A comparative study between the outcomes of visual internal urethrotomy for short segment anterior urethral...

This study is a randomized controlled study comparing the effectiveness and outcomes of direct visual inter urethrotomy (DVIU) for short segment anterior urethral strictures performed under local anesthesia versus spinal anesthesia.

Patients presenting with an anterior urethral stricture up to 2 cm were randomized into two interventional groups: Group I-DVIU done under spinal anesthesia and Group II-DVIU performed under local anesthesia. Procedural discomfort was analyzed with a visual analog scale (VAS) immediately postoperatively and after one hour of the procedure. The changes in the vital parameters (systolic blood pressure and pulse rate) were recorded. The success of the procedure was defined as the absence of symptoms of recurrent stricture along with the ability of self-urethral calibration with an 18Fr catheter on follow-up.

One hundred and twenty patients, between December 2015 and February 2017, were randomized into the two above-mentioned groups with 60 patients each. The demographic profile, the stricture characteristics (etiology, length, and duration of symptoms), and the preoperative parameters (Q_max, preoperative pulse rate, and systolic blood pressures) were comparable in both the groups. The mean (±SD) intraoperative and one-hour postoperative VAS scores were 1.96 (±1.04) and 1.20 (±0.73), respectively, for Group I, which were significantly less (p<0.05) than the VAS scores 4.26 (± 1.98) and 2.13 (±1.71), respectively, for Group II. The intraoperative mean increases in pulse rate and systolic blood pressure were also significantly lower in Group I (p<0.05). The change in postoperative Q_max (mL/sec) was comparable in both the groups (mean of 20.75±4.31 vs. 19.041 4.88) and so is the stricture free rate at a one-year follow-up. No significant differences in complication rates were observed in both the groups.

Although perioperative procedural parameters seem to be in favor of spinal anesthesia, the outcome of DVIU is independent of the type of anesthesia used.