Guidance for avoiding patient pain and discomfort during transurethral cystoscopy

INTRODUCTION: 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. AREAS COVERED: 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. EXPERT OPINION: 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.