Effectiveness of virtual reality to manage pain and anxiety in patients undergoing cystoscopy: A systematic review and meta-analysis.

Objective: We aimed to perform a systematic review and meta-analysis to assess the efficacy of virtual reality (VR) distraction technologies in managing pain and anxiety in patients undergoing cystoscopy procedures. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 2024, for studies comparing the use of VR distraction technologies versus no VR distraction in patients undergoing cystoscopy. The primary endpoints evaluated were patient-reported anxiety and procedural pain scores, and post-procedural heart rate (HR). Standardized mean differences (SMDs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model. The statistical analysis was conducted using Review Manager 5.4. Results: A total of 575 patients from four randomized controlled trials were included, of whom 289 (50%) underwent the cystoscopy procedure using VR distraction technologies. The mean age of all patients was 57.25 years old, and 395 (69%) of them were male. In our pooled analysis, we did not observe a statistically significant reduction in patient-reported procedural pain (SMD -0.16; 95% CI -0.32-0.00; p=0.060; I 2=0%), anxiety (SMD -0.37; 95% CI -1.65-0.90; p=0.6; I 2=93%), or post-procedural HR (SMD -0.58; 95% CI -1.62-0.45; p=0.3; I 2=97%). Conclusion: In this comprehensive meta-analysis comprising 575 patients who underwent cystoscopy, the use of VR was not associated with a significant difference in pain, anxiety, or HR levels.