Randomized Clinical Trial Comparing Effectiveness of Intracorpus Spongiosum Block Versus Topical Anesthesia for Performing Visual Internal Urethrotomy for Urethral Stricture Disease

OBJECTIVE To compare the efficacy and safety of intracorpus spongiosum block (ICSB) over topical anesthesia for performing visual internal urethrotomy (VIU) in a randomized clinical trial. METHODS VIU for urethral stricture can be performed under various types of anesthesia, including topical anesthesia. Although recent studies have shown that ICSB and general anesthesia have comparable efficacy for performing VIU, no studies have compared ICSB with topical anesthesia. Forty consenting patients with single, short, passable anterior urethral stricture were randomized into two groups. Group 1 patients received topical 2% lignocaine jelly and group 2 patients received 1% lignocaine ICSB for undergoing VIU. Pain perception during and after the procedure was assessed by visual analog scale (VAS). The changes in vital parameters during the procedure and procedure- related complications were recorded. Statistical analysis was done using the Mann- Whitney test or t test. RESULTS The mean +/- standard deviation VAS scores intraoperatively (2.85 +/- 1.34) and at 1- hour postoperatively (1.17 +/- 0.96) were significantly lower (P < .01) in group 2 patients than the corresponding scores in group 1 (4.9 +/- 1.9 and 2.35 +/- 1.34 respectively). The intraoperative rise in pulse rate and in blood pressure were significantly greater (P < .05) in group 1 patients (13 +/- 5.1/min and 11.3 +/- 6.44 mm Hg) than in group 2 (8.05 +/- 5.54/min and 6.35 +/- 5.86 mm Hg). CONCLUSION ICSB is safe and more effective than topical anesthesia for providing pain relief during VIU. This should become the local anesthesia technique of choice for performing VIU. UROLOGY 81:204-207, 2013. (C) 2013 Elsevier Inc.