The safety and efficacy of optical urethrotomy using a spongiosum block with sedation: a comparative nonrandomized study.

PURPOSE: Optical urethrotomy is generally performed with the patient under general or major regional anesthesia. We determined the safety and efficacy of optical urethrotomy using a spongiosum block with sedation for anterior urethral stricture in a comparative, nonrandomized study.

MATERIALS AND METHODS: In 32 patients with anterior urethral stricture optical urethrotomy was performed under general/major regional anesthesia in 16 patients (group 1) or a spongiosum block and sedation in 16 (group 2). In group 2 a total of 2 to 3 ml 1% lidocaine were slowly injected into the glans penis. Standard optical urethrotomy was performed immediately with a cold cut knife.

RESULTS: The 2 groups were matching in terms of patient age, and stricture cause and length. Optical urethrotomy was successfully completed in all patients in group 1 and in 15 of 16 in group 2. In group 2, 15 patients (94%) had no pain or discomfort. One patient reported moderate discomfort and the procedure was abandoned. In group 2 none of the patients required parental analgesia post procedure. The first year recurrence was not significantly different in the 2 groups (p = 0.192). The anesthetic effect lasted for about an hour and was satisfactory without any complications. Pain score on the visual analogue scale was not different in the 2 groups.

CONCLUSIONS: Optical urethrotomy using a spongiosum block with sedation is as safe and effective as using regional or general anesthesia, particularly in patients who are more ill. The shorter operative time in the local anesthesia group could also make it cost-effective.