title: A randomized clinical trial comparing intracorpus spongiosum block versus intraurethral lignocaine in visual internal urethrotomy for short segment anterior urethral strictures.
abstract: OBJECTIVE
  The primary objective was to compare the effectiveness in pain relief of intracorpus spongiosum block (ICSB) versus intraurethral topical anesthesia (TA) using 2% lignocaine jelly for performing visual internal urethrotomy (VIU) for short segment anterior urethral strictures.
  
  
  METHODS
  It was a randomized, parallel group controlled trial. Participants are adult patients with a single anterior urethral stricture up to 2 cm in length. Patients were allocated to two intervention groups with thirty patients in each group. For anesthesia of the urethra, Group 1 patients received ICSB whereas Group 2 patients received intraurethral TA using 2% lignocaine jelly before VIU. Patient discomfort was assessed with visual analog scale (VAS) during the procedure and 1 h postprocedure. The increase in pulse rate and the change in systolic blood pressure (BP) during the procedure were recorded. The procedure was considered successful if there was absence of symptoms or signs of recurrent stricture and ability to pass freely 18Fr catheter during urethral calibration at last follow-up.
  
  
  RESULTS
  From March 2014 to June 2015, sixty patients were randomized into two groups of thirty patients each. The mean (±standard deviation) intraoperative VAS score was 2.8 ± 1.1 in Group 1, which was significantly less (P < 0.05) than the 5.6 ± 1.7 score in Group 2. The mean 1 h postoperative VAS score was also significantly lower in Group 1 patients (1.0 ± 1.0) than in Group 2 patients (3.2 ± 1.5). The change in pulse rate was significantly greater in Group 2 (21.3 ± 10.1 beats/min) than in Group 1 (10.6 ± 4.6 beats/min, P < 0.05). The change in systolic BP was also significantly higher in Group 2 (16.3 ± 8.6 mmHg) than in Group 1 (9.1 ± 4.4 mmHg, P < 0.05). The stricture-free rate at 6-month after VIU in Group 1 and Group 2 patients were 88.5% and 89.6%, respectively.
  
  
  CONCLUSIONS
  ICSB has better pain control with similar complication and recurrence rate than intraurethral lignocaine jelly alone in VIU.
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Biswal
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Bastab
authors.initials: B
authors.lastname: Ghosh
authors.affiliation: Department of Urology, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Malay Kumar
authors.initials: MK
authors.lastname: Bera
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Dilip Kumar
authors.initials: DK
authors.lastname: Pal
keywords: Internal urethrotomy; intracorpus; local anesthesia; randomized; trial; visual internal urethrotomy