The literature on anxiety in cystoscopies thus far highlights the significance of age, gender, depression, disease diagnosis and surveillance as key determinants. The objective of our study was to understand local trends of anxiety in patients undergoing flexible cystoscopies. In particular, we aimed to assess the significance of socioeconomic, procedural and pathology specific factors.

Consecutive patients scheduled for outpatient flexible cystoscopies at Royal Hobart Hospital were prospectively asked to complete a questionnaire. A single doctor performed flexible cystoscopies in an outpatient setting under local anaesthesia. Data collection included pre & post cystoscopy anxiety levels on a self-reporting scale of 1-10 as well as a list of 30 standardized items including patient demographics, income, education, medical history, gender preference, gown use and preference, reason for cystoscopy and number of previous cystoscopies. Univariate analysis and ANOVA testing were then conducted on Microsoft Excel.

70 males and 35 females (n = 105) completed the questionnaire. Across the cohort there was a decrease in anxiety pre to post cystoscopy (3.06 vs. 1.69, p <0.05). Patients with a gender preference had higher pre (4.64 vs. 2.81, p <0.05) and post cystoscopy anxiety scores (2.92 vs. 1.49, p<0.05). Patients with pre-existing mental health burden had higher pre-cystoscopy anxiety scores (4 vs. 2.62, p<0.05). Additionally, ANOVA analysis also showed anxiety scores to be highest amongst those aged 40-70, lowest amongst those >70 and the greatest decrease in anxiety scores in those <40. Further ANOVA analysis showed indication for cystoscopy, number of previous cystoscopies, education, income and rurality to be insignificant at p = 0.05. The remainder of our univariate analysis showed abuse, substance use, gown use and gown preference to be insignificant at p = 0.05.

From this cohort, the overall anxiety burden in cystoscopies remains low, however patients with preexisting mental health diagnoses, those with a gender preference for their urologist (male or female) and those aged between 40-70 are likely to have higher anxiety levels. Interestingly, the cohort data also reflects that conventional socio-economic determinants including patient gender as well as reasons for and frequency of cystoscopic surveillance do not significantly affect anxiety scores.