Bal Dhiraj S, Chung David, Urichuk Matthew, Shah Jainik, Fidel Maximilian G, Panchendrabose Kapilan, Sidhom Karim, Bard Robert, Nayak Jasmir G, Patel Premal
Max Rady College of Medicine, University of Manitoba, Winnipeg, MB.
Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB.
Urology. 2024 Dec;194:7-13. doi: 10.1016/j.urology.2024.08.051. Epub 2024 Aug 28.
To prospectively assess surgical outcomes, complications, and patient-reported tolerability of invasive scrotal surgeries under local anesthesia (LA) alone, without sedation, compared to tolerability of penile procedures commonly performed in this manner.
Adult patients undergoing penile and scrotal surgeries under LA only were enrolled from August 2022 to June 2023 (NCT05617261). Demographics, surgeon-perceived and patient-reported pain, and surgical variables were collected. Tolerability to the procedures and future anesthetic choice for a repeat procedure was assessed on follow-up. Complication data were collected, including recurrence, infection, excessive pain, and emergency room and family physician visits.
Hundred and seven patients were enrolled with a mean age ± SD of 42.2 ± 16.4 years. There was a 100% procedural success rate and no cases of perioperative complications or escalation of anesthetic. Around 92.4% (n = 97) of patients indicated they would opt for LA only for a hypothetical repeat procedure. Of the minority opting for general anesthetic, most indicated discomfort or preferring an element of amnesia. No differences between intraoperative pain or tolerability scores of invasive scrotal procedures compared to penile procedures were observed. On univariate analysis, longer procedure duration (P = .003), cannabis use (P = .01), and higher intra-operative pain (P = .005) was associated with lower tolerability.
LA alone in an office-based setting is promising for scrotal surgeries. It offers similarly high patient tolerability compared to procedures that are routinely performed under LA, with the preservation of outcomes. Adopting this method has the potential for substantial cost savings, reduced wait times, enhanced accessibility, and improved surgical efficiency.
前瞻性评估单纯局部麻醉（LA）且无镇静情况下进行侵入性阴囊手术的手术效果、并发症及患者报告的耐受性，并与通常以这种方式进行的阴茎手术的耐受性进行比较。
2022年8月至2023年6月招募仅接受局部麻醉下阴茎和阴囊手术的成年患者（NCT05617261）。收集人口统计学数据、外科医生感知和患者报告的疼痛以及手术变量。随访时评估对手术的耐受性以及重复手术时未来的麻醉选择。收集并发症数据，包括复发、感染、过度疼痛以及急诊室就诊和家庭医生就诊情况。
共招募了107例患者，平均年龄±标准差为42.2±16.4岁。手术成功率为100%，无围手术期并发症或麻醉升级病例。约92.4%（n = 97）的患者表示，对于假设的重复手术，他们会选择仅接受局部麻醉。在选择全身麻醉的少数患者中，大多数表示有不适感或希望有遗忘效果。与阴茎手术相比，未观察到侵入性阴囊手术的术中疼痛或耐受性评分有差异。单因素分析显示，手术时间较长（P = 0.003）、使用大麻（P = 0.01）和术中疼痛较高（P = 0.005）与耐受性较低相关。
在门诊环境中单纯使用局部麻醉进行阴囊手术很有前景。与常规在局部麻醉下进行的手术相比，它具有同样高的患者耐受性，且能保持手术效果。采用这种方法有可能大幅节省成本、减少等待时间、提高可及性并改善手术效率。
