Transurethral resection (TUR) is a common minimally invasive surgical procedure for lower urinary tract diseases. However, postoperative urinary catheterization often causes catheter-related bladder discomfort (CRBD) and pain due to bladder spasms, which negatively impact recovery and sleep quality. Pharmacological agents used to alleviate CRBD and pain may cause adverse side effects. This study aims to evaluate the effects of cyclic sighing breathing exercises on CRBD severity, pain intensity, and sleep quality in patients undergoing TUR.
Aged 18 years or older
Undergoing Transurethral Resection of the Prostate (TUR-P) or Transurethral Resection of Bladder Tumor (TUR-M/TUR-BT)
Having an indwelling urethral catheter placed postoperatively
Fully conscious, oriented, and cooperative
American Society of Anesthesiologists (ASA) physical status score of IV or higher
Presence of any medical condition or physical impairment that prevents performing breathing exercises
Diagnosed history of sleep apnea
Regular use of sedative, hypnotic, or sleep-inducing medications
Parallel
Cyclic Sighing Breathing Exercise
Other interventionThe cyclic sighing intervention consists of structured breathing sessions taught preoperatively and supervised postoperatively. The patient assumes a comfortable supine or semi-Fowler position in bed. The exercise involves taking a slow, deep inhalation through the nose, immediately followed by a second short nasal inhalation to achieve maximum lung expansion, and then slowly and fully exhaling through the mouth, ensuring that exhalation lasts longer than inhalation. Patients perform this cycle continuously for 5 minutes at the 1st, 2nd, 6th, 12th, and 24th postoperative hours under researcher supervision. To protect nocturnal sleep patterns, sessions scheduled after 22:00 will be completed by 22:00.
Catheter-Related Bladder Discomfort (CRBD) Severity Score
Catheter-related bladder discomfort severity is assessed using the 4-point rating scale developed by Agarwal et al. The scale classifies discomfort as: 0 = none; 1 = mild (reported by the patient only upon direct questioning); 2 = moderate (reported spontaneously by the patient without being asked, but not accompanied by behavioral responses); and 3 = severe (reported spontaneously and accompanied by behavioral manifestations such as vocal complaints, restless limb movements, or attempting to pull out the urinary catheter). Higher scores indicate greater severity of bladder discomfort.
Postoperative Pain Intensity Score
Postoperative pain is assessed using the Numeric Rating Scale (NRS). Patients rate their perceived pain intensity on an 11-point scale from 0 to 10, where 0 represents "no pain" and 10 represents the "worst possible pain". Higher scores reflect higher pain intensity. In addition, total analgesic consumption and medication types will be recorded during the first 24 postoperative hours.
Postoperative Sleep Quality Score
Sleep quality is assessed using the Richard-Campbell Sleep Questionnaire (RCSQ). The instrument evaluates 5 domains (sleep depth, sleep latency, awakenings, time spent awake, and overall sleep quality) using a 0-100 mm Visual Analog Scale (VAS). Total scores range from 0 to 100, with higher scores indicating superior sleep quality (scores \>50 denote good sleep quality).
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