Effect of Supplementary Video Information on Patient Anxiety Before Urodynamic Testing: A Randomized Controlled Study

Article information

Int Neurourol J. 2025;29(2):135-141

Publication date (electronic) : 2025 June 30

doi : https://doi.org/10.5213/inj.2550038.019

Mehmet Şahin, Murat Gürbüz, Metin Savun, Yiğit Can Filtekin, Osman Can, Halil Lutfi Canat

Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey

Corresponding author: Mehmet Şahin Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey Email: mehmetsahinmd@gmail.com

Received 2025 January 30; Accepted 2025 February 13.

Abstract

INTRODUCTION

Urodynamic testing is an objective diagnostic method widely used to evaluate bladder function in individuals with lower urinary tract symptoms. By measuring bladder pressure and urine flow rates during the filling, storage, and voiding phases, this technique is essential for diagnosing conditions such as voiding dysfunction and urinary incontinence [1]. As an invasive procedure, it requires catheter insertion into the urethra, vagina, or rectum. Patients may experience pain during insertion [2], which can contribute to increased anxiety [3]. Although generally well tolerated, the test can result in complications such as mild dysuria, hematuria, or urinary tract infection [4].

Anxiety can arise in contexts such as awaiting medical test results or anticipating a procedure [5]. Furthermore, the procedure itself may induce both physical and emotional discomfort [6]. Physicians are instrumental in alleviating these burdens through a combination of medical interventions and nonmedical approaches. Recent studies suggest that various nonmedical strategies can effectively reduce anxiety and pain in patients undergoing urodynamic testing [7-10].

Effective patient education before urodynamic testing can be delivered through various modalities, including verbal explanations, written materials, and video-based content [11]. Numerous studies have demonstrated that providing video-based information prior to urological procedures reduces patient anxiety [12-15]. However, randomized controlled trials assessing the specific impact of video-animated educational content on preprocedural anxiety in urodynamic testing are lacking. This study therefore investigates the effect of video-animated information on anxiety levels in patients scheduled for urodynamic evaluation.

MATERIALS AND METHODS

This prospective, randomized trial enrolled patients scheduled for urodynamic testing between September and November 2024.

The study included patients who underwent urodynamic testing in our clinic. Patients were excluded if they had previously undergone urodynamic testing, had a previously diagnosed psychiatric or neurological disorder, were taking medications that could influence anxiety, lacked the mental capacity to understand the consent form or respond to the questions, or were unable to complete the procedure for any reason. The participant flowchart is presented in Fig. 1.

Fig. 1.

Participant flow diagram. STAI-S, State-Trait Anxiety Inventory-State; STAI-T, State-Trait Anxiety Inventory-Trait.

Patient demographic data, including age, sex, body mass index, comorbidities, smoking status, alcohol consumption, and preliminary diagnoses, were thoroughly recorded.

To minimize bias, simple randomization was performed using sequential assignment with randomly generated numbers. Patients were evenly divided into 2 groups. The video group (group 1): received verbal, written, and video-animated information, while the nonvideo group (group 2) received only verbal and written information.

The State-Trait Anxiety Inventory (STAI) questionnaire, adapted and validated in Turkish, was used to assess patients’ anxiety levels [16]. The STAI-State (STAI-S) measured momentary anxiety, whereas the STAI-Trait (STAI-T) evaluated general anxiety. Each form consisted of 20 questions, with response options for the STAI-S of (1) not at all, (2) somewhat, (3) moderately, and (4) very much so and for the STAI-T of (1) almost never, (2) sometimes, (3) often, and (4) almost always. Possible scores ranged from 20 to 80, with scores between 20 and 37 classified as “no or low anxiety,” 38 to 44 as “moderate anxiety,” and 45 to 80 as “high anxiety.” The STAI-T was completed to compare general anxiety levels between the groups, while the STAI-S was administered before and after the briefing to assess changes in situational anxiety.

RESULTS

A total of 219 patients were prospectively enrolled in the study. Of these, 8 were excluded due to a prior psychiatric or neurological diagnosis or treatment, 5 were unable to complete the forms, and 6 declined to participate. Consequently, each group comprised 100 patients.

The median age of the participants was 60 years (range, 18–82 years) in the video group and 58 years (range, 18–86 years) in group 2. Male patients comprised 64% of the video group and 72% of the group 2. The median body mass index was 27.9 kg/m² (range, 17.9–46 kg/m²) in the video group and 27.3 kg/m² (range, 19.3–43 kg/m²) in group 2. Alcohol consumption did not differ significantly between the groups; however, smoking status did (P=0.008). A comparison of preprocedure preliminary diagnoses revealed no significant differences between groups.

Although no significant differences were observed between the groups’ STAI-T scores or their preinformation STAI-S scores, their postinformation STAI-S scores differed significantly. Moreover, the magnitude of change in STAI-S scores from before to after information delivery was also significantly different between the 2 groups. Demographic characteristics, preliminary diagnoses, STAI-T scores, STAI-S scores obtained before and after information delivery, and the corresponding changes in STAI-S scores are summarized in Table 1. Fig. 2 further illustrates the change in STAI-S scores before and after the briefing for both groups.

Table 1.

Demographic features, questionnaire scores and the changes in STAI-S scores

Fig. 2.

The change in STAI-S scores before and after the briefing. The orange and dashed lines show the changes in STAI-S scores of group 1, and the green line shows the changes in STAI-S scores of group 2 before and after the information. Group 1, video group; group 2, nonvideo group; STAI-S, State-Trait Anxiety Inventory-State.

When examining the change in median STAI-S scores before and after the information was provided, the video group’s median score decreased from 34 (range, 20–62) to 26 (range, 20–39). In the group 2, the median score declined from 35 (range, 20–63) preinformation to 28 (range, 22–48) postinformation. These reductions were statistically significant for both groups (P<0.001). Changes in STAI-S scores for the groups 1 and 2, before and after information delivery, are detailed in Table 2.

Table 2.

Changes in STAI-S scores of video and nonvideo groups pre- and postınformation

DISCUSSION

Anxiety before an invasive procedure poses challenges for both the physician and the patient. In some cases, this anxiety may escalate to the point of treatment or diagnostic refusal. Some studies indicate that presurgical anxiety adversely impacts postoperative pain scores [18, 19]. Common contributors to preprocedural anxiety include fear of pain during and after the procedure, the possibility of requiring surgery, a perceived loss of control, concerns about changes in body image, and insufficient information [20, 21]. Providing adequate information before the procedure is therefore a crucial step.

The relative superiority of verbal, written, and visual information methods has yet to be demonstrated. Although several studies have examined the use of video-animated information prior to other urological procedures [12-15], to our knowledge, no study has yet investigated media-based education before urodynamic testing. In the initial stage of our trial, we compared patients’ STAI-T scores to assess general anxiety levels and found no significant difference between groups. Furthermore, both information delivery methods used in our study produced a significant reduction in STAI-S scores. However, the decrease in STAI-S scores was significantly greater in patients who received video-animated information.

Doctor-patient communication is a key factor that can influence the examination and treatment process [22]. High patient anxiety can create communication difficulties, and inadequate communication can, in turn, exacerbate anxiety. Complex written forms or a physician’s inability to explain medical terminology in the patient’s native language may negatively affect treatment adherence and undermine trust in the process. Stanley et al. [23] found that written and verbal information improved neither patients’ understanding of procedural risks and complications nor their perceived grasp of the operation. Furthermore, focusing on a computer screen rather than engaging in face-to-face dialogue can impair the doctor-patient interaction and may heighten anxiety related to diagnostic procedures and treatments. For example, it has been suggested that the recent increase in the use of electronic medical records has negatively impacted doctor-patient communication, although evidence remains inconclusive. In a systematic review, most studies reported no change, 5 showed a positive effect, and 1 reported a negative effect [24]. Based on our study and this review, we conclude that relying solely on video for patient education is not appropriate. Instead, providing both video and face-to-face verbal information could enhance patient-doctor communication and further reduce anxiety levels.

Recent years have seen a growing trend toward nonmedical strategies for managing preoperative anxiety. Kuang et al. [7] demonstrated that mindfulness meditation significantly improved postprocedure relaxation rates in patients undergoing urodynamics, and Öztürk et al. [8] reported a significant reduction in anxiety when classical music was played during the urodynamic procedure compared to a control group. Although these approaches are promising, they may prove impractical in routine clinical settings due to workload constraints. In contrast, our video-based educational intervention is both easy to implement and cost-effective. Moreover, consistent with our findings, Ozden et al. have shown that reducing anxiety through various information methods may represent a feasible solution [11].

Eberhart et al. [25] demonstrated that patients’ preoperative anxiety levels, whether low or high, may be influenced by specific fears such as a painful procedure, anesthesiologist error, failure to wake from anesthesia, or death under anesthesia. However, since no single fear is universally experienced by all patients, they recommended providing comprehensive information. In line with these findings, the present study demonstrated that combining detailed video-animated information about the procedure with written and verbal explanations addressing procedure-related fears resulted in a greater reduction in anxiety scores than written and verbal information alone.

Despite the significant and meaningful findings of our study, it has several limitations. For instance, to avoid overloading the study with additional endpoints, we did not assess the impact of the information method on postprocedure pain or patient satisfaction. We recommend that future research include these parameters. Additionally, the choice to exclude patients with prior urodynamic experience is debatable: previous exposure may increase preprocedure anxiety in some individuals while reducing it in others. We excluded these patients to eliminate this potential confounding factor and suggest that future studies be specifically designed to address this issue. Finally, all patients received verbal explanations from the same physician. Since communication styles can vary among providers, future research should examine whether anxiety levels differ depending on the healthcare provider delivering the information.

In conclusion, urodynamic examination is a commonly performed, minimally invasive diagnostic procedure in urological practice. However, it can still induce anxiety and concern among patients. Our study demonstrates that supplementing verbal and written instructions with video-animated information significantly reduces preprocedure anxiety. This approach is effective, straightforward, and cost-efficient, facilitating easy integration into routine clinical practice. Moreover, it has potential applicability to other urological procedures and beyond, offering a scalable strategy for managing preprocedure anxiety in clinical settings.

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