Immersive Virtual Reality for Pain and Anxiety Reduction During Transrectal Ultrasound-Guided Prostate Biopsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
5 affiliations
- 1Kuwait Board of Urology, Kuwait Institute for Medical Specializations (KIMS), Kuwait City 13018, Kuwait
- 2Royal College of Surgeons in Ireland (RCSI), Busaiteen 15503, Bahrain
- 3Otorhinolaryngology-Head and Neck Surgery, Kuwait Institute for Medical Specializations (KIMS), Kuwait City 13018, Kuwait
- 4Department of Otolaryngology-Head and Neck Surgery, Al-Jahra Hospital, Al-Jahra 03200, Kuwait
- 5Urology Unit, Department of Surgery, Jaber Al Ahmad Hospital, Kuwait City 91710, Kuwait
Abstract
Background: Transrectal ultrasound (TRUS) guided prostate biopsy is a distressing procedure associated with significant pain and anxiety, even with routine local anesthesia. Immersive virtual reality (VR) has emerged as a promising non-pharmacological distraction strategy, aiming to modulate pain perception via sensory overload and attentional shift. Methods: A comprehensive search of five databases, including PubMed, Web of Science, CENTRAL, Scopus, and Embase, was conducted up to April 2026. RCTs comparing intra-procedural immersive VR to standard care were included. Primary outcomes were biopsy-related pain and anxiety. Secondary outcomes included patient satisfaction and procedure-related adverse events. Standardized mean differences (SMD) were pooled using a random-effects model. Results: Four RCTs involving 454 patients were included. There was no significant difference between the two groups regarding biopsy-related pain (N = 355 patients, SMD: −1.24, 95% CI [−2.53, 0.04]; p = 0.06) and biopsy-related anxiety (N = 361 patients, SMD: −1.37, 95% CI [−2.76, 0.02]; p = 0.054). These analyses demonstrated significant inter-study heterogeneity (I2 > 95%), and leave-one-out sensitivity analyses revealed instability in the pooled estimates. Nevertheless, VR appeared feasible and well tolerated, with no major device-related adverse events reported in the available trials. Conclusions: The available evidence remains very uncertain regarding the effect of immersive VR on pain and anxiety during TRUS-guided prostate biopsy. Substantial clinical and statistical heterogeneity and instability of the pooled estimates limit definitive interpretation, and the current evidence is insufficient to support routine implementation. Larger, adequately powered, and standardized RCTs are warranted.
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BibTeX
@article{aljenfawi2026immersive,
title = {{Immersive Virtual Reality for Pain and Anxiety Reduction During Transrectal Ultrasound-Guided Prostate Biopsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials}},
author = {Khaled Aljenfawi and Malek Hasan and Ebraheem Albazee and Said Yaiesh},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208145},
url = {https://www.mdpi.com/2077-0383/15/20/8145},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Immersive Virtual Reality for Pain and Anxiety Reduction During Transrectal Ultrasound-Guided Prostate Biopsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
AU - Khaled Aljenfawi
AU - Malek Hasan
AU - Ebraheem Albazee
AU - Said Yaiesh
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208145
UR - https://www.mdpi.com/2077-0383/15/20/8145
AB - Background: Transrectal ultrasound (TRUS) guided prostate biopsy is a distressing procedure associated with significant pain and anxiety, even with routine local anesthesia. Immersive virtual reality (VR) has emerged as a promising non-pharmacological distraction strategy, aiming to modulate pain perception via sensory overload and attentional shift. Methods: A comprehensive search of five databases, including PubMed, Web of Science, CENTRAL, Scopus, and Embase, was conducted up to April 2026. RCTs comparing intra-procedural immersive VR to standard care were included. Primary outcomes were biopsy-related pain and anxiety. Secondary outcomes included patient satisfaction and procedure-related adverse events. Standardized mean differences (SMD) were pooled using a random-effects model. Results: Four RCTs involving 454 patients were included. There was no significant difference between the two groups regarding biopsy-related pain (N = 355 patients, SMD: −1.24, 95% CI [−2.53, 0.04]; p = 0.06) and biopsy-related anxiety (N = 361 patients, SMD: −1.37, 95% CI [−2.76, 0.02]; p = 0.054). These analyses demonstrated significant inter-study heterogeneity (I2 > 95%), and leave-one-out sensitivity analyses revealed instability in the pooled estimates. Nevertheless, VR appeared feasible and well tolerated, with no major device-related adverse events reported in the available trials. Conclusions: The available evidence remains very uncertain regarding the effect of immersive VR on pain and anxiety during TRUS-guided prostate biopsy. Substantial clinical and statistical heterogeneity and instability of the pooled estimates limit definitive interpretation, and the current evidence is insufficient to support routine implementation. Larger, adequately powered, and standardized RCTs are warranted.
SN - 2077-0383
ER -