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.