Prospective randomized evaluation of patient- and physician-reported pain concordance in flexible cystoscopy: impact of experience and anxiety

Abstract

Introduction

Flexible cystoscopy is commonly performed under local anesthesia. This study explores the effects of pre-procedural anxiety, depression, and physician experience on both patient pain and the physician's perception of it.

Methods

This prospective, randomized study included 120 male patients (≥18 years), scheduled for flexible cystoscopy under intraurethral 2% lidocaine. Patients were randomly assigned to four groups based on the experience level of the physician. Pain perception was assessed using the Visual Analog Scale (VAS), while pre-procedural anxiety and depression were measured with the Hospital Anxiety and Depression (HAD) scale.

Results

Postoperative VAS-pain scores were slightly higher than preoperative values (2 vs. 1.5; p < 0.001), but this difference was considered clinically negligible due to the overall low pain levels observed. Although doctors tended to underestimate patients' pain, a correlation was observed between patient- and physician-reported postoperative VAS-pain (r = 0.487, p < 0.01). Physician experience did not significantly affect pain perception (p = 0.585). Interestingly, although the differences in VAS-scores are not clinically important, the correlation analysis revealed that less experienced physicians -residents- demonstrated a stronger concordance between their perception of patient pain and the patients’ self-reported pain (r = 0.798 and r = 0.633). HADS-anxiety scores correlated positively with both preoperative and postoperative pain and anxiety levels (r = 0.194–0.404, p < 0.05), while HADS-depression showed no association.

Conclusion

Flexible cystoscopy performed under local anesthesia is a well-tolerated procedure, irrespective of the physician’s level of experience. The correlation between patient and physician pain scores suggests that physicians can reliably assess patient discomfort. Managing preoperative anxiety is essential to enhance patient comfort during the procedure.