Greenstein Alexander, Bar-Yosef Yuval, Chen Juza, Matzkin Haim
Department of Urology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
BJU Int. 2005 Dec;96(9):1307-9. doi: 10.1111/j.1464-410X.2005.05828.x.
To evaluate the effect of a routine explanation provided to men on their expectation of pain associated with a urodynamic study (UDS).
The purpose of UDS is to reproduce patient's symptoms during the urine storage and voiding phases, and thus understand the causes of the patient's symptoms. UDS may cause discomfort and pain, mainly from the urethral instrumentation; the fear of pain related to UDS may affect the patients' behaviour and the information provided by them, and thus may alter the conclusions drawn from the study. Routinely as with any other invasive procedures, patients are provided with an explanation about the UDS. Sixty-three men referred for UDS in an outpatient clinic, who had not had previous UDS, were included (mean age 56.4 years, range 25-89). Of these patients, 15 had had previous instrumentation of the urethra (urethral catheterization, cystoscopy), and 14 had had a prostatectomy. One urologist provided a detailed explanation of the different stages of the UDS. Use of an anaesthetic gel, and instrumentation of the urethra and anus by an experienced urologist, were emphasized. Pain was assessed using a visual analogue pain scale three times, to provide an expected pain score (EPS) on entering the examination room, after the explanation, and the actual pain felt during the UDS.
The mean EPS before the explanation was 4.2, significantly higher (5.17) after the explanation (P = 0.02) and the actual pain scored during the UDS was 3.76, lower than both the previous EPS. In patients who had had previous instrumentation of the urethra, the EPS after the explanation was significantly higher, at 6.06 (P < 0.05). Pain scores were not significantly different in patients after prostatectomy.
The routine guidance provided to male patients undergoing UDS enhances their expectations of pain, especially in those who have had previous instrumentation of the urethra. As the fear of pain may alter the information provided by the patient, different strategies of providing patients with information about UDS should be devised.
评估向男性患者提供常规解释对其与尿动力学检查（UDS）相关疼痛预期的影响。
UDS的目的是重现患者储尿期和排尿期的症状，从而了解患者症状的原因。UDS可能会引起不适和疼痛，主要源于尿道器械操作；对UDS相关疼痛的恐惧可能会影响患者的行为及他们提供的信息，进而可能改变研究得出的结论。与任何其他侵入性操作一样，通常会向患者提供有关UDS的解释。纳入了63名在门诊被转诊进行UDS的男性患者，他们之前未进行过UDS（平均年龄56.4岁，范围25 - 89岁）。在这些患者中，15人曾有过尿道器械操作史（尿道插管、膀胱镜检查），14人曾接受过前列腺切除术。一名泌尿科医生对UDS的不同阶段进行了详细解释。强调了使用麻醉凝胶以及由经验丰富的泌尿科医生进行尿道和肛门器械操作。使用视觉模拟疼痛量表对疼痛进行了三次评估，以得出进入检查室时、解释后以及UDS期间实际感受到的预期疼痛评分（EPS）。
解释前的平均EPS为4.2，解释后的EPS显著更高（5.17）（P = 0.02），UDS期间的实际疼痛评分为3.76，低于之前的EPS。在有尿道器械操作史的患者中，解释后的EPS显著更高，为6.06（P < 0.05）。前列腺切除术后患者的疼痛评分无显著差异。
向接受UDS的男性患者提供的常规指导会提高他们对疼痛的预期，尤其是在那些有尿道器械操作史的患者中。由于对疼痛的恐惧可能会改变患者提供的信息，因此应制定不同的向患者提供UDS信息的策略。
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