Guidance for avoiding patient pain and discomfort during transurethral cystoscopy

Cystoscopy is one of the most commonly performed invasive urological procedures, serving as a critical diagnostic and surveillance tool in urology, particularly for patients with bladder cancer and hematuria. Despite its routine use in outpatient settings, the procedure is frequently associated with significant patient-reported discomfort, which may adversely affect compliance with surveillance protocols and overall quality of care.

This review synthesizes evidence from 53 randomized controlled trials assessing interventions aimed at reducing discomfort during flexible cystoscopy. Strategies examined include intraurethral lidocaine, real-time visualization, music, hydrostatic irrigation, pharmacologic agents, devices, and behavioral approaches. The literature search encompassed studies published from January 2000 to September 2025 using PubMed and included a range of key terms related to cystoscopy and pain management.

While no single intervention eliminates discomfort, several low-cost, easily implementable strategies, such as increased irrigation pressure, patient-selected music, and real-time visualization, demonstrate meaningful benefit. Pharmacologic interventions may be appropriate for select high-risk patients. Future efforts should prioritize multimodal, personalized approaches and real-world implementation research. Integrating patient-centered discomfort mitigation into routine cystoscopy workflows represents a tangible opportunity to improve procedural quality and adherence in urologic care.