psd-502 and Urethral-Stricture

Meatotomy is a simple, common procedure for the treatment of meatal stenosis. We compared the outcomes of meatotomy performed using local anesthesia and sedation, and general anesthesia with and without penile block.. A prospective comparative design was used. Participants included 76 boys 1.5 to 10 years old treated for meatal stenosis at a tertiary, university affiliated, pediatric medical center in 2008. Children were randomly allocated to undergo surgery with sedation and local anesthesia, or general anesthesia with or without penile block. All procedures were performed with the same method by the same surgeon. For local anesthesia EMLA 5% cream (lidocaine 2.5% and prilocaine 2.5%) covered with an occlusive dressing was applied 1 hour preoperatively, and midazolam (in patients younger than 5 years) or nitrous oxide (older than 5 years) was used for sedation. General anesthesia was induced with inhaled sevoflurane, and ropivacaine was used for dorsal penile nerve block.. There was no difference among the groups in pain level intraoperatively (no pain in 92% to 93% of patients), 24 hours postoperatively (no pain in 81% to 88%) or after 1 month, or in complication rates (bleeding in 3 patients, laryngospasm in 2). General anesthesia with penile block was associated with a trend of less dysuria. Quality of void was excellent in 87% of patients at 24 hours and in 70% at 1 month, and parental satisfaction was high (88% to 92%).. Meatotomy performed using local anesthesia and sedation has an equally good outcome to meatotomy performed using general anesthesia with or without penile block.

Topics: Administration, Topical; Anesthesia, General; Anesthesia, Local; Anesthetics, Local; Child; Child, Preschool; Conscious Sedation; Follow-Up Studies; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain Measurement; Pain, Postoperative; Postoperative Care; Preoperative Care; Prilocaine; Prospective Studies; Risk Assessment; Statistics, Nonparametric; Treatment Outcome; Urethral Stricture; Urologic Surgical Procedures, Male

We determined the effectiveness of lidocaine and prilocaine (EMLA) topical cream for anesthesia during urethral meatotomy performed in an office setting.. Meatotomy was performed in 58 patients 1 hour after topical application of EMLA cream to the glans.. Of the 58 patients 55 had no pain, while early in our experience 3 had limited discomfort because EMLA cream was applied in too small a volume or it became dislodged. Results have been good in 57 patients, while partial restenosis developed in 1.. Urethral meatotomy in an office setting with EMLA cream for anesthesia is generally painless, well tolerated, successful and cost-effective versus operative meatotomy.

Topics: Ambulatory Surgical Procedures; Anesthetics, Local; Child; Child, Preschool; Drug Combinations; Follow-Up Studies; Humans; Infant; Lidocaine; Lidocaine, Prilocaine Drug Combination; Prilocaine; Urethral Stricture

Topics: Ambulatory Surgical Procedures; Anesthetics, Local; Child; Child, Preschool; Dilatation; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Pain; Pain Measurement; Prilocaine; Urethral Stricture

A number of minor urological surgical procedures can be readily carried out in children in outpatient clinics with the availability of a good topical local anaesthetic. In boys, the separation of preputial adhesions, frenulotomy, meatoplasty, meatal dilatation following circumcision or meatal surgery, the removal of smegma and excision of penile skin lesions can be performed as outpatient treatment. In girls, hymenal abnormalities, meatal abnormalities and labial adhesions come into consideration for its use. Success is dependent on a good estimation of the mental capacity of the child to undergo a local surgical procedure and correct use of the anaesthetic.

Topics: Ambulatory Surgical Procedures; Anesthetics, Combined; Anesthetics, Local; Child; Child Development; Child, Preschool; Circumcision, Male; Dilatation, Pathologic; Female; Humans; Hymen; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Minor Surgical Procedures; Ointments; Penile Diseases; Prilocaine; Smegma; Tissue Adhesions; Treatment Outcome; Urethra; Urethral Diseases; Urethral Stricture; Urologic Surgical Procedures; Vulvar Diseases