Use of Sedation and Local Anesthesia in Meatotomy: A Prospective Comparison Study
Use of Sedation and Local Anesthesia in Meatotomy: A Prospective Comparison Study
The aim of the study is to prospectively investigate the feasibility, pain control, and
 outcome of meatotomy performed under sedation and local anaesthesia compared with general
 anaesthesia with and without patient block
Background- Meatal stenosis requiring surgery occurs more often in circumcised than in
 uncircumcised boys, with an estimated rate of 7.3%. At our institute, meatotomy is usually
 performed under general anesthesia and penile block is routinely added after induction.
 Recently, several reports have described the performance of meatotomy as an office procedure
 under local anesthesia, with good patient tolerability and a considerable reduction in
 operative time and costs.

 Purpose - The aim of the study is to prospectively investigate the feasibility, pain control,
 and outcome of meatotomy performed under sedation and local anaesthesia compared with general
 anaesthesia with and without patient block.

 Materials and Methods- The study population will include 75 otherwise healthy boys aged 3
 years to 15 years scheduled for meatotomy at our institute. Children with ASA grade >2 will
 be excluded. The children will be reexamined by a senior pediatric ulologist to confirm the
 need for surgery. All children and their parents will be given a detailed explanation of the
 procedure and of the anesthesia and pain control options available by a urology nurse,
 pediatric urologist, and anesthesist.

 Prior to surgery, study participants will be randomly allocated to one of the following
 groups:

 Group 1 will include 25 patients who will undergo meatotomy under sedation and local
 anesthesia. The penis will be topically treated with EMLA cream one hour before surgery and
 then covered with tegaderm. In children aged 3-5 years, sedation will consist of midazolam
 0.5 mg/kg (up to 10 mgs) p.o., administered 20 minutes before surgery; children aged 5 years
 and older will receive nitrous oxide (up to 60%) with oxygen. All patients will be connected
 to a pulse oximeter and monitored by a sedation nurse or an anesthesist.

 Group 2 will include 25 boys operated on under general anaesthesia. Anesthesia will be
 induced by Sevoflurane 8% or IV propofol 2 mg/kg and maintained with sevoflurane 3% or
 isoflurane 1% and nitrous oxide. Ropivacaine 0.2% 1 cc-5 cc will be administered for penile
 block following induction.

 Group 3 will include 25 boys operated on under general anesthesia, like group 2, but without
 penile block.

 All children in all groups will receive paracetamol 15 mg/kg (up 500 mg) as suppository or
 suspension after completion of the meatotomy, and will be monitored by a sedation nurse until
 they are fully recovered. They will be discharged from the hospital after a successful
 spontaneous void.

 Prior to patient discharge, the parents will be asked to complete a form grading their
 child's current pain level and their general satisfaction with the procedure (Appendix I).
 Boys older than 5 years will be asked to complete their own pain scale as well.

 Twenty-four hours after surgery, the parents will be asked, by telephone, to again grade
 their child's current pain; to report the type and doses of pain medications used within this
 time frame, to score their child's voiding quality; and to rate their general satisfaction
 (Appendix II).

 All patients will be invited for a follow-up visit at the clinic one month after the
 procedure. At that time, a urologist will assess the meatal width and voiding quality
 (Appendix III).
Inclusion Criteria:

 -  Boys between 3 years and 18 years with meatal stenosis requiring meatotomy

 Exclusion Criteria:

 -  ASA grade > 2