title: (Almost) painless surgery: a historical review of the evolution of intraurethral anesthesia in urology.
abstract: OBJECTIVE
  The discovery of local anesthesia revolutionized urologic surgery. We investigate the evolution of intraurethral anesthesia in urologic surgery beginning in 1884.
  
  
  METHODS
  A review of the literature was performed, reviewing the history of local anesthesia for urologic surgery, with a specific emphasis on intraurethral anesthesia. Using the University of Rochester libraries catalog "Voyager," a search was performed reviewing the primary literature published on intraurethral anesthesia beginning from 1884 through 2009. We also reviewed published literature in Ovid Med and PubMed for articles relevant to the topic of intraurethral anesthesia. The search terms were intraurethral, cocaine, lidocaine, and anesthesia.
  
  
  RESULTS
  In the 1840s, it was demonstrated that ether, nitrous oxide, and chloroform could prevent the pain of surgery, resulting in a dramatic increase in surgery. At Massachusetts General Hospital between 1845 and 1847, surgeries increased 2.5-fold. Four decades later, it was demonstrated that cocaine allowed for adequate analgesia without the side effects of general anesthesia, resulting in a dramatic increase in urologic surgery. Cocaine was gradually replaced as an intraurethral anesthetic as safer local anesthetics, such as lidocaine, became introduced. Modern studies show conflicting results over the efficacy and ideal administration of intraurethral anesthetics.
  
  
  CONCLUSIONS
  Local anesthesia was rapidly accepted by urologists around the world and used in a wide variety of urologic surgeries, contributing to the acceptance of anesthesia and a revolution of the practice of surgery. To this day, intraurethral anesthesia continues to be a widely used and effective technique in urology, although the ideal method of use is largely left up to individual preference.
authors.affiliation: University of Rochester Medical Center, Department of Urology, Rochester, New York 14642-8656, USA. Jennifer_Gordetsky@urmc.rochester.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gordetsky
authors.forename: Emma
authors.initials: E
authors.lastname: Bendana
authors.forename: Jeanne
authors.initials: J
authors.lastname: O'Brien
authors.forename: Ronald
authors.initials: R
authors.lastname: Rabinowitz
mesh_terms: D000772:Anesthesia, Local / Q000266:history* / Q000379:methods*; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control*; D014521:Urethra; D013520:Urologic Surgical Procedures / Q000009:adverse effects*