The Effect of Preoperative Education on Postoperative Pain and Anxiety in Patients Undergoing Percutaneous Nephrolithotomy (PCNL)

Document Type : Original Article (s)


1 Assistant Professor, Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: One of the most common urologic diseases is renal and urinary tract stone. Patients experience severe pain after lithotripsy operation; one cause maybe the limited knowledge about the procedures. Due to important and considerable application of percutaneous nephrolithotomy (PCNL) procedure, we decided to evaluate the effect of preoperative education on postoperative pain and anxiety in these patients.Methods: This clinical trial study included 130 patients who underwent the percutaneous nephrolithotomy. Nephrolithiasis was confirmed via spiral computed tomography (CT) scan in them. Patients divided randomly into two groups. This study followed with two parallel groups of equal size, and the effect of preoperative education on postoperative pain and anxiety evaluated by means of visual analog scale (VAS) and Beck Anxiety Inventory (BAI), respectively. Postoperative anxiety and pain intensity were compared using independent t test.Findings: The mean anxiety level was 34.89 ± 4.84 and 22.98 ± 2.37 in control and case groups, respectively (P < 0.050). In addition, the mean pain intensity level was 74.44 ± 26.74 and 34.18 ± 8.17 in control and case groups, respectively (P < 0.050).Conclusion: In our study, postoperative stress and pain intensity after percutaneous nephrolithotomy were significantly less in experimental group. Due to less costs of preoperative educations and potential physiological and psychological effects, it is acceptable for patients to get information before surgery.


  1. Sakhaee K, Maalouf NM, Sinnott B. Clinical review. Kidney stones 2012: pathogenesis, diagnosis, and management. J Clin Endocrinol Metab 2012; 97(6): 1847-60.
  2. Miller NL, Lingeman JE. Management of kidney stones. BMJ 2007; 334(7591): 468-72.
  3. Sandhu C, Anson KM, Patel U. Urinary tract stones--Part II: current status of treatment. Clin Radiol 2003; 58(6): 422-33.
  4. Sjoling M, Nordahl G, Olofsson N, Asplund K. The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. Patient Educ Couns 2003; 51(2): 169-76.
  5. Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med 2010; 83(1): 11-25.
  6. Ni S, Qiyin C, Tao W, Liu L, Jiang H, Hu H, et al. Tubeless percutaneous nephrolithotomy is associated with less pain and shorter hospitalization compared with standard or small bore drainage: a meta-analysis of randomized, controlled trials. Urology 2011; 77(6): 1293-8.
  7. Schwartz-Barcott D, Fortin JD, Kim HS. Client-nurse interaction: testing for its impact in preoperative instruction. Int J Nurs Stud 1994; 31(1): 23-35.
  8. Gammon J, Mulholland CW. Effect of preparatory information prior to elective total hip replacement on post-operative physical coping outcomes. Int J Nurs Stud 1996; 33(6): 589-604.
  9. Scott LE, Clum GA, Peoples JB. Preoperative predictors of postoperative pain. Pain 1983; 15(3): 283-93.
  10. Shuldham C. A review of the impact of pre-operative education on recovery from surgery. Int J Nurs Stud 1999; 36(2): 171-7.
  11. Guo P, East L, Arthur A. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial. Int J Nurs Stud 2012; 49(2): 129-37.
  12. Crabtree TD, Puri V, Bell JM, Bontumasi N, Patterson GA, Kreisel D, et al. Outcomes and perception of lung surgery with implementation of a patient video education module: a prospective cohort study. J Am Coll Surg 2012; 214(5): 816-21.
  13. Papanastassiou I, Anderson R, Barber N, Conover C, Castellvi AE. Effects of preoperative education on spinal surgery patients. SAS J 2011; 5(4): 120-4.
  14. Aydin D, Klit J, Jacobsen S, Troelsen A, Husted H. No major effects of preoperative education in patients undergoing hip or knee replacement--a systematic review. Dan Med J 2015; 62(7).
  15. McDonald S, Page MJ, Beringer K, Wasiak J, Sprowson A. Preoperative education for hip or knee replacement. Cochrane Database Syst Rev 2014; (5): CD003526.
  16. Doering S, Katzlberger F, Rumpold G, Roessler S, Hofstoetter B, Schatz DS, et al. Videotape preparation of patients before hip replacement surgery reduces stress. Psychosom Med 2000; 62(3): 365-73.