Music as a Nonpharmacological Adjunct for Reducing Pain, Anxiety, and Physiological Stress During Cystoscopy: A Systematic Review and Meta-Analysis.

INTRODUCTION AND HYPOTHESIS: Cystoscopy is a commonly performed invasive urological procedure often associated with pain and anxiety, negatively affecting patient compliance and satisfaction. Music has been proposed as a simple, low-cost, nonpharmacological intervention to reduce procedural discomfort and stress. This systematic review and meta-analysis evaluated the effectiveness of music during cystoscopy.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines, PubMed, Scopus, Web of Science, and the Cochrane Library were searched through 5 January 2026. Randomized controlled trials (RCTs) including male patients undergoing cystoscopy and comparing music with a placebo were eligible. Primary outcomes were changes in pain and anxiety scores; secondary outcomes were heart rate and systolic blood pressure. Data were pooled using a random-effects model, and study quality was assessed using the Cochrane Risk-of-Bias 2 tool.

RESULTS

Thirteen RCTs comprising 1,347 participants were included. Music significantly reduced pain (MD = -1.39, 95% CI -1.87 to -0.91), anxiety (MD = -7.35, 95% CI -12.16 to -2.56), and heart rate (MD = -3.31, 95% CI -4.47 to -2.15) compared with control. No significant reduction was observed in systolic blood pressure (MD = -1.27, 95% CI -4.08 to 1.53). Subgroup analysis showed consistent reductions in pain and heart rate for both rigid and flexible cystoscopy. Anxiety reduction was significant in flexible cystoscopy but not in rigid procedures.

CONCLUSION

Music is a safe, inexpensive adjunct that effectively reduces pain, anxiety, and heart rate during cystoscopy and may enhance patient comfort and procedural tolerance.