A Randomized Controlled Trial Comparing Two Different Local Intraurethral Anesthetics in Optical Internal Urethrotomy...

Area of Science:

• Urology
• Anesthesiology

Background:

• Urethral strictures require surgical intervention, often optical internal urethrotomy (OIU).
• Effective local anesthesia is crucial for patient comfort and procedure feasibility in outpatient settings.

Purpose of the Study:

• To evaluate the feasibility and efficacy of topical urethral anesthesia using prilocaine versus lidocaine for OIU.
• To compare pain levels and treatment outcomes between the two anesthetic agents.

Main Methods:

• 128 patients with anterior/posterior urethral strictures were randomized to receive intraurethral prilocaine (Group 1) or lidocaine (Group 2).
• Pain was assessed using a Visual Analog Scale (VAS) during and after OIU.
• Treatment success was defined by uroflowmetry (Qmax) and cystoscopy findings at 12-month follow-up.

Main Results:

• The overall success rate for OIU was 75.8%.
• Group 1 (prilocaine) reported significantly lower intraoperative VAS scores (3.7 ± 1.9) compared to Group 2 (lidocaine) (5.1 ± 1.77; P=0.0001).
• Stricture recurrence rates were similar between groups, with a median time to recurrence of 9.2 months.

Conclusions:

• Intraurethral prilocaine is a more effective local anesthetic than lidocaine for OIU in an outpatient clinic.
• Prilocaine facilitates successful OIU, especially for patients unfit for general/regional anesthesia.
• While prilocaine improves pain relief, further research is needed for optimal pain management during OIU.