Patient perceptions of anxiety before and after in-office cystoscopy

Objectives: The primary aim of this study is to assess anxiety levels in female patients undergoing office-based rigid cystoscopy before and after the procedure. Our goal is to present this data to future patients when counseling them regarding their anxiety and expectations.

Methods: A retrospective chart review of patient cystoscopy consent forms scanned into the electronic medical records was conducted for patients who underwent cystoscopy at a private urogynecology office between January 2018 through December 2020. Consent forms included two survey questions requesting patients to quantify their level of anxiety on a scale of 1-10, with 1 being no anxiety and 10 being most anxious. Patients were asked to rate their anxiety levels prior to undergoing cystoscopy. After cystoscopy had been completed, they were asked to rate what their pre-cystoscopy anxiety level should have been now that the procedure had been performed. Patients who completed both survey questions on the cystoscopy consent form, were at least 18 years of age at time of their cystoscopy, and had presenting chief complaints of pelvic organ prolapse, irritative voiding symptoms, urinary incontinence, or abnormal urine lab results included for analysis. Individual patient indications for cystoscopy and subsequent cystoscopy findings were reviewed as well. A p-value of < 0.05 was set for statistical significance. A Wilcoxon signed-rank test was conducted to compare the anxiety reported pre and post-cystoscopy. This study was exempt by the submitting author’s institution’s Institutional Review Board.

Results: 1256 patient charts were reviewed, of which 161 charts met inclusion criteria for final analysis. No significant differences were appreciated across patient age, race or ethnicity. There was a significant difference between anxiety levels reported before and after the procedure. Mean patient pre-cystoscopy anxiety score was 5.1, and mean post-cystoscopy anxiety score was 2.07 (p-value < 0.001). (Figure 1) 38.5% of patients underwent cystoscopy for evaluation of urinary incontinence, whereas 24.2% for irritative bladder symptoms, and 18.6% for combined urinary incontinence and irritative bladder symptoms, with remaining 18.6% of patients undergoing evaluation of frequent bladder infections, urinary retention, hematuria, or dysuria (p-value 0.617). (Table 1) 87% of patients had normal findings noted on cystoscopy, whereas 9.9% had cystitis and remaining patients had either bladder polyp, interstitial cystitis, or other abnormal findings. (p-value 1.0).

Conclusions: It is important to assess patient anxiety levels regarding in-office cystoscopy because there is a tendency to be anxious prior to the procedure. However, after the procedure had been performed, patients reported that their anxiety levels should have been significantly lower. The results from this study can be used to help counsel future patients regarding their anxiety and expectations.