
==== Front
Urol Ann
Urol Ann
UA
Urol Ann
Urology Annals
0974-7796
0974-7834
Wolters Kluwer - Medknow India

UA-16-247
10.4103/ua.ua_89_23
Original Article
Office-based pediatric urology procedures
Alwehaibi Abdulaziz
Alyami Fahad 1
Altwijri Faisal 2
Trbay Mahmoud 2
Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
1 Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
2 Department of Urology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Address for correspondence: Dr. Abdulaziz Alwehaibi, Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia. E-mail: abdulaziz.a.w@hotmail.com
Jul-Sep 2024
03 7 2024
16 3 247249
22 8 2023
22 2 2024
18 3 2024
Copyright: © 2024 Urology Annals
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Introduction:

Office-based procedures under local anesthesia are not a popular and well-accepted concept in pediatric urology except for newborn circumcision. There is limited literature on the utilization of office-based procedures under local anesthesia in pediatric urology. In this study, we present our experience of office-based procedures under local anesthesia from a tertiary center.

Materials and Methods:

This is a retrospective study of the patients who underwent meatotomy and penile adhesion release in the clinic under local anesthesia between January 2017 and August 2022 by a single surgeon in a tertiary center. A total of 92 patients were included in this study.

Results:

There were 65 patients diagnosed with meatal stenosis and 27 patients diagnosed with penile adhesion. The overall incidence of recurrence was noted in four patients. Only one patient had minimal complications. The overall average follow-up was 5.39 months (1–10 months).

Conclusion:

Selective office-based procedure (meatotomy and penile adhesion release) under topical local anesthesia is a simple, safe, and effective method to treat such conditions with a high success rate, especially with financial and time constraints on health care nowadays.

Circumcision
meatal stenosis
meatotomy
penile adhesion
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pmcINTRODUCTION

Office-based procedures under local anesthesia are not a popular and well-accepted concept in pediatric urology except for newborn circumcision. The main factors that limit its use are related to family concerns/stress, children’s cooperation, surgeon’s acceptance, and hospital regulations sometimes. Meatal stenosis and penile adhesion are common problems faced in pediatric urology.[1,2] With the time and financial constraints, we face nowadays in health care, management encourages us to utilize office-based and day surgery procedures. There is limited literature on the utilization of office-based procedures under local anesthesia in pediatric urology. In this study, we present our experience of office-based procedures under local anesthesia from a tertiary center.

MATERIALS AND METHODS

This is a retrospective study of the patients who underwent meatotomy and penile adhesion release in the clinic under local anesthesia between January 2017 and August 2022 by a single surgeon in a tertiary center. A total of 92 patients were included in this study. All of the patients underwent meatotomy or release of penile adhesion in the clinic under the application of topical anesthesia. Patients who had a history of complex anatomy or who underwent previous penile surgery like hypospadia repair were not included in the study.

All patients underwent meatotomy or release of penile adhesion as an office procedure under the application of topical anesthesia (PRILA® cream). In each case, PRILA® cream (2.5% lidocaine and 2.5% prilocaine) was applied directly over the glans and secured with a glove finger over the penis and fixed with adhesive dressing for 30 min before the procedure [Figure 1]. At the time of the procedure, the occlusive dressing was removed, and the penis was prepared with antiseptic. Adequacy of local anesthesia was checked in each case before gripping the tissue with tooth forceps and assure the numbness of the area.

Figure 1 Local anesthesia was applied and secured with a glove fingerand fixed with adhesive dressing

Meatotomy was done in a standard manner with ventral midline application of hemostat at the stenosed segment up to a few millimeters down from the meatus, followed by ventral midline incision along the crushed segment with scissors with no sutures applied. Penile adhesion was done in a classic way with the tip of the hemostat but sliding it in the right place and releasing the adhesion. After the procedure, the local antibiotic ointment was applied and the patient was reassessed for pain and bleeding, then discharged, and follow-up was given a month after the procedure.

RESULTS

A total of 92 patients’ data were included and analyzed in this study. There were 65 patients diagnosed with meatal stenosis and 27 patients diagnosed with penile adhesion. The overall median age was 22.39 months (2 months–11 years). For the meatal stenosis patients, the average age was 24.60 months (2 months–11 years), and for the penile adhesion patients was 17.07 (2 months–9 years).

The overall incidence of recurrence was noted in four patients. There were two patients who had a recurrence of meatal stenosis and underwent meatotomy in a similar fashion and two patients had a recurrence of penile adhesion, which was released in the same fashion [Figure 2].

Figure 2 Incidence of recurrence

Only one of the patients (1.09%) had penile adhesion and had bleeding after release, requiring a single simple suture and there was no need for further procedures [Figure 3].

Figure 3 Incidence of complication

The overall average follow-up was 5.39 months (1–10 months). The average follow-up for the patient who underwent meatotomy was 5.28 months (1–10 months) and 5.67 months (1–8 months) for the patient who underwent release of glandular adhesion.

DISCUSSION

Almost 20 years after Cartwright et al.[3] demonstrated the feasibility and effectiveness of clinic meatotomy under topical lidocaine and prilocaine anesthesia, more than 50% of meatotomies are still performed under general anesthesia (GA).[4]

Topical application of local anesthesia has minor degree of reported complications.[5,6] Minimal edema, erythema, and blanching of the tissues in contact with EMLA® have been reported as side effects.[7,8] A study by Taddio et al. found that the application of EMLA® cream is effective and safe in neonatal circumcision, with no adverse effects.[9] In comparison to GA and locally injected anesthetics, topical application of EMLA® has minor degree of reported complications and simple, safe, and effective method of local anesthesia for minor procedures like meatotomy.[10] Meatoplasty under GA has been associated with a lower recurrence rate than meatotomy (0.2% vs. 3.5%).[4] The cost of a meatotomy under GA is approximately ten times the cost of office meatotomy.[7] However, given the low recurrence rate, much lower costs, and safety of local anesthesia, it is believed that office meatotomy and release of penile adhesion under local anesthesia should be the standard of care for the treatment in the appropriate patients.

Our study showed an overall success rate of >96% of the office-based pediatric urology procedures and one patient had a minimal complication (1%) and this is comparable to the Aghababian et al. study which showed a success rate of >95% and the overall complication rate of 0.6%.[11]

CONCLUSION

Selective office-based procedure (meatotomy and penile adhesion release) under topical local anesthesia is a simple, safe, and effective method to treat such conditions with a high success rate, especially with financial and time constraints on health care nowadays. We believe that pediatric urologists should utilize it more as an effective method to treat such conditions with great outcomes and without compromising their patient care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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REFERENCES

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