The following is the summary of  “A Randomized Controlled Trial Comparing Two Different Local Intraurethral Anesthetics in Optical Internal Urethrotomy at the Outpatient Clinic” published in the December 2022 issue of Urology by Ergün, et al.

Patients with anterior and posterior urethral strictures undergoing optical internal urethrotomy (OIU) in an outpatient clinic will evaluate their comfort level with the local topical urethral anesthetic. About 128 patients were prospectively assigned to receive OIU with either intraurethral prilocaine solution (group 1=64 patients) or intraurethral lidocaine gel (group 2=64 patients). Procedure-related pain was measured pre-, intra-, and post-procedure using a visual analog scale. All patients were followed up for at least a year. Failure of treatment was determined by uroflowmetry (Qma<x 12ml/sec) and cystoscopy (observed urethral stricture).

The OIU had an overall success percentage of 75.8%. Comparing groups 1 and 2, the intraoperative mean visual analog scale for group 2 was (5,1±1,77), a statistically significant improvement over group 1’s score of 3.7±1.9 (P=0.0001). In most cases, strictures would not return for another 9.2 months (range 1-13 months). Over the course of the study’s follow-up period, 15 patients in Group 1 and 16 patients in Group 2 experienced a recurrence of their initial restrictive event.

Successful OIU can be carried out in an outpatient clinic when the local anesthetic prilocaine solution is used instead of intraurethral lidocaine gel. In patients who are not candidates for general or regional anesthesia, it may be the local anesthetic of choice during OIU. Although it is effective in relieving pain, it does not prevent some patients from experiencing mild to severe discomfort. During OIU at the outpatient clinic, more research is needed into more effective local anesthetics.