DOI: 10.1177/17562872261477472 ISSN: 1756-2872

Optimizing patient consent and counselling for flexible cystoscopy with virtual reality: Prospective outcomes from a university teaching hospital

Arianna Pischetola, Sohani N. Dassanayake, Phoebe C. J. Reynolds, Dara Bamerni, Tanya Davis, Loretta Tear, Amelia Pietropaolo, Florencia Maria Frascheri, Anna Cornwall, Bhaskar K. Somani
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Background

Informed consent in outpatient urology remains challenging, with patients often demonstrating limited understanding and experiencing anxiety prior to procedures such as flexible cystoscopy. Virtual reality (VR) has emerged as a potential tool to enhance patient education and engagement.

Objectives

To evaluate the effectiveness of virtual reality (VR) as a tool for enhancing informed consent and patient counselling in individuals undergoing flexible cystoscopy, by assessing its impact on patient understanding, emotional response, pain perception, and overall satisfaction.

Design

This single-arm prospective study was conducted from July to October 2025 at our university teaching hospital.

Methods

This single-arm prospective study was conducted from July to October 2025 at our university teaching hospital. Adult patients undergoing flexible cystoscopy were recruited to assess the impact of a VR-enhanced consent process. Participants viewed a 3-minute VR module via headset, featuring interactive 3D anatomical models and narrated explanations based on British Association of Urological Surgeons (BAUS) and European Association of Urology (EAU) patient information materials, outlining the procedure, expected outcomes, and potential risks. To evaluate the intervention, patients completed three validated questionnaires before and after the VR session: a 4-point Likert-scale Procedure Understanding Questionnaire, a Visual Analogue Scale (VAS) for pain, and the State-Trait Anxiety Inventory (STAI) to measure emotional state.

Results

101 patients were included in the study. VR significantly improved patient comprehension, with mean scores rising for understanding (3.03 to 3.81, p <0.001), ability to explain (2.87 to 3.68, p <0.001), and accessibility (2.93 to 3.65, p <0.001). Reported difficulties decreased (1.59 to 1.22, p <0.001), while nervousness did not reach significance (2.17 to 1.93, p =0.034). STAI scores demonstrated significant improvements in positive emotional states including calmness, satisfaction, and self-confidence, alongside reductions in tension, worry, indecisiveness, and confusion. Pain perception of cystoscopy declined but was not statistically significant (VAS, 3.57 to 3.34, p =0.132). Patient evaluation revealed strong preference for VR over traditional consent materials, with most rating the content positively.

Conclusion

VR-enhanced counselling was associated with improved patient understanding, reduced anxiety, and lowered perceived pain during flexible cystoscopy. Patients strongly preferred VR over conventional information, supporting its use as a practical adjunct to routine outpatient consent.

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