title: Meatotomy using local anesthesia and sedation or general anesthesia with or without penile block in children: a prospective randomized study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  Meatotomy performed using local anesthesia and sedation has an equally good outcome to meatotomy performed using general anesthesia with or without penile block.
authors.affiliation: Pediatric Urology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. davidbm@clalit.org.il
authors.forename: David
authors.initials: D
authors.lastname: Ben-Meir
authors.forename: Pinhas M
authors.initials: PM
authors.lastname: Livne
authors.forename: Elad
authors.initials: E
authors.lastname: Feigin
authors.forename: Ranit
authors.initials: R
authors.lastname: Djerassi
authors.forename: Rachel
authors.initials: R
authors.lastname: Efrat
mesh_terms: D000287:Administration, Topical; D000768:Anesthesia, General / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control*; D011182:Postoperative Care; D011300:Preoperative Care; D011318:Prilocaine / Q000008:administration & dosage*; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014525:Urethral Stricture / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine