HypnoVR^® in minimally invasive surgical techniques (MISTs) for lower urinary tract symptoms (LUTS): a safe, sedation-reducing tool improving patient experience

Alberto Olivero^1,*, Sofia Giudici², Alberto Caviglia¹, Erika Palagonia¹, Marco Nizzardo³, Alberto Quistini³, Andrea Grasso⁴, Ofir Maltzman¹, Marco Colombo⁵, Stefano Tappero¹, Elio Mazzone¹, Paolo Dell’Oglio¹, Aldo Massimo Bocciardi¹, Antonio Galfano¹, Silvia Secco¹
1 Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
2 Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
3 Department of Urology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
4 Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
5 Department of Oncology, Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
* Corresponding Author: Alberto Olivero. Email: email
(This article belongs to the Special Issue: Advances and Evolving Techniques in Functional Urology)

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.076804

Received 27 November 2025; Accepted 05 February 2026; Published online 03 March 2026

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Abstract

Background: Minimally invasive surgical techniques (MISTs) are becoming an increasingly popular outpatient treatment option for lower urinary tract symptoms. Although generally well-tolerated, MISTs may cause periprocedural discomfort. Virtual reality devices (VRDs) have been shown to reduce patient-reported pain during several procedures. This study aims to evaluate whether the use of VRD during MISTs could improve perioperative endovenous sedation needs of a VRD during MISTs in a case-control design. Methods: We retrospectively analyzed patient data from MISTs performed between January 2024 and July 2025 at a single referral center (ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy). Procedures were conducted with or without a VRD (HypnoVR^®, Strasbourg, France), based on patient preference and device availability. Patients were grouped into MISTs without VRD (group 1) and MISTs with VRD (group 2). Periprocedural data, endovenous sedation needs, Visual Analogue Scale (VAS) score for pain, use of additional painkiller drugs after the procedure, and complication rate have been addressed. Results: Twenty-one procedures with VRD and 66 control procedures were analyzed. Groups were comparable in age, prostate volume, PSA, indwelling catheter presence, and type of MIST. Median (IQR) prostate volume was 41 (30–56) mL in group 1 and 36 (30–45) mL in group 2. MIST distribution was similar, though iTIND procedures were more frequent with VRD. Endovenous sedation rate was higher in group 1 (86.4 vs. 38.1%, p < 0.001). Median (IQR) VAS scores were 2 (1–2) in group 1 and 1.5 (1–2.75) in group 2. No VRD-related side effects or procedure interruptions occurred. Conclusion: This is the first study demonstrating the safety, feasibility, and tolerability of VRD use during MISTs. Although VRD did not significantly reduce pain scores, it markedly decreased endovenous sedation use, potentially facilitating faster recovery and discharge. VRD may be considered for patients undergoing MISTs where available.