that simple devices can have on quality of life.Penile prosthesis and artificial urinary sphincter implantation are the cornerstone procedures on which this specialty focuses.Modern research largely concentrates on decreasing the rates of complication and infection,as the current devices offer superior rates of satisfaction when revision is not necessary.These techniques are also able to salvage sexual function and continence in more difficult patient populations including female-to-male transgender individuals,those with ischemic priapism,and those with erectile dysfunction and incontinence secondary to prostatectomy.This review summarizes modern techniques,outcomes,and complications in the field of prosthetic urology.

Commentaryon"Penile augmentation with injectable hyaluronic acid gel:an alternative choiceforsmall penis syndrome"

We read with special interest the study by Zhang et al.i regarding hyaluronic acid penile augmentation for patients with small penis syndrome(SPS).Utilization of hyaluronic acid(HA)-based injections as dermal fller has become increasingly popular in the past decade.^(2)For patients who have small penis syndrome,a body dysmorphic disorder in which the patients believe they have a small penis,HA injections present a noninvasive option forpenile size augmentation.Current literature on this procedure is sparse,and the findings and experiences reported in Zhang et al.^(1)