Effects of Music Therapy on Procedural Pain, Anxiety and Comfort Level During Cystoscopy
Effects of Music Therapy on Procedural Pain, Anxiety and Comfort Level During Cystoscopy
Aims and objectives: This study aimed to determine the effect of music therapy on procedural
 pain intensity and anxiety and comfort levels in patients during cystoscopy.

 Background: Cystoscopy is a procedure that is commonly performed as day surgery in urology
 clinics in order to diagnose lower urinary tract system symptoms as well as to diagnose and
 follow up tumors associated with the lower urinary system. During cystoscopy, which is an
 invasive intervention, individuals may experience pain and anxiety, and their comfort may be
 negatively affected.

 Methods: This study was a prospective, randomized controlled trial. Study participants were
 randomly assigned to either a control or music group. The outcome measures were assessed
 using the Visual Analogue Scale, State Anxiety Scale, and General Comfort Questionnaire. This
 report followed the CONSORT checklist.
1. INTRODUCTION Cystoscopy is a common procedure in urology clinics and has two types:
 flexible and rigid. Especially recently, there has been an increase in the use of
 flexibles. Both of these types can be preferred as a diagnostic procedure in hematuria,
 atypical dysuria, bladder and upper urinary tract cancers, and suspected urethral
 stenosis. Rigid cystoscopy can be more painful than flexible cystoscopy.

 2. BACKGROUND Cystoscopy is a procedure performed in urology clinics to evaluate the lower
 urinary tract for a large number of symptoms and pathologies, but it is painful and
 causes anxiety in individuals. It is recommended to perform local anesthesia to the
 patients during the procedure, to select appropriate cystoscopy equipment, and to make
 the necessary environmental arrangements in order to reduce the patients' pain and
 anxiety and increase their comfort levels.

 Environmental arrangements to manage interventional pain in cystoscopy include music therapy
 that has recently been used widely.Music is used as one of the complementary therapies in the
 treatment of many diseases due to its physical, psychological, and functional effects on
 individuals. The use of music as therapy in hospitals began to become widespread with the
 beginning of the world wars, but the introduction of pharmacological methods for the
 treatment of pain and anxiety has reduced the popularity of music in this context. With the
 identification of side effects of drugs in the subsequent years, starting again to use music
 as complementary therapy has come to the fore.

 Music therapy in nursing first started in the 1800s with Florence Nightingale. Nightingale
 described music as an effective method in the recovery process in order to provide and
 increase patient comfort and reduce their anxiety levels. Music therapy has also been
 accepted as part of nursing practices within the scope of Nursing Interventions
 Classification.

 In the literature, international studies have been conducted to reduce the pain and anxiety
 levels of individuals and increase their comfort levels. Considering two systematic reviews
 related to the subject;some studies noted that music played during flexible cystoscopy did
 not reduce pain and anxiety, while some studies stated that music could be effective in
 reducing pain and anxiety during cystoscopy. Controversial results were found in these two
 studies, which have high evidence levels. Experimental studies with control groups showed
 that music reduced pain and anxiety and increased comfort levels in patients undergoing
 flexible cystoscopy. Given the limitations of the studies on the subject and sample
 power/deficiencies, it may be observed that controversial conclusions have been reached about
 the effectiveness of music in relieving pain and anxiety. On the other hand, only one study
 has been found in Turkey regarding this issue. In a study, the effects of various distraction
 methods applied during the cystoscopy procedure (group 1: music, group 2: stress ball, group
 3: video, and group 4: control) on pain, anxiety, and satisfaction were examined. The study
 found that the patients in the video group had lower pain and anxiety levels than those in
 the other groups. Considering the national and international studies available in the
 literature, regarding the topic of music therapy that may be effective in reducing pain and
 anxiety during the cystoscopy procedure, it is necessary to conduct further studies that
 provide high levels of evidence and produce scientific knowledge with greater sample sizes
 and by using randomized-controlled trials that are fundamental in assessing the effectiveness
 of evidence-based practices. This study aimed to determine the effect of music therapy on
 procedural pain intensity and anxiety and comfort levels in patients during cystoscopy.

 2.1. Study hypotheses Hypothesis 1. Music therapy reduces procedural pain in patients during
 cystoscopy.

 Hypothesis 2. Music therapy reduces anxiety in patients during cystoscopy. Hypothesis 3.
 Music therapy increases comfort level in patients during cystoscopy.
Inclusion criteria:

 -  Patients older than 18 years,

 -  Being literate,

 -  Having no hearing problems.

 Exclusion criteria:

 -  Patients who had allergies to anesthetic drugs

 -  Urinary tract infection.