Unterschiede in der Schmerzhaftigkeit von unterschiedlichen urethrozystoskopischen Techniken im klinischen Anwendungsbereich

In our prospective observational study we examined the differences in pain between patients who were able to watch their own urethrocystoscopy on a real-time video screen and those who were not able to do so. 185 patients from the outpatient clinic of the department of Urology of the University Hospital, Philipps University Marburg were recruited. The aim of the study was to mirror everyday clinical practise, therefore we did not randomise. We included all patients who had rigid or flexible urethrocystoscopy and excluded only those who had additional pain relief like anaesthesia or use of analgesics. The procedure was performed by residents and attendings alike. It was also documented if patients had had urethrocystoscopy before. The patients could choose whether or not they wanted to watch the procedure on a real-time video screen and were afterwards ask to quantify their pain using a numeric rating scale from 0 to 10. Statistical analyses were performed using the Mann-Whitney-U Test. A p value of < 0.05 was considered to be statistically significant. There was no statistically significant difference in pain between those patients who watched their procedure real time on a video screen and those who did not (p>0.05). Nevertheless men who had flexible urethrocystoscopy had significantly less pain when they were able to watch the procedure as when they were not (p=0.007). No such effect could be measured in women (p=0.290). Women mainly had rigid urethrocystoscopy, only two women underwent flexible urethrocystoscopy. They also had significantly more pain during their procedure than men had (p= 0.032). Patients who had had urethrocystoscopy before experienced significantly less pain than those who had no experience with the procedure (p=0.003). Nevertheless there was no statistically significant difference in pain between those patients who had experienced urethrocystoscopy before and could watch their procedure on a real-time video screen and those who also had had urethrocystoscopy before and could not watch their procedure. In conclusion, it can be said that flexible urethrocystoscopy is less painful for men who want to watch their own examination and are allowed to do so. Furthermore more effort should be put in pain relief for women during urethrocystoscopy as the procedure is more painful for them.