title: Meatotomy using topical anesthesia: A painless option.
abstract: OBJECTIVE
  Urethral meatotomy is an office procedure often done under local anesthesia with or without penile block or under short general anesthesia. Whatever may be the method, the patient has to bear the pain of injection. To avoid painful injections, in the present study, topical anesthesia in the form of eutectic mixture of prilocaine and lidocaine anesthetics (EMLA/Prilox) has been used to perform such procedures and its effectiveness determined.
  
  
  METHODS
  A total of 48 consecutive patients with meatal stenosis who attended urology outdoor were enrolled in this study. After exclusion, in 32 patients, 3-4 g of Prilox cream was applied over the glans and occlusive covering was maintained for 45 min before the procedure. Meatotomy was done in a standard manner with hemostat application at the stenosed segment for 2-3 min followed by ventral incision at meatus. The patient's pain perception was measured using visual analog score.
  
  
  RESULTS
  Out of 32, only one patient that had inappropriate application of cream, had a perception of pain during the procedure. Rest all the patient had no discomfort during the procedure. Mean visual analog score was 1.8 which is not a significant percepted pain level. No patient had any major complication.
  
  
  CONCLUSIONS
  Use of topical anesthesia in form of Prilox (EMLA) cream for meatotomy is safe and effective method that avoids painful injections and anxiety related to it and should be considered in most of such patients as an alternative of conventional penile blocks or general anesthesia.
authors: Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors: Vinod
authors: V
authors: Priyadarshi
authors: Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors: Anurag
authors: A
authors: Puri
authors: Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors: Jitendra Pratap
authors: JP
authors: Singh
authors: Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors: Shwetank
authors: S
authors: Mishra
authors: Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors: Dilip Kumar
authors: DK
authors: Pal
authors: Department of Urology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India.
authors: Anup Kumar
authors: AK
authors: Kundu
keywords: Eutectic mixture of local anesthetics; local anesthesia; meatal stenosis; meatotomy; topical anesthesia
references: J Plast Reconstr Aesthet Surg. 2006;59(4):404-8
references: 16756258
references: J Urol. 2011 Feb;185(2):654-7
references: 21172701
references: J Urol. 2004 Oct;172(4 Pt 2):1760-1
references: 15371808
references: Urol Ann. 2012 Sep;4(3):145-9
references: 23248519
references: Pediatrics. 1993 Nov;92(5):710-4
references: 8414860
references: JAMA. 1993 Aug 18;270(7):850-3
references: 8340985
references: Obstet Gynecol Surv. 2002 Mar;57(3):171-8
references: 11889416
references: Am Fam Physician. 2002 Jul 1;66(1):99-102
references: 12126037
references: J Urol. 1996 Aug;156(2 Pt 2):857-8; discussion 858-9
references: 8683801
references: Dermatol Surg. 2012 May;38(5):709-21
references: 22243434
references: Cochrane Database Syst Rev. 2000;(2):CD000496
references: 10796371
references: Br J Anaesth. 1990 Feb;64(2):173-7
references: 2317421
references: N Engl J Med. 1997 Apr 24;336(17):1197-201
references: 9110906