Cystoscopy is one of the most common procedures in urological practice, though it is often met with hesitancy from patients who worry it will be painful.

This is especially true with male patients, who experience more discomfort during the procedure than women due to anatomical differences. To address that, a recent systematic review published in the Journal of Men’s Health examined several “practical, inexpensive, and harmless” nonpharmacologic interventions to help alleviate pain associated with flexible cystoscopy in male patients.

The findings reveal five methods that proved effective in lowering pain, and identified two strategies that did not generate the same results.

The studied methods include:

• Increasing irrigation pressure by squeezing the irrigation bag or increasing its height
• Increasing time between administering local anesthetic and performing cystoscopy
• Allowing a patient to watch the cystoscopy on a monitor
• Playing music
• Hand holding
• Urinating
• Virtual reality

Three studies, which included 453 male patients, demonstrated that those with higher irrigation levels had significantly lower pain scores. The “bag squeeze” method increases fluid pressure, which might dilate the pathway for the cystoscope to increase its visualization and movability.

Three trials featuring 392 patients showed no significant difference in pain levels between groups that underwent the procedure at differing time periods following the administration of local anesthetics.

Three articles found allowing men to watch the cystoscopy on the monitor resulted in significantly lower pain than in those who did not watch the operation. This method included 340 male patients.

Two studies examining 272 patients found that playing music during the procedure significantly decreased perceived pain. Classical music is the genre utilized most often. 

One study found that allowing the patient to hold a nurse’s hand “resulted in a remarkable reduction of pain” while also reducing the anxiety associated with cystoscopy. Another study suggests having the patient urinate lowered the pain felt during insertion of the cystoscope, often the most painful part of the operation.

Lastly, one study determined virtual reality did not reduce pain or anxiety.

In total, the review examined 14 randomized control trials out of 717 identified studies and included 1,684 male patients from nine countries.