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From Nature Clinical Practice Urology

Can Hypnosis Reduce Distress and Improve Compliance With Voiding Cystourethrogram in Children?

By: Christian Radmayr

Synopsis

Background
The voiding cystourethrogram (VCUG) is the standard procedure for diagnosis of vesicoureteral reflux in children. Children with vesicoureteral reflux are at risk of upper urinary tract infections and require repeat VCUG follow-up examinations. This invasive procedure is highly distressing for both the children and parents.

Objective
To determine whether hypnosis can reduce a child's distress during VCUG and facilitate the procedure.

Design and Intervention
This study recruited children scheduled for VCUG at two US institutions from January 1999 to August 2002. Eligible patients were English-speaking, and had undergone at least one previous VCUG at =4 years of age with reported distress. Patients were randomized to receive routine care (with optional recreation therapy to familiarize the child with the procedure, and practice relaxation and breathing) or hypnosis. All children underwent an initial 1 h assessment during which they (and their parents) were asked questions about previous VCUG experiences. Children in the hypnosis arm then attended a 1 h training session in self-hypnosis. After assessing the child's degree of hypnotizability , a therapist taught the child to relax and focus on pleasurable imaginary experiences, and instructed parents and children to practice this procedure several times a day in the run up to their next VCUG. Therapists (recreational or hypnotic) assisted the child during the VCUG.

Outcome Measures
Distress levels as rated by the child, parents, and observers, parents' assessment of overall trauma compared with previous VCUG, medical staff ratings of procedural difficulty, and total procedure time.

Results
Of the 44 children included in the study (29 girls and 15 boys; mean age 7.6 years, mean 2.95 previous VCUGs), 21 received hypnosis and 23 routine care (19 of whom elected recreation therapy). In both groups, catheterization was found to be the most distressing part of the procedure. Physical restraint of 22% of routine-care patients was required, compared with 5% of the hypnosis group. There was no significant correlation between hypnotizability and child distress ( r = 0.22 and child reports of distress during the procedure did not significantly differ between treatment groups, but parents of children in the hypnosis group reported lower overall trauma with respect to the last VCUG than parents whose children received routine care ( P = 0.03). Observational ratings of distress were lower in the hypnosis group ( P = 0.01), as were medical staff ratings of procedural difficulty ( P = 0.01). Total procedure time was shorter in the hypnosis group (mean 35.3 min vs 49.2 min, P = 0.002).

Conclusion
Hypnosis reduces objective measures of distress experienced by children during VCUG and reduces procedural difficulty and duration. This noninvasive method may be useful in other traumatic procedures.

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C Radmayr is Head of the Department of Pediatric Urology at Medical University Innsbruck, Austria.

Competing interests: The author declared no competing interests.