Candela L. et al., 2023: The Use of a Virtual Reality Device (HypnoVR) During Extracorporeal Shockwave Lithotripsy for Treatment of Urinary Stones: Initial Results of a Clinical Protocol
Candela L, Ventimiglia E, Corrales M, Sierra Del Rio A, Villa L, Goumas IK, Salonia A, Montorsi F, Doizi S, Traxer O.
Department of Urology, AP-HP, Sorbonne University, Tenon Hospital, Paris, France; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Urology, AP-HP, Sorbonne University, Tenon Hospital, Paris, France.
Department of Urology, Beato Matteo Clinic, Vigevano, Italy.
Objective: To assess the impact of a Virtual Reality Device (VRD, HypnoVR, Strasbourg, France) on patient-reported pain and anxiety during extracorporeal shockwave lithotripsy (ESWL).
Materials and methods: We enrolled 30 patients submitted to ESWL for urinary stones. Patients with either epilepsy or migraine were excluded. ESWL procedures were performed using the same lithotripter (Lithoskop; Siemens, AG Healthcare, Munich, Germany) at a frequency of 1 Hz delivering 3000 shock waves per procedure. The VRD was installed and started 10 minutes before the procedure. Tolerability of pain and treatment-related anxiety represented the primary efficacy outcomes and were evaluated using: (1) a visual analogue scale (VAS), (2) the short version of the McGill pain questionnaire (MPQ), and (3) the short version of the surgical fear questionnaire (SFQ). Secondary outcomes were VRD ease of use and patient satisfaction.
Results: Median (IQR) age was 57 (51-60) years and body mass index (BMI) was 23 (22-27) kg/m2. Median (IQR) stone size was 7 (6-12) mm with a median (IQR) density of 870 (800-1100) HU. Stone location was kidney in 22 (73%), and ureter in 8 (27%) patients. Median (IQR) extra time for installation was 6.5 (4-8) minutes. Overall, 20 (67%) patients were at their first ESWL treatment. Side effects were experienced by only 1 patient. Comprehensively, 28 (93%) patients would recommend and would use VRD again during ESWL.
Conclusion: VRD application during ESWL is safe and feasible. The initial report from patients is positive in terms of pain and anxiety tolerance. Further comparative studies are needed.
Urology. 2023 Feb 15:S0090-4295(23)00143-7. doi: 10.1016/j.urology.2023.01.048. Online ahead of print. PMID: 36796544
This is an interesting report in which a virtual reality device was used to distract patients’ attention from pain and discomfort during SWL. Previous studies have shown that music has similar successful effects by reducing the experience of pain, and VDR is a novel approach with the same purpose.
In the current series 30 patients were given the VRD HypnoVR equipment in association with SWL carried out in a Siemens Lithoscope. A total of 3000 shockwaves at a frequency of 1 Hz were delivered at each treatment session. No other analgesics or sedatives were administered, which is interesting!
Whether VRD can replace administration of analgesic and sedative agents in all SWL settings remains to be shown in large series of treatments, but even if VRD cannot completely replace analgesic-sedation during SWL when shock waves are administered at energy levels usually required for successful treatment, the VRD is an interesting idea that needs to be further explored.