Integration of Virtual Reality as analgesia for office based flexible cystoscopy: a randomized prospective study

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Virtual reality has made an impact in areas of acute and chronic pain as an adjunct to standard analgesia regimes. Research has already shown benefit in areas of paediatric procedures, burn wound debridements and endoscopic gynaecological procedures to manage acute procedural pain. It appears subjective pain scores and anxiety levels may be reduced with this non-pharmacological approach This has not been introduced within the scope of urology procedures. Flexible cystoscopy is commonly carried out in the outpatient clinic under local anaesthetic. There wide variation in patients experience with this procedure, with a large number tolerating it poorly, which can also detract from the accuracy of the procedure. Integrating Virtual reality as an analgesia for office based flexible cystoscopy may improve patient satisfaction outcomes, and reduce numbers of patients requiring cystoscopy under General Anaesthesia. Aim: To determine if virtual reality technology will act as an analgesic aid to improve patient satisfaction following outpatient flexible cystoscopy. Method: This will be a single-centre, randomized prospective cohort study conducted within the Urology Department of Dunedin Hospital. Eligible participants will be patients who present for flexible cystoscopy in the outpatient setting. Patients with vision impairment or significant cognitive impairment will be excluded. Recruitment will be from the outpatient clinic over a 12-month period. Estimated sample size 200 patients. Patients will be consented then randomly allocated to Virtual Reality (VR) intervention group or control group. Routine flexible cystoscopy under local anaesthetic will take place with no procedural change in the way samples are collected in both groups. However, the intervention group will wear a VR headset with distraction environment VR software. They will then watch a VR movie for the duration of the procedure. Prior to the procedure in each group, Patients will complete a standardized questionnaire about their expectations of the procedure. This will include questions relating to pain, anxiety and overall expectation. After the procedure, patients will complete the same questionnaire investigating their pain, anxiety, VR response (if applicable) and overall satisfaction. The primary outcome will be patients’ pain, anxiety and overall satisfaction scores. This will be collected on standardized questionnaires as guided by similar international studies. Data will then be analysed to see if there is correlation between VR and primary outcome scores. All data collection will be anonymous with no identifiable information collected. No further follow up is required.

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