Effect of music on pain and anxiety during cystoscopy: A systematic review and meta-analysis of randomised controlled trials

Objective To assess whether music improves pain and anxiety during cystoscopy.Methods We performed a PRISMA-2020 compliant systematic review and meta-analysis of randomised controlled trials (RCTs) comparing music versus standard care during cystoscopy under local anaesthesia. Electronic databases were searched to 17 January 2026 using predefined MeSH terms. The primary outcome was patient-reported post-procedural pain scores on a 0–10 visual analogue scale (VAS). Secondary outcomes included change in anxiety scores, patient satisfaction, willingness to undergo repeat cystoscopy and post-procedural physiological parameters. Risk of bias was assessed using Rob 2.Results Eleven RCTs involving 1287 participants were included. Music was associated with lower pain scores than control [mean difference −1.80 (95% CI −2.61 to −0.99, p = 0.0005)], although heterogeneity was substantial (I2 = 97%), and the prediction interval crossed the null. In subgroup analysis, the reduction in pain was greater in studies involving rigid cystoscopy (MD −2.50, 95% CI −3.60 to −1.40) than in studies limited to flexible cystoscopy (MD −0.93, 95% CI −1.84 to −0.02). Music was also associated with lower anxiety scores (standardised mean difference −1.42, 95% CI − 2.70 to −0.14), but heterogeneity was extreme (I2 = 98%), limiting confidence in the magnitude of effect. Music was associated with higher post-procedural satisfaction and lower heart rate. Certainty of evidence was moderate for pain and low for anxiety and other secondary outcomes.Conclusion Music may reduce pain during cystoscopy, with a larger observed effect in studies involving rigid instrumentation. However, substantial heterogeneity and a prediction interval crossing the null suggest that benefit is unlikely to be consistent across all clinical settings. Music may be offered as a low-cost, low-risk adjunct to improve patient experience, but the optimal delivery method and patient groups most likely to benefit remain uncertain.