Among commonly used interventions, intraurethral lidocaine provides a modest reduction in discomfort, though its effectiveness appears to depend more on administration technique. Cooling the gel, using higher instillation volumes, and slower delivery appear to improve tolerability, while increased instillation time does not consistently reduce pain. Environmental interventions, such as real-time visualization and listening to music, demonstrate benefit in select populations, particularly patients receiving cystoscopy for the first time. Increasing hydrostatic irrigation pressure is one of the most consistently effective interventions across randomized trials and can be easily incorporated into standard workflows without additional resources. Pharmacologic agents such as NSAIDs, anxiolytics, and inhaled nitrous oxide may further improve comfort in selected patients but introduce logistical considerations that limit routine use.
Overall, the evidence supports a patient-centered, multimodal approach to reducing cystoscopy discomfort, emphasizing simple procedural and behavioral modifications as first-line strategies. Future studies should focus on combining these interventions and evaluating their impact on long-term adherence and patient-reported outcomes in real-world practice.
Written by: Avani P. Desai, BS,1 Angela B. Smith, MD, MS,1 Yair Lotan, MD,2
- Department of Urology, University of North Carolina, Chapel Hill, NC
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX