Quarà A. et al., 2025: The use of a virtual reality device (HypnoVR) during extracorporeal shockwave lithotripsy for urinary stones: A case-control study.

Alberto Quarà 1, Luigi Candela 2, Aideen Madden 1, Mariela Corrales 1, Johan Cabrera 1, Stefano Moretto 1, Eugenio Ventimiglia 3, Frederic Panthier 1, Steeve Doizi 1, Olivier Traxer 1
1Department of Urology, Tenon Hospital, Assistance Publique-Hôpitaux des Paris, Sorbonne University, Paris, France.
2Department of Urology, Tenon Hospital, Assistance Publique-Hôpitaux des Paris, Sorbonne University, Paris, France.
3Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.

Abstract

Introduction: Extracorporeal shockwave lithotripsy (SWL) is a standard of care for the management of urinary stones up to 2cm. Although it is generally well-tolerated, ESWL can be a painful procedure for some patients. Virtual reality devices (VRDs) have recently proven to be useful in reducing patient-reported pain during SWL. This study aims to evaluate the safety and efficacy of a VRD during SWL in a case-control study.

Materials and methods: We retrospectively analyzed data of patients undergoing SWL at a single academic stone center. According to patient preference and device availability, a number of procedures were performed using a VRD (HypnoVR®, Strasbourg, France). Patients who underwent more than one SWL session, with at least one session using a VRD, were enrolled in a case-control study (group 1: SWL with VRD, and group 2: SWL without VRD). Periprocedural data were collected. A Visual Analogue Scale (VAS) was used to measure pain tolerance. Descriptive statistics, Chi2 test and t-test were used to compare the 2 cohorts.

Results: A total of 103 procedures with VRD were performed, and 69 procedures were included in the control group. No significant differences in terms of sex, age, BMI, and comorbidities were found between the two groups. In group 1, the median (IQR) stone volume was 109 (78-189) mm3 with a median (IQR) density of 1100 (900-1400) HU, and the stone was located in the kidney in 56 (54%) patients. In the control group, the median (IQR) stone volume was 164 (104-245) mm3, the median (IQR) density was 1195 (918-1356), and stones located in the kidney in 42 (61%) patients. The median (IQR) number of shockwaves was 2831 (2377-3004) in the VRD group versus 2622 (2287-3001) in the control group. The median (IQR) VAS score was comparable between the 2 cohorts: 5 (3-6) in group 1 and 5 (2-5) in group 2. No VRD-related side effects or interruptions have been reported.

Conclusion: This study confirms that the use of VRD during SWL is safe, feasible and well-tolerated. However, current results do not demonstrate a reduction in pain during the procedure compared to a control group. VRD may be proposed to patients undergoing SWL.

Fr J Urol. 2025 Feb 19;35(5):102871. doi: 10.1016/j.fjurol.2025.102871. Online ahead of print. PMID: 3998390