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INTRODUCTION AND OBJECTIVES: Pain, anxiety and embarrassment are well documented feelings in patients undergoing ambulatory diagnostic cystoscopy.Peak-end theory suggests that humans' perception of any experience depends mainly on the peak and end of that experience regardless of its duration. This theory has been utilized in many applications to improve perception of different experiences, but it has never been studied at the office based urological setting.In this study, we explored utilizing Peak-end theory in improving pain perception in patients undergoing diagnostic cystoscopy. We hypothesized that if we created a less unpleasant ending of the cystoscopy procedure by leaving the scope for 2 minutes without any manipulation at the end, this will improve patient's pain and anxiety perception after cystoscopy.METHODS: We conducted a randomized clinical trial for patients undergoing an ambulatory flexible diagnostic cystoscopy for the first time. Males to females as well as arm-allocation ratios were 1:1. Control arm received a standard cystoscopy. Cystoscopies that included endourological interventions were excluded.In the intervention arm the cystoscope was left in the bladder for additional 2 minutes without further manipulation before scope removal. Pain and anxiety scores after cystoscopy were assessed using Visual Analogue Scale (VAS).RESULTS: We present the results of 54 patients out of 61 patients recruited so far after exclusion of 7 patients. Baseline characteristics were balanced between the two arms. Mean VAS scores were lower in the intervention arm but not statistically significant (17.2 mm vs. 12.0 P[0.30). VAS scores were also lower in the intervention arm in the females' subgroup (8.1 vs 9.6) (P[0.73) and in the males' subgroup (16.1 vs 23.2) (P[0.36).Post-cystoscopy anxiety scores were lower in the intervention arm (1.1 vs. 2.3)(P[ 0.024). In gender stratified subgroup analysis, anxiety scores were significantly lower only in the males subgroup (0.96 vs 3.4) ( P[0.013). In females subgroup, intervention arm showed lower scores but this was not statistically significant (0.92 vs 1.0) (P[0.90).CONCLUSIONS: Our study represents the first assessment of Peak-end theory in the office based urological setting.Utilizing the tenets of the Peak-end theory, by making the endphase of an unpleasant procedure like diagnostic cystoscopy less unpleasant, showed promising improvement in post-procedure pain and anxiety perception scores.