The effect of video-animated information on the anxiety of male patients before flexible cystoscopy performed under local anesthesia

The effect of video-animated information on the anxiety of male patients before flexible cystoscopy performed under local anesthesia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of video-animated information on the anxiety of male patients before flexible cystoscopy performed under local anesthesia Recep Burak Degirmentepe, Muammer Bozkurt, Mustafa Erkoc, Deniz Gul, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4154201/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To investigate the effect of video-animated information given before flexible cystoscopy under local anesthesia on the anxiety of male patients. Methods: Before cystoscopy, patients were divided into two groups with 1:1 standard randomization. While one group was given written and verbal information, the other group was additionally given video-animated information. The patients' anxiety levels before the procedure and their hemodynamic parameters during the procedure were compared between the groups. In addition, pain, satisfaction and willingness to repeat the procedure were compared between the groups. Results: STAI-s levels were found to be statistically significantly lower in the group given video animation information before cystoscopy (p<0.01). It was observed that video information had a positive effect on systolic blood pressure, diastolic blood pressure and heart rate, and the values were measured lower compared to the other group (p <0.01). While there was no statistically significant difference between the two groups in VAS-pain scores (p=0.24), VAS-satisfaction and VAS-willingness to repeat the procedure scores were found to be statistically significantly different (p<0.01). It was observed that video-animated information made a positive contribution to satisfaction and willingness to repeat the procedure. Conclusion: Video-animated information given before the flexible cystoscopy procedure performed on male patients under local anesthesia has positive effects on the patients' anxiety. In addition, it contributes positively to the patient's satisfaction and desire to repeat the procedure. Video-animated information may be routinely used to verbal and written information before the csytoscopy. Figures Figure 1 Introduction Cystoscopy is a minimally invasive procedure that is frequently used by urologists in their daily practice and is used in diagnosis and treatment to clarify causes such as hematuria, anatomical disorders, and irritant bladder symptoms. Flexible and rigid cystocopes can be used in practice. Cystoscopy performed under local anesthesia is a painful and uncomfortable procedure for patients( 1 ). Since the male urethra is longer, the procedure is more uncomfortable in men. Flexible cystoscopy is less traumatic and less painful than rigid cystoscopy. However, many patients may still experience anxiety before the procedure( 2 ). Anxiety about cystoscopy can reduce the effectiveness of the procedure and lead to disruptions in the patient's treatment( 3 ). Anxiety before a surgical procedure is a normal feeling of potential danger( 4 ). They may experience high anxiety before the surgical procedure due to reasons such as uncertainty, fear of death, fear of not recovering, fear of anesthesia( 5 ). Lack of understanding of surgical procedures can further increase patients' anxiety and cause patients to avoid or delay treatment. In addition, anxiety experienced during treatment may disrupt hemodynamic stability and lead to conditions such as arrhythmia and hypertension( 6 ). In the daily surgical routine, patients are often given written and verbal information before the invasive procedure. Adding detailed visual information alongside routine written and verbal information contributes positively to the patient's understanding. Recently, various studies have been published showing that video information added to verbal and written information provides better understanding of patients due to a decrease in their anxiety level( 4 , 7 , 8 ). However, there are currently no studies focusing on the anxiety levels of patients who were given video-animated information before cystoscopy. Our study aimed to investigate the effects of video-animated information on the patient's anxiety, satisfaction, pain, desire to repeat the procedure, and hemodynamic parameters during the procedure in case of flexible cystoscopy under local anesthesia. Methods This was designed as a single-center, randomized controlled study. The study was conducted by including patients who underwent cystoscopy under local anesthesia at Sakarya University Training and Research Hospital between January 2024 and March 2024. Local ethics committee approval was obtained. Male patients who were over 18 years of age, who were going to undergo flexible cystoscopy for diagnostic purposes for the first time, and who were communicative and had the intellectual knowledge to understand the purpose and details of the study, were included in the study. The exclution criteria were as follows: ( 1 ) patients with active urinary infection or urethral deformities; ( 2 ) Had an endoscopic invasive intervention to the urethra or bladder before (Double-J stent removal, urethral dilatation, diagnosed with bladder cancer etc.); ( 3 ) Had used painkillers within 24 hours before the procedure; ( 4 ) Had used medication that affects consciousness and communication; ( 5 ) diagnosed with overactive bladder or chronic pain syndrome; ( 6 ) had uncontrolled blood pressure disease; ( 7 ) patients who had already in pain. Patients demographic data such as age, previous operations, weight and height, as well as medical parameters such as the reason for cystoscopy and American Society of Anesthesiologists (ASA) score were collected from interviews with the patients and their medical records. Initially, 172 patients were evaluated for inclusion in the study. Three of these patients did not want to participate in the study, and nine of them did not meet the inclusion criteria. Simple randomization was performed with a 1:1 ratio according to the order of admission to the patients. The patients were divided into two groups: video and non-video. In addition to written information, participants in the video group were given video information under the supervision of a doctor. Participants were able to directly ask any question they wanted to the doctor next to them during the video information. Participants in the non-video group were provided with written information only. Cystoscopy was performed in the standard lithotomy position in all patients. No painkillers were administered before the procedure. During the procedure, the same 16 Fr flexible cystoscope was used, the patients' perineum was cleaned with povidone iodine, and 10 ml of 2% lidocaine gel was applied to the urethra as local anesthesia. State-Trait Anxiety Inventory(STAI) is a self-reported anxiety assessment questionnaire consisting of 20 questions, each with a four-point Likert scale, consisting of two separate components: STAI-state(STAI-S) and STAI-trait(STAI-T). A person's current anxiety level is evaluated with STAI-S, and long-term anxiety level is evaluated with STAI-T. The highest score that can be obtained from the scale is 80, while the lowest score is 20. In the present study, initial anxiety levels were evaluated using the Turkish version of STAI-S and STAI-T before giving verbal information to the patients before the procedure. STAI-T was used to determine whether there was a difference in long-term anxiety between groups before cystoscopy. STAI-S was used to evaluate the difference in anxiety in the same groups after video information. The flow chart of the research is shown in figure-1. The surgeons performed the procedure blindly to the groups. Visual analog scale(VAS) score was performed after cystoscopy to evaluate participants' perceptions of pain, satisfaction, and desire to undergo the procedure again. VAS is a 10-unit Likert scale. The patient's perceptions are evaluated through participants' answers to designated questions with extreme descriptors on points 1 to 10 (e.g., ''no pain'' - ''severe pain''). In addition, the patients' hemodynamic parameters were recorded during the procedure to compare between groups. Statistical analysis Data analysis was performed using IBM SPSS Statistics 22 (SPSS Inc., Chicago, IL, U.S.). The suitability of quantitative data for normal distribution was evaluated using the Kolmogorov-Smirnov test. A two-sided t-test was used to compare differences between two normally distributed groups, while the Mann-Whitney U test was used to compare abnormally distributed continuous variables. Relationships between categorical variables were evaluated using the Pearson Chi-square test. Statistical significance was considered at p < 0.05. Video information Video information was provided with patient information videos on the official website of the European Urology Association ( https://patients.uroweb.org/videos/cystoscopy-video/ ). This video is in English, lasts a little more than 2 minutes, and explains the cystoscopy procedure in detail with 3D animations. While the participant was watching the video, the doctor sat next to him and provided simultaneous Turkish translation if translation was needed. The participant had the authority to stop the video, ask questions, and rewind the video if he did not understand or was confused about a point. Results Demographic data and characteristics of the participants are summarized in Table-1. The average age of the participants was 62 ± 10.4 in the non-video group and 64.4 ± 8.8 in the video group, respectively (p = 0.48). When the two groups of participants were examined in terms of BMI, ASA scores, and cystoscopy purposes, they were observed to have similar distributions. In the evaluation before cystoscopy, no statistically significant difference was detected when STAI-T and STAI-S were compared between the groups, respectively (p = 0.62, p = 0.94). The STAI-S comparison between groups before and after information is shown in Table-2. While STAI-S scores did not change statistically significantly in the group without video information (p = 0.92), It was observed that the STAI-S score decreased statistically significantly in the group with video information (p < 0.01). The changes in the hemodynamic parameters of the participants in the evaluation made during the procedure are shown in Table-3. When systolic heart pressure, diastolic blood pressure and heart rate were compared between groups, it was observed that video information made a statistically significant positive contribution to hemodynamic parameters (p < 0.01). The data in which VAS scores of pain, satisfaction and willingness to repeat were evaluated after the procedure are shown in Table-4. While it was observed that video information had no effect on procedure pain (p = 0.24), statistically significant improvements were observed in satisfaction and willingness to repeat parameters after video information (p < 0.01). Discussion Anxiety before surgical procedures poses a challenge for both surgeons and patients. This anxiety may be related to the surgical procedure itself. One of the important triggers of preoperative anxiety is the lack of information about the procedure( 4 ). Cystoscopy, which is performed quite frequently in daily urology practice, can also cause serious patient anxiety( 3 ). Recently, many innovative studies involving pharmacological and various environmental controls have been conducted to relieve pain and anxiety during cystoscopy( 2 , 9 – 11 ). In this study, we investigated the effect of video-animated information about the procedure given by the doctor before cystoscopy on the patient's anxiety reduction, pain management and relief, and increased satisfaction. Pharmacological methods such as instillation and lubrication of the urethra with 2% lidocaine, premedication with a short-acting anxiolytic drug, and use of inhaled nitrous oxide are helpful methods in coping with pain and anxiety. In addition to the use of pharmacological agents, some distraction methods can also be used during the procedure to reduce pain and anxiety and increase procedure satisfaction( 3 ). Ways of interacting with the environment, such as grasping and squeezing a stress ball, watching videos, and listening to music, have been accepted as non-pharmacological methods to relieve pain and are used in many minimally invasive procedures, including cystoscopy( 3 ). Raheem et al.( 11 ) investigated the effects of listening to classical music during cystoscopy on anxiety and pain in 137 patients. Improvements in VAS pain score and STAI anxiety score were reported as statistically significant. Gezici et al.( 12 ) conducted a study in which all three distracting arguments, video, stress ball, and music, were used during cystoscopy. Significant reductions in pain and anxiety were observed when all three distractors were used. The goodness of communication between the patient and the doctor has an inverse correlation with the patient's anxiety and a direct correlation with the patient's satisfaction. Therefore, for patient-doctor communication to be effective, it is essential to give patients sufficient information and ensure that the patient understands the procedures to be performed. The patient's sociocultural level, literacy, attention and motivation are very important in understanding the information given about the procedures, however, anxiety before the surgical intervention can negatively affect the patient's cognitive skills. Therefore, a complete understanding of the procedure to be performed will lead to increased motivation, self-confidence and compliance with the surgical procedure( 13 ). Recently, we have seen the use of video information, in which the process is explained in detail via video, in addition to routine verbal and written information. After Bozkurt et al.'s video-animated information to patients undergoing percutaneous nephrolithotomy surgery, a statistically significant decrease in anxiety levels was observed, which was correlated with the present study( 7 ). Besides, Can et al.( 4 ) observed a decrease in the anxiety and an increase in the satisfaction of patients who were given video-animated information before the ureteral stent removal procedure, which is similar to cystoscopy. In addition, it has been shown by Tarhan et al.( 14 ) that video information given before the prostate biopsy procedure under local anesthesia, which is widely used in daily urology practice, contributes positively to patients' anxiety. Oral and written informed consent is routinely obtained from patients before surgical procedures. Due to legal regulations, written information is detailed and long, which may cause confusion in patients. In the study conducted by Stanley et al., it was reported that written and verbal patient information did not create a significant change in patients' perceptions of the surgical intervention and the complications that may occur due to it( 15 ). Recently, with the development of technology, there are multiple publications showed that patient information provided with VR devices or video animations makes a significant positive contribution to patients' preoperative anxiety( 3 , 7 , 14 ). In light of this information, it can be concluded that an additional information method will enable the patient to better understand the procedure to be performed, compared to only verbal and written information. In parallel, it is obvious in our study that patient information provided with video animation has a positive effect on the anxiety levels of patients. In minimally invasive surgical procedures performed under local anesthesia, the patient's level of consciousness may cause additional anxiety. This may negatively affect patient satisfaction. When Ketsuwan et al.'s randomized controlled study conducted by VR on anxiety was examined, no statistically significant results were obtained in the post-intervention pain scores, while satisfaction and willingness to repeat scores were found to be statistically significant after the intervention( 3 ). Consistent with these findings, while we did not observe a significant change in pain scoring after the intervention, we obtained statistically significant positive results in satisfaction and desire to repeat scores in the present study. This study shows that a decrease in anxiety levels tends to increase patients' satisfaction and willingness to repeat the procedure. Painful minimally invasive surgical procedures such as cystoscopy performed under local anesthesia may affect hemodynamic parameters. Many studies have been conducted to investigate the effects of distracting activities used to reduce pain and anxiety during cystoscopy on hemodynamic parameters. Gupta et al. reported in their study that simple distracting activities significantly reduced the heart rate and systolic pressure of patients( 16 ). In another study, Gezginci et al. showed that simple distraction methods made a positive contribution to hemodynamic parameters( 12 ). Based on this, in the present study, we measured the hemodynamic parameters of the patients during the procedure after the information given through video animation. In the present study, it was observed that providing information via video not only had a positive effect on anxiety, but also had a statistically significant positive effect on hemodynamic parameters such as systolic blood pressure, diastolic blood pressure and heart rate. The strength of our study was its clear format and prospective nature. However, the current study had some limitations. First, although the same cystoscopy protocol was applied to each patient, the surgeon performing the procedure was not the same. Surgical techniques may vary individually. Secondly, situations that may affect anxiety such as income level, cultural structure, and sociocultural level have been ignored. Thirdly, since the study was carried out in a single center, in a single local cystoscopy room, the same results may not be obtained in another center where environmental factors will change. Fourth, differences in patients' prostate sizes may affect the response to the procedure. In conclusion, cystoscopy may be a simple procedure that is frequently performed by urologists in their daily routine, but it can be worrying for patients. Providing written and verbal information before cystoscopy, as well as video-animated information, is a simple to apply, low-cost and effective method that reduces the patient's anxiety and increases satisfaction. We recommend video information to patients before cystoscopy. Declarations Author Contribution Substantial contributions to conception and design: R.B.D., M.B, M.E. Drafting and revising the article critically for important intellectual content: M.Y.A, D.G. H.I.C. Final approval of the version to be published: F.H All authors reviewed the manuscript. References Ahn ST, Kim HJ, Jeong HG, Park TY, Shim JS, Kim JW, et al. The effects of using a heating pad on reduction of anxiety, pain and distress during a cystoscopy in the female patients. Eur Urol Suppl. 2018;17(2):e487–8. Gezginci E, Bedir S, Ozcan C, Iyigun E. Does Watching a Relaxing Video During Cystoscopy Affect Pain and Anxiety Levels of Female Patients? A Randomized Controlled Trial. Pain Manag Nurs [Internet]. 2021;22(2):214–9. Available from: https://doi.org/10.1016/j.pmn.2020.08.005 Ketsuwan C, Matang W, Ratanapornsompong W, Sangkum P, Phengsalae Y, Kongchareonsombat W, et al. Prospective randomized controlled trial to evaluate effectiveness of virtual reality to decrease anxiety in office-based flexible cystoscopy patients. World J Urol [Internet]. 2022;40(10):2575–81. Available from: https://doi.org/10.1007/s00345-022-04142-9 Can O, Bozkurt M, Danış E, Taha Keskin E, Kandemir E, Lutfi Canat H. The effect of informative video before the procedure on anxiety levels in patients who will have ureteral stent removal under local anesthesia. Actas Urológicas Españolas (English Ed. 2024;(xxxx). Perks A, Chakravarti S, Manninen P. Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol. 2009;21(2):127–30. Vetter D, Barth J, Uyulmaz S, Uyulmaz S, Vonlanthen R, Belli G, et al. Effects of art on surgical patients: A systematic review and meta-analysis. Ann Surg. 2015;262(5):704–13. Bozkurt M, Erkoc M, Can O, Danıs E, Canat HL. The effect of an information video on preoperative anxiety level before percutaneous nephrolithotomy procedure: A prospective, randomized trial. Can Urol Assoc J. 2023;17(3):86–9. Ahmed KJ, Pilling JD, Ahmed K, Buchan J. Effect of a patient-information video on the preoperative anxiety levels of cataract surgery patients. J Cataract Refract Surg [Internet]. 2019;45(4):475–9. Available from: https://doi.org/10.1016/j.jcrs.2018.11.011 Gunendran T, Briggs RH, Wemyss-Holden GD, Neilson D. Does Increasing Hydrostatic Pressure (“Bag Squeeze”) During Flexible Cystoscopy Improve Patient Comfort: A Randomized, Controlled Study. Urology. 2008;72(2):255–8. Song YS, Song ES, Kim KJ, Park YH, Ku JH. Midazolam anesthesia during rigid and flexible cystoscopy. Urol Res. 2007;35(3):139–42. Raheem OA, Mirheydar HS, Lee HJ, Patel ND, Godebu E, Sakamoto K. Does Listening to Music during Office-Based Flexible Cystoscopy Decrease Anxiety in Patients: A Prospective Randomized Trial. J Endourol. 2015;29(7):791–6. Gezginci E, Iyigun E, Kibar Y, Bedir S. Three Distraction Methods for Pain Reduction During Cystoscopy: A Randomized Controlled Trial Evaluating the Effects on Pain, Anxiety, and Satisfaction. J Endourol. 2018;32(11):1078–84. Ha JF, Longnecker N. Doctor-patient communication: A review. Ochsner J. 2010;10(1):38–43. Tarhan H, Cakmak O, Unal E, Akarken I, Un S, Ekin RG, et al. The effect of video-based education on patient anxiety in men undergoing transrectal prostate biopsy. Can Urol Assoc J. 2014;8(11–12):e894–900. Handelsman MM, Rosen J, Arguello A. Informed Consent of Students: How Much Information is Enough? Teach Psychol. 1987;14(2):107–9. Gupta S, Das S, Jana D, Pal D. Distraction during cystoscopy to reduce pain and increase satisfaction: Randomized control study between real-time visualization versus listening to music versus combined music and real-time visualization. Urol Ann. 2019;11(1):33–8. Tables Table-1: Patient descriptive characteristics, pre-information STAI and ASA comparisons between video and non-video groups Non-video group(n=80) Video group(n=80) Age (years) BMI (kg/m 2 ) (mean ± SD) 62±10.4 28.4±4.3 64.4 ±8.8 28.8±5.1 STAI-T (mean+SD) 34.2±3.6 35.8±3.8 STAI-S (mean+SD)(pre-information) 39.22±5.88 39.14±5.24 ASA score (ASA 1–2/ASA 3–4) 32/48 27/53 Reasons for flexible cystoscopy Macroscopic hematuria 36 32 Microscopic hematuria 28 22 Lower urinary tract symptoms 19 22 Suspicious bladder calculus 0 1 Table-2: Change of STAI-S after informations between groups Pre-information Post-information P STAI-S (mean+SD)(pre-information) STAI-S (mean+ SD)(post-information) Non-video group 39.22±5.88 38.98±8.66 0.92 Video group 39.14±5.24 32.68±2.63 <0.01 SD: standard deviation; STAI-S: State-Trait Anxiety Inventory, state anxiety Table-3: Comparisons of Hemodynamic Parameters Measured During Cystoscopy Between Groups Non-video group Video group p Systolic pressure (mean±SD) 155.6±14.8 142.4±10.8 <0.01 Diastolic pressure (mean±SD) 109.8±11.1 92.3±8.5 <0.01 Heart rate (mean±SD) 96.3±3.8 85.6±4.6 <0.01 SD: standard deviation Table-4: Comparison of pain, satisfaction, willingness between two groups Non-video group Video group p VAS-pain (0–10) (mean ± SD) 3.2±2.2 3.1±2.4 0.24 VAS-satisfaction (0–10) (mean ± SD) 8.6±1.3 9.2±1.1 <0.01 VAS-willingness to repeat (0–10) (mean ± SD) 1.8±0.3 2.2±0.4 <0.01 SD: standard deviation, VAS: visual analog scale Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4154201","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284609813,"identity":"3f66a2b1-6007-448c-a082-cca73a93a27c","order_by":0,"name":"Recep Burak Degirmentepe","email":"data:image/png;base64,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","orcid":"","institution":"Sakarya University","correspondingAuthor":true,"prefix":"","firstName":"Recep","middleName":"Burak","lastName":"Degirmentepe","suffix":""},{"id":284609814,"identity":"67148cdd-d288-4aa0-8618-c1a2064d70d8","order_by":1,"name":"Muammer Bozkurt","email":"","orcid":"","institution":"Okmeydanı Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Muammer","middleName":"","lastName":"Bozkurt","suffix":""},{"id":284609815,"identity":"80b3039c-656d-415c-b3f2-b5669fd3cd4e","order_by":2,"name":"Mustafa Erkoc","email":"","orcid":"","institution":"Okmeydanı Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Mustafa","middleName":"","lastName":"Erkoc","suffix":""},{"id":284609816,"identity":"1740eef1-8206-4065-bc1b-d552bed2a0ac","order_by":3,"name":"Deniz Gul","email":"","orcid":"","institution":"Sakarya University","correspondingAuthor":false,"prefix":"","firstName":"Deniz","middleName":"","lastName":"Gul","suffix":""},{"id":284609817,"identity":"052eacbc-9b08-47cb-9611-f01b35cc3a25","order_by":4,"name":"Haci Ibrahim Cimen","email":"","orcid":"","institution":"Sakarya University","correspondingAuthor":false,"prefix":"","firstName":"Haci","middleName":"Ibrahim","lastName":"Cimen","suffix":""},{"id":284609818,"identity":"b3ff9fcd-84fd-4594-b9e3-4794504d8427","order_by":5,"name":"Muhammet Yasir Akca","email":"","orcid":"","institution":"Sakarya University","correspondingAuthor":false,"prefix":"","firstName":"Muhammet","middleName":"Yasir","lastName":"Akca","suffix":""},{"id":284609819,"identity":"3344512b-68ef-4448-b3bd-69f81c328538","order_by":6,"name":"Fikret Halis","email":"","orcid":"","institution":"Sakarya University","correspondingAuthor":false,"prefix":"","firstName":"Fikret","middleName":"","lastName":"Halis","suffix":""}],"badges":[],"createdAt":"2024-03-23 11:47:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4154201/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4154201/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53874574,"identity":"b27e8966-e688-4544-b96d-c062532266d5","added_by":"auto","created_at":"2024-04-01 16:20:53","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":393932,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the randomized controlled study\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4154201/v1/b11c09c99ec31d2f84616406.jpeg"},{"id":53967024,"identity":"c657ece0-f1a7-44c4-9894-90c5a7cb5f7f","added_by":"auto","created_at":"2024-04-02 19:53:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":280379,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4154201/v1/449d9bfd-8bc6-4392-8bfc-f3ff01cd1e54.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of video-animated information on the anxiety of male patients before flexible cystoscopy performed under local anesthesia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCystoscopy is a minimally invasive procedure that is frequently used by urologists in their daily practice and is used in diagnosis and treatment to clarify causes such as hematuria, anatomical disorders, and irritant bladder symptoms. Flexible and rigid cystocopes can be used in practice. Cystoscopy performed under local anesthesia is a painful and uncomfortable procedure for patients(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Since the male urethra is longer, the procedure is more uncomfortable in men. Flexible cystoscopy is less traumatic and less painful than rigid cystoscopy. However, many patients may still experience anxiety before the procedure(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Anxiety about cystoscopy can reduce the effectiveness of the procedure and lead to disruptions in the patient's treatment(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnxiety before a surgical procedure is a normal feeling of potential danger(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). They may experience high anxiety before the surgical procedure due to reasons such as uncertainty, fear of death, fear of not recovering, fear of anesthesia(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Lack of understanding of surgical procedures can further increase patients' anxiety and cause patients to avoid or delay treatment. In addition, anxiety experienced during treatment may disrupt hemodynamic stability and lead to conditions such as arrhythmia and hypertension(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the daily surgical routine, patients are often given written and verbal information before the invasive procedure. Adding detailed visual information alongside routine written and verbal information contributes positively to the patient's understanding. Recently, various studies have been published showing that video information added to verbal and written information provides better understanding of patients due to a decrease in their anxiety level(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, there are currently no studies focusing on the anxiety levels of patients who were given video-animated information before cystoscopy. Our study aimed to investigate the effects of video-animated information on the patient's anxiety, satisfaction, pain, desire to repeat the procedure, and hemodynamic parameters during the procedure in case of flexible cystoscopy under local anesthesia.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eThis was designed as a single-center, randomized controlled study. The study was conducted by including patients who underwent cystoscopy under local anesthesia at Sakarya University Training and Research Hospital between January 2024 and March 2024. Local ethics committee approval was obtained.\u003c/p\u003e\u003cp\u003eMale patients who were over 18 years of age, who were going to undergo flexible cystoscopy for diagnostic purposes for the first time, and who were communicative and had the intellectual knowledge to understand the purpose and details of the study, were included in the study. The exclution criteria were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) patients with active urinary infection or urethral deformities; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Had an endoscopic invasive intervention to the urethra or bladder before (Double-J stent removal, urethral dilatation, diagnosed with bladder cancer etc.); (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Had used painkillers within 24 hours before the procedure; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Had used medication that affects consciousness and communication; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) diagnosed with overactive bladder or chronic pain syndrome; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) had uncontrolled blood pressure disease; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) patients who had already in pain.\u003c/p\u003e\u003cp\u003ePatients demographic data such as age, previous operations, weight and height, as well as medical parameters such as the reason for cystoscopy and American Society of Anesthesiologists (ASA) score were collected from interviews with the patients and their medical records. Initially, 172 patients were evaluated for inclusion in the study. Three of these patients did not want to participate in the study, and nine of them did not meet the inclusion criteria. Simple randomization was performed with a 1:1 ratio according to the order of admission to the patients. The patients were divided into two groups: video and non-video. In addition to written information, participants in the video group were given video information under the supervision of a doctor. Participants were able to directly ask any question they wanted to the doctor next to them during the video information. Participants in the non-video group were provided with written information only.\u003c/p\u003e\u003cp\u003eCystoscopy was performed in the standard lithotomy position in all patients. No painkillers were administered before the procedure. During the procedure, the same 16 Fr flexible cystoscope was used, the patients' perineum was cleaned with povidone iodine, and 10 ml of 2% lidocaine gel was applied to the urethra as local anesthesia.\u003c/p\u003e\u003cp\u003eState-Trait Anxiety Inventory(STAI) is a self-reported anxiety assessment questionnaire consisting of 20 questions, each with a four-point Likert scale, consisting of two separate components: STAI-state(STAI-S) and STAI-trait(STAI-T). A person's current anxiety level is evaluated with STAI-S, and long-term anxiety level is evaluated with STAI-T. The highest score that can be obtained from the scale is 80, while the lowest score is 20.\u003c/p\u003e\u003cp\u003eIn the present study, initial anxiety levels were evaluated using the Turkish version of STAI-S and STAI-T before giving verbal information to the patients before the procedure. STAI-T was used to determine whether there was a difference in long-term anxiety between groups before cystoscopy. STAI-S was used to evaluate the difference in anxiety in the same groups after video information. The flow chart of the research is shown in figure-1. The surgeons performed the procedure blindly to the groups.\u003c/p\u003e\u003cp\u003eVisual analog scale(VAS) score was performed after cystoscopy to evaluate participants' perceptions of pain, satisfaction, and desire to undergo the procedure again. VAS is a 10-unit Likert scale. The patient's perceptions are evaluated through participants' answers to designated questions with extreme descriptors on points 1 to 10 (e.g., ''no pain'' - ''severe pain''). In addition, the patients' hemodynamic parameters were recorded during the procedure to compare between groups.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData analysis was performed using IBM SPSS Statistics 22 (SPSS Inc., Chicago, IL, U.S.). The suitability of quantitative data for normal distribution was evaluated using the Kolmogorov-Smirnov test. A two-sided t-test was used to compare differences between two normally distributed groups, while the Mann-Whitney U test was used to compare abnormally distributed continuous variables. Relationships between categorical variables were evaluated using the Pearson Chi-square test. Statistical significance was considered at p \u0026lt; 0.05.\u003c/p\u003e\u003cp\u003eVideo information\u003c/p\u003e\u003cp\u003eVideo information was provided with patient information videos on the official website of the European Urology Association (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://patients.uroweb.org/videos/cystoscopy-video/\u003c/span\u003e\u003cspan address=\"https://patients.uroweb.org/videos/cystoscopy-video/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). This video is in English, lasts a little more than 2 minutes, and explains the cystoscopy procedure in detail with 3D animations. While the participant was watching the video, the doctor sat next to him and provided simultaneous Turkish translation if translation was needed. The participant had the authority to stop the video, ask questions, and rewind the video if he did not understand or was confused about a point.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic data and characteristics of the participants are summarized in Table-1. The average age of the participants was 62\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 in the non-video group and 64.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 in the video group, respectively (p\u0026thinsp;=\u0026thinsp;0.48). When the two groups of participants were examined in terms of BMI, ASA scores, and cystoscopy purposes, they were observed to have similar distributions. In the evaluation before cystoscopy, no statistically significant difference was detected when STAI-T and STAI-S were compared between the groups, respectively (p\u0026thinsp;=\u0026thinsp;0.62, p\u0026thinsp;=\u0026thinsp;0.94).\u003c/p\u003e \u003cp\u003eThe STAI-S comparison between groups before and after information is shown in Table-2. While STAI-S scores did not change statistically significantly in the group without video information (p\u0026thinsp;=\u0026thinsp;0.92), It was observed that the STAI-S score decreased statistically significantly in the group with video information (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eThe changes in the hemodynamic parameters of the participants in the evaluation made during the procedure are shown in Table-3. When systolic heart pressure, diastolic blood pressure and heart rate were compared between groups, it was observed that video information made a statistically significant positive contribution to hemodynamic parameters (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eThe data in which VAS scores of pain, satisfaction and willingness to repeat were evaluated after the procedure are shown in Table-4. While it was observed that video information had no effect on procedure pain (p\u0026thinsp;=\u0026thinsp;0.24), statistically significant improvements were observed in satisfaction and willingness to repeat parameters after video information (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAnxiety before surgical procedures poses a challenge for both surgeons and patients. This anxiety may be related to the surgical procedure itself. One of the important triggers of preoperative anxiety is the lack of information about the procedure(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Cystoscopy, which is performed quite frequently in daily urology practice, can also cause serious patient anxiety(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Recently, many innovative studies involving pharmacological and various environmental controls have been conducted to relieve pain and anxiety during cystoscopy(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). In this study, we investigated the effect of video-animated information about the procedure given by the doctor before cystoscopy on the patient's anxiety reduction, pain management and relief, and increased satisfaction.\u003c/p\u003e \u003cp\u003ePharmacological methods such as instillation and lubrication of the urethra with 2% lidocaine, premedication with a short-acting anxiolytic drug, and use of inhaled nitrous oxide are helpful methods in coping with pain and anxiety. In addition to the use of pharmacological agents, some distraction methods can also be used during the procedure to reduce pain and anxiety and increase procedure satisfaction(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Ways of interacting with the environment, such as grasping and squeezing a stress ball, watching videos, and listening to music, have been accepted as non-pharmacological methods to relieve pain and are used in many minimally invasive procedures, including cystoscopy(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Raheem et al.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) investigated the effects of listening to classical music during cystoscopy on anxiety and pain in 137 patients. Improvements in VAS pain score and STAI anxiety score were reported as statistically significant. Gezici et al.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) conducted a study in which all three distracting arguments, video, stress ball, and music, were used during cystoscopy. Significant reductions in pain and anxiety were observed when all three distractors were used.\u003c/p\u003e \u003cp\u003eThe goodness of communication between the patient and the doctor has an inverse correlation with the patient's anxiety and a direct correlation with the patient's satisfaction. Therefore, for patient-doctor communication to be effective, it is essential to give patients sufficient information and ensure that the patient understands the procedures to be performed. The patient's sociocultural level, literacy, attention and motivation are very important in understanding the information given about the procedures, however, anxiety before the surgical intervention can negatively affect the patient's cognitive skills. Therefore, a complete understanding of the procedure to be performed will lead to increased motivation, self-confidence and compliance with the surgical procedure(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Recently, we have seen the use of video information, in which the process is explained in detail via video, in addition to routine verbal and written information. After Bozkurt et al.'s video-animated information to patients undergoing percutaneous nephrolithotomy surgery, a statistically significant decrease in anxiety levels was observed, which was correlated with the present study(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Besides, Can et al.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) observed a decrease in the anxiety and an increase in the satisfaction of patients who were given video-animated information before the ureteral stent removal procedure, which is similar to cystoscopy. In addition, it has been shown by Tarhan et al.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) that video information given before the prostate biopsy procedure under local anesthesia, which is widely used in daily urology practice, contributes positively to patients' anxiety.\u003c/p\u003e \u003cp\u003eOral and written informed consent is routinely obtained from patients before surgical procedures. Due to legal regulations, written information is detailed and long, which may cause confusion in patients. In the study conducted by Stanley et al., it was reported that written and verbal patient information did not create a significant change in patients' perceptions of the surgical intervention and the complications that may occur due to it(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Recently, with the development of technology, there are multiple publications showed that patient information provided with VR devices or video animations makes a significant positive contribution to patients' preoperative anxiety(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In light of this information, it can be concluded that an additional information method will enable the patient to better understand the procedure to be performed, compared to only verbal and written information. In parallel, it is obvious in our study that patient information provided with video animation has a positive effect on the anxiety levels of patients.\u003c/p\u003e \u003cp\u003eIn minimally invasive surgical procedures performed under local anesthesia, the patient's level of consciousness may cause additional anxiety. This may negatively affect patient satisfaction. When Ketsuwan et al.'s randomized controlled study conducted by VR on anxiety was examined, no statistically significant results were obtained in the post-intervention pain scores, while satisfaction and willingness to repeat scores were found to be statistically significant after the intervention(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Consistent with these findings, while we did not observe a significant change in pain scoring after the intervention, we obtained statistically significant positive results in satisfaction and desire to repeat scores in the present study. This study shows that a decrease in anxiety levels tends to increase patients' satisfaction and willingness to repeat the procedure.\u003c/p\u003e \u003cp\u003ePainful minimally invasive surgical procedures such as cystoscopy performed under local anesthesia may affect hemodynamic parameters. Many studies have been conducted to investigate the effects of distracting activities used to reduce pain and anxiety during cystoscopy on hemodynamic parameters. Gupta et al. reported in their study that simple distracting activities significantly reduced the heart rate and systolic pressure of patients(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In another study, Gezginci et al. showed that simple distraction methods made a positive contribution to hemodynamic parameters(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Based on this, in the present study, we measured the hemodynamic parameters of the patients during the procedure after the information given through video animation. In the present study, it was observed that providing information via video not only had a positive effect on anxiety, but also had a statistically significant positive effect on hemodynamic parameters such as systolic blood pressure, diastolic blood pressure and heart rate.\u003c/p\u003e \u003cp\u003eThe strength of our study was its clear format and prospective nature. However, the current study had some limitations. First, although the same cystoscopy protocol was applied to each patient, the surgeon performing the procedure was not the same. Surgical techniques may vary individually. Secondly, situations that may affect anxiety such as income level, cultural structure, and sociocultural level have been ignored. Thirdly, since the study was carried out in a single center, in a single local cystoscopy room, the same results may not be obtained in another center where environmental factors will change. Fourth, differences in patients' prostate sizes may affect the response to the procedure.\u003c/p\u003e \u003cp\u003eIn conclusion, cystoscopy may be a simple procedure that is frequently performed by urologists in their daily routine, but it can be worrying for patients. Providing written and verbal information before cystoscopy, as well as video-animated information, is a simple to apply, low-cost and effective method that reduces the patient's anxiety and increases satisfaction. We recommend video information to patients before cystoscopy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSubstantial contributions to conception and design: R.B.D., M.B, M.E. Drafting and revising the article critically for important intellectual content: M.Y.A, D.G. H.I.C. Final approval of the version to be published: F.H All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAhn ST, Kim HJ, Jeong HG, Park TY, Shim JS, Kim JW, et al. The effects of using a heating pad on reduction of anxiety, pain and distress during a cystoscopy in the female patients. Eur Urol Suppl. 2018;17(2):e487\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGezginci E, Bedir S, Ozcan C, Iyigun E. Does Watching a Relaxing Video During Cystoscopy Affect Pain and Anxiety Levels of Female Patients? A Randomized Controlled Trial. Pain Manag Nurs [Internet]. 2021;22(2):214\u0026ndash;9. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.pmn.2020.08.005\u003c/span\u003e\u003cspan address=\"10.1016/j.pmn.2020.08.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKetsuwan C, Matang W, Ratanapornsompong W, Sangkum P, Phengsalae Y, Kongchareonsombat W, et al. Prospective randomized controlled trial to evaluate effectiveness of virtual reality to decrease anxiety in office-based flexible cystoscopy patients. World J Urol [Internet]. 2022;40(10):2575\u0026ndash;81. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00345-022-04142-9\u003c/span\u003e\u003cspan address=\"10.1007/s00345-022-04142-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCan O, Bozkurt M, Danış E, Taha Keskin E, Kandemir E, Lutfi Canat H. The effect of informative video before the procedure on anxiety levels in patients who will have ureteral stent removal under local anesthesia. Actas Urol\u0026oacute;gicas Espa\u0026ntilde;olas (English Ed. 2024;(xxxx).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerks A, Chakravarti S, Manninen P. Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol. 2009;21(2):127\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVetter D, Barth J, Uyulmaz S, Uyulmaz S, Vonlanthen R, Belli G, et al. Effects of art on surgical patients: A systematic review and meta-analysis. Ann Surg. 2015;262(5):704\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBozkurt M, Erkoc M, Can O, Danıs E, Canat HL. The effect of an information video on preoperative anxiety level before percutaneous nephrolithotomy procedure: A prospective, randomized trial. Can Urol Assoc J. 2023;17(3):86\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed KJ, Pilling JD, Ahmed K, Buchan J. Effect of a patient-information video on the preoperative anxiety levels of cataract surgery patients. J Cataract Refract Surg [Internet]. 2019;45(4):475\u0026ndash;9. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jcrs.2018.11.011\u003c/span\u003e\u003cspan address=\"10.1016/j.jcrs.2018.11.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGunendran T, Briggs RH, Wemyss-Holden GD, Neilson D. Does Increasing Hydrostatic Pressure (\u0026ldquo;Bag Squeeze\u0026rdquo;) During Flexible Cystoscopy Improve Patient Comfort: A Randomized, Controlled Study. Urology. 2008;72(2):255\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSong YS, Song ES, Kim KJ, Park YH, Ku JH. Midazolam anesthesia during rigid and flexible cystoscopy. Urol Res. 2007;35(3):139\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaheem OA, Mirheydar HS, Lee HJ, Patel ND, Godebu E, Sakamoto K. Does Listening to Music during Office-Based Flexible Cystoscopy Decrease Anxiety in Patients: A Prospective Randomized Trial. J Endourol. 2015;29(7):791\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGezginci E, Iyigun E, Kibar Y, Bedir S. Three Distraction Methods for Pain Reduction During Cystoscopy: A Randomized Controlled Trial Evaluating the Effects on Pain, Anxiety, and Satisfaction. J Endourol. 2018;32(11):1078\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHa JF, Longnecker N. Doctor-patient communication: A review. Ochsner J. 2010;10(1):38\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarhan H, Cakmak O, Unal E, Akarken I, Un S, Ekin RG, et al. The effect of video-based education on patient anxiety in men undergoing transrectal prostate biopsy. Can Urol Assoc J. 2014;8(11\u0026ndash;12):e894\u0026ndash;900.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHandelsman MM, Rosen J, Arguello A. Informed Consent of Students: How Much Information is Enough? Teach Psychol. 1987;14(2):107\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta S, Das S, Jana D, Pal D. Distraction during cystoscopy to reduce pain and increase satisfaction: Randomized control study between real-time visualization versus listening to music versus combined music and real-time visualization. Urol Ann. 2019;11(1):33\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable-1: Patient descriptive characteristics, pre-information STAI and ASA comparisons between video and non-video groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"75%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-video group(n=80)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVideo group(n=80)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e) (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e62\u0026plusmn;10.4\u003c/p\u003e\n \u003cp\u003e28.4\u0026plusmn;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e64.4\u0026nbsp;\u0026plusmn;8.8\u003c/p\u003e\n \u003cp\u003e28.8\u0026plusmn;5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003eSTAI-T (mean+SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e34.2\u0026plusmn;3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e35.8\u0026plusmn;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003eSTAI-S (mean+SD)(pre-information)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e39.22\u0026plusmn;5.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e39.14\u0026plusmn;5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003eASA score (ASA 1\u0026ndash;2/ASA 3\u0026ndash;4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e32/48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e27/53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003eReasons for flexible cystoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Macroscopic hematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Microscopic hematuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Lower urinary tract symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.97959183673469%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Suspicious bladder calculus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.551020408163264%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.46938775510204%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable-2: Change of STAI-S after informations between groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.775510204081634%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003eSTAI-S (mean+SD)(pre-information)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.775510204081634%\" valign=\"top\"\u003e\n \u003cp\u003eSTAI-S (mean+ SD)(post-information)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003eNon-video group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003e39.22\u0026plusmn;5.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.775510204081634%\" valign=\"top\"\u003e\n \u003cp\u003e38.98\u0026plusmn;8.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003eVideo group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.734693877551024%\" valign=\"top\"\u003e\n \u003cp\u003e39.14\u0026plusmn;5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.775510204081634%\" valign=\"top\"\u003e\n \u003cp\u003e32.68\u0026plusmn;2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.204081632653061%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: standard deviation; STAI-S: State-Trait Anxiety Inventory, state anxiety\u003c/p\u003e\n\u003cp\u003eTable-3: Comparisons of Hemodynamic Parameters Measured During Cystoscopy Between Groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.31313131313131%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-video group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVideo group\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.31313131313131%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.31313131313131%\" valign=\"top\"\u003e\n \u003cp\u003eSystolic pressure (mean\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e155.6\u0026plusmn;14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e142.4\u0026plusmn;10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.31313131313131%\" valign=\"top\"\u003e\n \u003cp\u003eDiastolic pressure (mean\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e109.8\u0026plusmn;11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e92.3\u0026plusmn;8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.31313131313131%\" valign=\"top\"\u003e\n \u003cp\u003eHeart rate (mean\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.22222222222222%\" valign=\"top\"\u003e\n \u003cp\u003e96.3\u0026plusmn;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e85.6\u0026plusmn;4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: standard deviation\u003c/p\u003e\n\u003cp\u003eTable-4: Comparison of pain, satisfaction, willingness between two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-video group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVideo group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003eVAS-pain (0\u0026ndash;10) (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e3.2\u0026plusmn;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e3.1\u0026plusmn;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003eVAS-satisfaction (0\u0026ndash;10) (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e8.6\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e9.2\u0026plusmn;1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.91836734693877%\" valign=\"top\"\u003e\n \u003cp\u003eVAS-willingness to repeat (0\u0026ndash;10) (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.387755102040817%\" valign=\"top\"\u003e\n \u003cp\u003e1.8\u0026plusmn;0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\" valign=\"top\"\u003e\n \u003cp\u003e2.2\u0026plusmn;0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: standard deviation, VAS: visual analog scale\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4154201/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4154201/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose: To investigate the effect of video-animated information given before flexible cystoscopy under local anesthesia on the anxiety of male patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: Before cystoscopy, patients were divided into two groups with 1:1 standard randomization. While one group was given written and verbal information, the other group was additionally given video-animated information. The patients' anxiety levels before the procedure and their hemodynamic parameters during the procedure were compared between the groups. In addition, pain, satisfaction and willingness to repeat the procedure were compared between the groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: STAI-s levels were found to be statistically significantly lower in the group given video animation information before cystoscopy (p\u0026lt;0.01). It was observed that video information had a positive effect on systolic blood pressure, diastolic blood pressure and heart rate, and the values were measured lower compared to the other group (p \u0026lt;0.01). While there was no statistically significant difference between the two groups in VAS-pain scores (p=0.24), VAS-satisfaction and VAS-willingness to repeat the procedure scores were found to be statistically significantly different (p\u0026lt;0.01). It was observed that video-animated information made a positive contribution to satisfaction and willingness to repeat the procedure.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Video-animated information given before the flexible cystoscopy procedure performed on male patients under local anesthesia has positive effects on the patients' anxiety. In addition, it contributes positively to the patient's satisfaction and desire to repeat the procedure. Video-animated information may be routinely used to verbal and written information before the csytoscopy.\u003c/p\u003e","manuscriptTitle":"The effect of video-animated information on the anxiety of male patients before flexible cystoscopy performed under local anesthesia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-01 16:20:48","doi":"10.21203/rs.3.rs-4154201/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e16960b4-ac5e-4c64-ae8d-8d0e08e2d86a","owner":[],"postedDate":"April 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-02T19:45:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-01 16:20:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4154201","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4154201","identity":"rs-4154201","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}