Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
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Comparative Study of Directly Visualised Internal Urethrotomy under Local Anaesthesia by Percutaneous Intracorpus Spongiosum Block Verses Subcutaneous Periurethral Intracorpus Spongiosum Block in a Tertiary Care Hospital of Eastern India
Partha Protim Mondal, Rajkumar Singha Mahapatra, Debiprasad Das and Arif Mohammad
Page: 565-571 | Received 24 May 2024, Published online: 23 Jun 2024
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Abstract
Urethral stricture is a prevalent urologic disorder, mainly in developing nations. For strictures smaller than 2 cm, most urologists recommend directly visualized internal urethrotomy as the first line of treatment. The usual anesthetic used for this surgery is either spinal or general. Comparing the effectiveness, safety and results of subcutaneous periurethral intracorpus spongiosum block vs percutaneous intracorpus spongiosum block during directly visible internal urethrotomy is the main goal. The study was carried out from December 2022 to February 2024 in the urology department of the RG Kar Medical College in Kolkata. Thirty-six adult patients with single, passable strictures up to two centimeters in length are randomly divided into two groups, each including eighteen individuals. Patients in Group I got 5 ml of 1% lignocaine injected slowly into the glans penis (ICSB) using a 26 G hypodermic needle, while patients in Group 2 received the same amount of 1% lignocaine ICSB using a 24 G hypodermic needle inserted subcutaneously through the periurethral route. Using a cold-cutting urethrotome, an optical internal urethrotomy was carried out right away. The visual analogue scale (VAS) was used to measure the patient's discomfort during the surgery and one hour after using a questionnaire. Prior to, during and after the surgery, changes in vital parameters including heart rate and systolic blood pressure are measured and studied. If there are no recurring stricture symptoms or signs and the 18 Fr catheter passed readily during urethral calibration during the follow-up period, the surgery is considered successful. From June 2021 to August 2022, total 36 patients, 18 from each group were assessed. In terms of mean age, length, location and type of strictures, as well as preoperative blood pressure and pulse rate, the patients in both groups were comparable. The age range of the patients was 23-78 years, with a mean (±SD) of 39.7 (±13.6) years. The stricture lasted an average of 15.7 months (median 12 months, range 6-57 months) in group I and 17.1 months (median 15 months, range 9-59 months) in group II. Idiopathic stricture accounted for 47.2% of the total number of patients (17 individuals) in both groups. Nine patients, or twenty-five percent, had inflammatory strictures. The preoperative examination of both research groups showed identical baseline pulse rates, systolic blood pressure, post void residual volume and maximum flow rate (Qmax) on uroflowmetry (Fig. 1). In Group 1, the average baseline pulse rate was 76.2 (±8.3) beats per minute, whereas in Group 2, it was 78.5 (±7.6) beats per minute. For Group 1 patients, the mean baseline systolic blood pressure was 124.7 (±12.3) mm Hg, while for Group 2 patients it was 126.3 (±9.3) mm Hg. For every patient in both groups, an internal urethrotomy with direct visualization was finished. The intraoperative VAS scores of patients in groups 1 (2.6±1.24) and 2 (2.664±1.36) did not exhibit statistical significance in terms of mean (±SD). Additionally, there was no significant difference in the mean 1-hour postoperative VAS score (1.6±1.12) between group 1 patients and group 2 patients (1.72±0.87) (p-value is 0.78).Preoperative vs. maximal perioperative pulse rate changes were not statistically significant in groups 1 (7.82±3.8 beats/min) or 2 (7.5±4.4 beats/min, P-value >0.05). Additionally, there was no significant difference in the systolic blood pressure between groups 1 (8.24±4.2 mm Hg) and 2 (8.6±4.7 mm Hg, p-value is >0.05). All patients were discharged on first post -operative day. The foley catheter was removed after 5 days except for one patient in each group who were developed urinary extravasation (Clavien-Dindo Grade 1). After seven days, the catheter was taken out while they received conservative care. There were no issues linked to the anesthesia. 14 months was the median follow-up time (range: 3-26 months). Two patients in Group 1 had recurrences during follow-up. Three patients in group 2 had urethral stricture recurrence. There was no difference in the recurrence of stricture between the two groups according to the Kaplan-Meier survival analysis (p = 0.423). DVIU (n = 2), anastomic urethroplasty (n = 2) and buccal mucosal graft augmentation urethroplasty (n = 1) were used to treat recurrence strictures. The most often used endoscopic method for treating short segment urethral strictures up to 2 cm in length is called directly visualized internal urethrotomy (DVIU). Pain management during DVIU operations can be achieved safely and effectively using both percutaneous periurethral intracorpus spongiosum block and intracorpus spongiosum block via glans penis. When considering DVIU, percutaneous intracorpus spongiosum block and periurethral intracorpus spongiosum block should be done due to their shown safety and effectiveness, especially in individuals who are at high risk for general or regional anesthesia.
How to cite this article:
Partha Protim Mondal, Rajkumar Singha Mahapatra, Debiprasad Das and Arif Mohammad. Comparative Study of Directly Visualised Internal Urethrotomy under Local Anaesthesia by Percutaneous Intracorpus Spongiosum Block Verses Subcutaneous Periurethral Intracorpus Spongiosum Block in a Tertiary Care Hospital of Eastern India.
DOI: https://doi.org/10.36478/10.59218/makrjms.2024.2.18.565.571
URL: https://www.makhillpublications.co/view-article/1815-9346/10.59218/makrjms.2024.2.18.565.571