Objectives. To compare two different distal sensor flexible endoscopes with standard fiberoptic cystoscopes for optical resolution. Distal video sensor flexible endoscopy may represent the cusp of a new endoscopic revolution. Methods. Twenty-three participants evaluated the optical resolution capabilities of six flexible cystoscopes. The two presently available distal sensor flexible cystoscopes, ACMI DCN-2010 digital flexible cystoscope and Olympus CYF-V EndoEYE flexible video cystoscope, were compared with the four leading fiberoptic cystoscopes, ACMI ACN-2 fiberoptic cystoscope, Olympus CYF-4 Cystofiberscope, Karl Storz 11272CU1 Flexible Cystoscope, and Richard Wolf Flexible Fibre Urethro-Cystoscope, in an in vitro model. The participants recorded the numerical digits they were able to visualize through five solutions with progressively increasing concentrations of hematoxylin dye (C1 to C5). The cystoscopic images were viewed on a 13-in. medical grade Olympus monitor with an Olympus Visera camera system. Results. No differences were detected among the cystoscopes at the lowest concentrations of hematoxylin dye (C1 and C2). At C3 to C5, the mean percentage of visualized numbers for the ACMI and Olympus distal sensor flexible cystoscopes was significantly greater than for all fiberoptic cystoscopes (P <0.01). At the highest concentration (C5), the ACMI distal sensor cystoscope performed significantly better than did the Olympus distal sensor flexible cystoscopes (P <0.01), although at all other concentrations, the two digital video cystoscopes performed equivalently. Conclusions. The results of this in vitro study suggest that cystoscopes with distal sensor technology improve visibility in a simulated challenging working environment compared with fiberoptic cystoscopes.