BACKGROUND Urethrocystoscopy is among the commonest daycase procedures performed by the urologist. It involves visualization of the lower urinary tract and bladder with a cystoscope. This procedure could be painful and attempts have been made to make it less discomforting for patients. This includes the use of flexible cystoscopes, general and regional anaesthesia. However, some investigators believe that gentle instrument handling and adequate lubrication is all that is required. Although this might be true for the flexible cystoscopy, additional analgesia is required for rigid cystoscopy which is often the practice in low resource centres because it is less expensive and rugged. The most commonly used anaesthesia for most minor urological procedures is caudal block. Although it is effective, it is invasive and as it is often done blindly, the success rate is not more than 68%, in experienced hands. Intraurethral instillation of lignocaine is simpler and can achieve similar analgesia for diagnostic cystoscopy. Hence this study designed to compare the analgesic effect of intraurethral instillation of lignocaine gel compared to caudal block anaesthesia using visual analogue scale (VAS). METHODS A prospective randomised study was carried out among patients who had indications for urethrocystoscopy in the urology division of University College Hospital, Ibadan. A total of 64 patients (32 patients per arm) who met the inclusion criteria were randomised using simple randomisation to either of Group A to receive caudal anaesthesia with 10ml of 2% xylocaine or Group B to have intraurethral instillation of 30ml of 2% xylocaine gel for urethrocystoscopy which was performed using size 22Fr Karl Storz cystoscope. The visual analog scale pain score was obtained at the end of the procedure in addition to data on demographic variables, indications for urethrocystoscopy, diagnosis at urethrocystoscopy and complications. The mean pain scores were compared using Mann-Whitney U test. Other categorical and continuous variables were compared with chi square and student t test using the version 20 statistical package for social sciences(SPSS) RESULTS There were no significant differences in the mean ages, marital status, occupation and other demographic variables between the two groups. The mean VAS pain score of the participants was 4.2. Although the mean pain score of those in intraurethral instillation of xylocain gel group was 0.3 less than those in the caudal group, there was no significant difference between the mean pain score of both groups(p=0.462). There was significant correlation(r=0.843,p=0.001) between the patients‟ assessed pain score and that estimated by the endoscopist. Thirty-two patients (50%) had evaluation of lower urinary tract symptoms as the indication for having urethrocystoscopy, thus LUTS was the commonest indication for urethrocystoscopy. The most common diagnosis at urethrocystoscopy was benign prostate enlargement which accounted for 46.6%. There was also no significant difference in the incidence of complications in both groups. CONCLUSION The two methods of analgesia were similar in efficacy and are safe to employ in the performance of urethrocystoscopy. Either of the methods can be employed in the ever increasing busy urology daycase procedure clinic which has urethrocystoscopy as the commonest procedure. Keywords: Analgesia; caudal block; intraurethral instillation of xylocain gel; visual analog scale pain score; urethrocystoscopy.