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A Randomized Controlled Trial Comparing Two Different Local Intraurethral Anesthetics in Optical Internal Urethrotomy at the Outpatient Clinic

Published:September 30, 2022DOI:https://doi.org/10.1016/j.urology.2022.08.033

      Abstract

      Objective

      To assess feasibility and efficacy of local topical urethral anesthesia at optical internal urethrotomy (OIU) in patients with anterior and posterior urethral strictures at outpatient clinic.

      Methods

      One hundred and twenty eight patients were prospectively randomized to perform OIU with intraurethral prilocaine solution (group 1 = 64 patients) or intraurethral lidocaine gel (group 2 = 64 patients). Visual analog scale was used for procedure related pain evaluation at the beginning, during, and one hour after the procedure. All patients had follow-ups for a minimum of 12 months. Treatment failure was defined as Qmax < 12ml/sec at uroflowmetry and observed urethral stricture on cystoscopy.

      Results

      The overall success rate of the OIU was 75.8%. The intraoperative mean visual analogue score in group 2 (5,1 ± 1,77) was significantly higher than the group 1 (3.7 ± 1.9) (P = 0.0001). The median time to stricture recurrence was 9.2 months (range 1-13 months). Stricture recurrences were noted in 15 patients in Group 1 and 16 patients in Group 2 during the follow-up period.

      Conclusion

      Prilocaine solution as a local anesthetic is a better option than intraurethral lidocaine gel in the OIU procedure and allows successful OIU to be performed in outpatient clinic. It can be preferred as a local anesthetic for OIU, particularly in unfit patients for general/regional anesthesia. Although it provides successful pain relief, it still cannot prevent experiencing moderate or severe pain in a group of patients. More studies about more effective local anesthetics for pain relief during OIU at the outpatient clinic are required.
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