The emotional condition of patients before uroflowmetry (UF) may affect the micturition and consequently the results of the examination. Limited literature data are available on the correlation between anxiety levels and uroflowmetry1. Aim of this study was to assess the correlation between emotional condition of the patients at UF and whether anxiety/embarrassment may affect patient’s micturition.

This is a prospective multicenter ongoing study started on July 2018. Patients were enrolled during an office uroflowmetry. Data recorded were: demographics (sex, age, educational level), urological history (therapy, surgical urological treatment), International Prostate Symptoms Score (IPSS) questionnaire in males, and ICIQ-FLUTS questionnaire in females. General anxiety level of the patient was evaluated by the General Anxiety Disorder - 7 (GAD - 7) questionnaire2 considering the levels of severity as following: scores <5 no anxiety, scores 5-9 mild anxiety, scores 10-14 moderate anxiety, scores 15-21 severe anxiety. Moreover, to better understand the anxiety level related to UF we applied questions #4-6 of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).3 Levels of severity were considered as follow: scores 3-6 no anxiety, scores 7-10 moderate anxiety, scores 11-15 severe anxiety. Specific linker-type scales assessed the subjective micturition satisfaction/reproducibility and the discomfort using a threshold score of 60. A dedicated nurse measured post-void residual (PVR) urine by bladder-scan immediately after the examination. Statistical analysis was performed using one-way ANOVA test, and Mann-Whitney test.

Patients enrolled in the study were 125 (mean age 65+ 13 yrs): 85 men (68%) and 40 women (32%).  Voided volumes, Qmax, PVR, and discomforts did not correlate with higher level of anxiety. However, greater anxiety negatively influenced the subjective satisfaction and the UF reproducibility. Patients with higher anxiety levels showed greater symptomatology questionnaires. Table 1 shows results according to GAD scores and APAIS modified scores. A general high level of anxiety was assessed by GAD in 41,6% (52/125) of the cohort, while a high level of UF-related anxiety was recorded by APAIS in 42,4% (53/125). Women reported GAD score >5 in the 87.5% (35/40), and APAIS score >6 in the 70% (28/40). GAD score > 5 and APAIS modified score >6 were documented in males in 44,7% (38/85) and 29% (25/85) respectively. The relation between GAD - APAIS levels and satisfaction/reproducibility and discomforts of the patient are reported in Table 2. A low satisfaction/reproducibility of the exam was reported by 31.2% of the patients (39/125): 38.5% males and 45% females. High discomforts were recorded in 51.2% (74/125) of the population: 56.5% men and 65% women.

Most factors may influence UF outcomes, but the level of anxiety has been poorly investigated. In our study a high levels of general, and UF-related anxiety was found in 4/10 patients. Surprisingly, we found a severe discrepancy of anxiety levels between genders. Women were mostly affected by high general and UF-related high anxiety. Quite the reverse, in men an impaired emotional condition was documented in less than a half of the cases. Moreover, the higher levels of anxiety mainly influenced the subjective satisfaction/reproducibility of the UF. However, no significant differences were found among the objective outcomes (VV/Qmax/PVR). Patients with higher anxiety levels showed worst results at the symptomatology questionnaires. The emotional condition poorly influenced the UF discomforts.

A relevant rate of patients showed high anxiety levels. This study demonstrated that UF, although is a simple and not invasive test, has an important impact on the emotional condition of the patients, mostly in women. This issue should be considered in the counseling of the patients. Anxiety influenced the subjectivity of the patients leading to the sensation of not having reproduced the normal urinary pattern. Therefore, a proper counseling may lower anxiety levels obtaining more physiological results at UF.

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