The following is a summary of the “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.

For a study, researchers sought to analyze the viability and effectiveness of local topical urethral anesthesia during optical internal urethrotomy (OIU) in patients with anterior and posterior urethral strictures in a clinical setting.

Prospective randomization was performed on 128 patients to perform OIU using intraurethral prilocaine solution (group 1 = 64 patients) or intraurethral lidocaine gel (group 2 = 64 patients). A visual analog scale was used to assess procedure-related pain at the start, throughout, and an hour after the procedure. For a minimum of 12 months, all patients underwent follow-up visits. Failure of the treatment was determined by Qmax being <12 ml/sec on the uroflowmeter and urethral stricture being seen on cystoscopy.

About 75.8% of OIU participants were successful overall. In comparison to group 1 (3.7±1.9), group 2 (5,1 ± 1,77) had a considerably higher intraoperative mean visual analog score (P = 0.0001). It took 9.2 months on average for strictures to reoccur (range 1-13 months). During the observation period, there were stricture recurrences in 15 patients in Group 1 and 16 patients in Group 2.

A successful OIU surgery can be carried out in an outpatient clinic when using prilocaine solution as a local anesthetic instead of intraurethral lidocaine gel. It may be chosen as a local anesthetic for OIU, especially in individuals who cannot safely undergo general or regional anesthesia. It effectively reduced pain but could not shield some patients from feeling moderate or severe pain. More research was needed on more potent local anesthetics for pain management during OIU at the outpatient clinic.