In order to better plan new or update sewer pipe condition assessment protocols, this paper presents systematic comparisons of four most widely-used sewer condition assessment protocols, including the fourth edition of Sewer Rehabilitation Manual (SRM-4) in UK, Pipeline Assessment and Certification Program (PACP) in America, Sewer Physical Condition Grading Protocols (SPCCM) in Canada, and Technical Specification for Inspection and Evaluation of Urban Sewer (TSIEUR) in China. In qualitative comparison, the defects, deduct values and assessment methods of the four protocols were analyzed; in quantitative comparison, protocols were used to evaluate the same 182 sewer pipe segments based on field data and the assessment results were compared. It was found that SRM-4 are the most optimistic with 59% pipes being Grade 1 and Grade 2, while SPCCM gives the most pessimistic results with 62% pipes being Grade 3 and Grade 4. Assessment results by PACP and TSIEUR are in the middle. The main reasons for the different evaluation results were due to the different weight of defect and evaluation methods used.