Considering the effectiveness of tramadol in alleviating pain following major operations, trauma, labour and even chronic neuropathic pain, this study was designed to evaluate the efficacy of intraurethral administration of the drug in alleviating cystoscopy-related pain in men. Sixty male candidates of diagnostic cystoscopy, aged between 20 and 50 years, in ASA physical status I or II were included in the study. Patients were randomized into intervention [who received tramadol (100 mg) and lidocaine gel] or control group (in whom distilled water and lidocaine was administered) based on a permuted block randomization method. The severity of pain and the incidence of adverse effects were measured during and following the cystoscopy. The urologist' satisfaction was also assessed. Total pain score in the intervention group was significantly lower than the control group (P = 0·037). The urologist was more satisfied with the ease and convenience of performing the cystoscopy in the intervention group. No significant side effect was reported in either group. Adding 100 mg tramadol to lidocaine gel is more effective than using lidocaine gel alone in alleviating the pain associating with male rigid cystoscopy.