title: Internal urethrotomy under local urethral anaesthesia is feasible with sedation and analgesia.
abstract: BACKGROUND
  Urethral stricture is a common condition, and direct vision internal urethrotomy is prefered as the first treatment option by many urologists, for strictures shorter than 2 cm. This procedure is generally performed under general or spinal anaesthesia.
  
  
  OBJECTIVE
  To investigate the feasibility of adding local urethral anaesthesia to intravenous sedation and analgesia (sedoanalgesia) methods in patients undergoing internal urethrotomy.
  
  
  METHODS
  A total of 21 and 15 patients with anterior urethral strictures underwent internal urethrotomy under local urethral anaesthesia, with or without sedoanalgesia, respectively. Patient discomfort and pain levels were evaluated using the visual analog scale (VAS). Statistical analyses were calculated with a Mann-Whitney U test to compare difference in VAS scores between the subjects in both groups.
  
  
  RESULTS
  Two of the 15 (13%) patients operated under local urethral anaesthesia without sedoanalgesia were converted to general anaesthesia due to patient intolerability. Mean pain VAS scores for patients operated under 2% lidocain urethral gel anaesthesia with or without sedoanalgesia were 2.86 cm and 4.5 cm, respectively (P = 0.001). In addition, a VAS score over 3 cm was found in 3 of the 21 (14%) patients with, and 13 of the 15 (86%) patients without sedoanalgesia (P = 0.001).
  
  
  CONCLUSIONS
  The addition of intravenous sedoanalgesia improved the VAS scores of pain and discomfort, compared to patients operated under only local urethral anaesthesia. This may offer patients safer anaesthesia and shorter operative times with equilavent results in selected patients.
authors.affiliation: Department of Urology, School of Medicine Rize University, Rize, Turkey.
authors.forename: Hakki
authors.initials: H
authors.lastname: Uzun
authors.forename: Orhan Ünal
authors.initials: OÜ
authors.lastname: Zorba
authors.forename: Yakup
authors.initials: Y
authors.lastname: Tomak
authors.forename: Habip
authors.initials: H
authors.lastname: Bostan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kalkan
keywords: Anaesthesia; Internal Urethrotomy; Urethral Stricture