Expected versus experienced pain in office-based flexible cystoscopy: A prospective study

This study prospectively evaluated the relationship between pre-procedural pain expectations and experienced pain during first-time office-based cystoscopy, and assessed whether the discrepancy between them is influenced by age and gender in an outpatient tertiary care setting.

This prospective study included adults undergoing first-time office-based cystoscopy between January and April 2026, excluding those with prior cystoscopy or chronic pain requiring analgesics/anxiolytics. All procedures were performed by a single urologist using a 16-Fr flexible cystoscope with intraurethral lidocaine. Expected and experienced pain were assessed using a 0-10 numerical rating scale and analyzed by age and gender, with p < 0.05 considered significant.

A total of 117 patients (83 males, 34 females; mean age 57.6 ± 11.7 years) were included. Post-procedural pain scores were significantly lower than pre-procedural expectations in both male and female patients (all p < 0.001). The magnitude of pain reduction did not differ significantly between male and female patients (p = 0.114) or between patients aged <65 and ≥65 years (p = 0.573). Overall, median pain scores decreased from 6 (5-7) before the procedure to 2 (2-4) after the procedure. Procedure duration was 1.54 ± 0.3 min and did not differ by sex or age. The majority of patients (81.2%) would undergo repeat cystoscopy if required, with no significant difference between male and female patients.

Patients undergoing office-based cystoscopy report significantly lower pain than anticipated, and these findings may inform clinical counseling by facilitating reassurance and contributing to reduced anxiety through effective pre-procedural education.