Effectiveness of Combined Intraurethral Lidocaine with Sedoanalgesia in Optical Internal Urethrotomy

Yıl 2021, , 96 - 101, 27.04.2021

Cem Nedim Yücetürk , Türkay Çakan

https://doi.org/10.20492/aeahtd.820138

Öz

Aim: In this study, our aim was to compare the effectiveness of combined intraurethral lidocaine and intravenous sedoanalgesia with intraurethral lidocaine alone in patients with undergoing optical internal urethrotomy(OIU) for primary anterior urethral strictures.
Materials and methods: A total of 76 patients who underwent OIU with anterior urethral stricture 2-3 cm long were analysed. Patients were divided into two groups. There were 36 patients in group 1 received only intraurethral lidocaine gel (12.5 g,% 2 ) and there were 40 patients in group 2 operated under intraurethral lidocaine gel anesthesia with intravenous sedoanalgesia (1 mg/kg Propofol and 1µg/kg Fentanyl). Anatomic location, length and etiology of the urethral stricture, procedure time, patients’ follow-up and postoperative VAS scores were compared in two groups.
Results: There was no significant differences between the two groups in the length of the urethral stricture,age and in the follow-up time. Most of the patients in two groups had iatrogenic as the cause of urethral stricture and the stricture was most commonly located in the bulbar urethra. The mean procedure time and VAS score in group 1 were significantly higher than group 2 (p<0.001). Recurrence of urethral stricture developed in 4 and 6 patients at a mean follow-up of 9.47 in group 1, 9.62 months in group 2. No serious complication was developed in both groups.
Conclusion: Intraurethral lidocaine with sedoanalgesia is effective and satisfactory with better pain control than intraurethral lidocaine alone in OIU for anterior urethral strictures.

Anahtar Kelimeler

Internal urethrotomy, local anesthesia, sedoanalgesia, urethral stricture

Destekleyen Kurum

--

Proje Numarası

--

Teşekkür

--

İnternal Üretrotomide İntraüretral Lidocaine ile Sedoanaljezi Kombinasyonunun Etkinliği

Öz

Amaç: Bu çalışmadaki amacımız, primer anterior üretral darlığı olan ve internal üretrotomi yapılan hastalarda uygulanan intraüretral lidokain ve sedoanaljezi kombinasyonu ile tek başına uygulanan intraüretral lidokainin etkinliğini karşılaştırmaktır.
Gereç ve Yöntemler: 2-3 cm uzunluğunda anterior üretral darlığı olan ve internal üretrotomi yapılan 76 hasta analiz edildi.Hastalar iki gruba ayrıldı.Grup 1̓̓ de 36 hasta olup işlem sırasında sadece intraüretral lidokain jel(12.5 g,% 2 ) uygulandı. Grup 2̓ de ise 40 hasta vardı ve operasyon esnasında intraüretral lidokain jel ve intravenöz sedoanaljezi kombinasyonu ( 1 mg/kg Propofol and 1µg/kg Fentanyl) verildi.Gruplar, anatomik lokasyon,üretral darlığın uzunluğu ve etiyolojisi, işlem süresi,takip süreleri ve postoperatif VAS skorlamaları açısından karşılaştırıldı.
Bulgular: Gruplar arasında yaş, üretral darlık uzunluğu ve takip süreleri açısından anlamlı farklar yoktu.Üretral darlığın sebebi her iki gruptaki hastalarda çoğunlukla iatrojenikti ve daha çok bulber üretrada idi.Ortalama işlem zamanı ve VAS skoru grup 1 de grup 2 ye göre anlamlı olarak daha yüksekti. (p<0.001). Üretral darlık nüksü ortalama 9.47 ay takip sonucunda grup 1 de 4 hastada ve grup 2 de 9.62 ay ortalaması ile 6 hastada gerçekleşti .Hastalarda herhangi bir ciddi komplikasyon gelişmedi.
Sonuç:Anterior üretral darlıkların internal üretrotomi ile tedavisi sırasında uygulanan intraüretral lidokain ve intravenöz sedoanaljezi kombinasyonu hastalarda ağrı kontrolü açısından tek başına uygulanan intraüretral lidokain anestezisine göre çok daha etkili ve memnuniyet vericidir.

Anahtar Kelimeler

İnternal üretrotomi, lokal anestezi, sedoanaljezi, üretral darlık

Proje Numarası

--

Kaynakça

• 1. Pansadoro V, Emiliozzi P. Internal urethrotomy in the management of anterior urethral strictures: long-term followup. J Urol. 1996; 156(1) :73-5.
• 2. Yücetürk CN, Yıldız Y, Özgur BC, et al .The efficacy of intraurethral lidocaine in optical internal urethrotomy for anterior urethral stricture: a multicenter study. Minerva Urol Nefrol. 2017; 69(6): 619-25.
• 3. Kreder KJ, Stack R, Thrasher JB et al . Direct vision internal urethrotomy using topical anesthesia. Urology 1993; 42(5):548-550.
• 4. Ghosh B, Dorairajan LN, Kumar S, et al.Randomized clinical trial comparing effectiveness of intracorpus spongiosum block versus topical anesthesia for performing visual internal urethrotomy for urethral stricture disease.Urology 2013 ; 81(1):204-7.
• 5. Ather MH, Zehri AA, Soomro K, et al . The safety and efficacy of optical urethrotomy using a spongiosum block with sedation: a comparative nonrandomized study. J Urol. 2009; 181(5):2134-38.
• 6. Al-Hunayan A, Kehinde EO, Shihab-Eldeen A, et al. An assessment of the clinical utility of transperineal urethrosphincteric block (TUSB) in outpatient rigid cystoscopy: a single blind, randomized study. Int Urol Nephrol. 2009;41(1): 47-53.
• 7. Ye G, Shan-Hong Y, Xiang-Wei W, et al. Use of a new local anesthesia--intracorpus spongiosum anesthesia--in procedures on anterior urethra.Int J Urol. 2005 ;12(4):365-68.
• 8. Sachse H.Treatment of urethral stricture: transurethral slit in view using sharp section. Fortschr Med. 1974 ; 92(1):12-15.
• 9. Kumar S, Prasad S, Parmar K, et al. A randomized controlled trial comparing combined spongiosum block and intraurethral lignocaine with intraurethral lignocaine alone in optical internal urethrotomy for urethral stricture. J Endourol. 2012; 26(8): 1049-52.
• 10. Munks DG, Alli MO, Goad EH. Optical urethrotomy under local anaesthesia is a feasible option in urethral stricture disease. Trop Doct. 2010; 40(1):31-2.
• 11. Altınova S, Turkan S. Optical urethrotomy using topical anesthesia. Int Urol Nephrol. 2007; 39(2):511-12.
• 12. Ye G, Rong-gui Z. Optical urethrotomy for anterior urethral stricture under a new local anesthesia: intracorpus spongiosum anesthesia. Urology 2002; 60(2):245-47.
• 13. Biswal DK, Ghosh B, Bera MK, et al . A randomized clinical trial comparing intracorpus spongiosum block versus intraurethral lignocaine in visual internal urethrotomy for short segment anterior urethral strictures.Urol Ann. 2016 ; 8(3): 317-24.
• 14. Uzun H, Zorba OÜ, Tomak Y, et al. Internal urethrotomy under local urethral anaesthesia is feasible with sedation and analgesia. Nephrourol Mon. 2012; 4(4):636-39.
• 15. Jerjes W, Jerjes WK, Swinson B, et al. Midazolam in the reduction of surgical stress: a randomized clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 ; 100(5) :564-70.
• 16. Albers P, Fichtner J, Brühl P, et al . Long-term results of internal urethrotomy.J Urol. 1996; 156(5):1611-14.
• 17. Pain JA, Collier DG. Factors influencing recurrence of urethral strictures after endoscopic urethrotomy: the role of infection and peri-operative antibiotics. Br J Urol. 1984; 56(2):217-19.