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The following is a summary of “Utilizing local anesthesia only for penile and scrotal urologic surgery: a prospective study on patient tolerability and surgical outcomes for a sedation-free option” published in the August 2024 issue of Urology by S.Bal et al.

This study prospectively assesses the surgical outcomes, complications, and patient-reported tolerability of invasive scrotal surgeries performed under local anesthesia (LA) alone, without sedation, comparing these outcomes to those of penile procedures commonly conducted under similar anesthetic conditions. Adult patients undergoing either penile or scrotal surgeries with only LA from August 2022 to June 2023 were enrolled in the study (NCT05617261). Data on demographics, surgeon-perceived and patient-reported pain levels, as well as various surgical variables, were meticulously collected. The primary focus was on evaluating patient tolerability and their preferences for anesthetic choices in potential future procedures. Follow-up assessments also included tracking any complications, such as recurrence, infection, excessive pain, and any subsequent visits to emergency rooms or family physicians.

A total of 107 patients were enrolled, with a mean age of 42.2 years (±16.4 years). The study reported a 100% procedural success rate with no incidences of perioperative complications or the need to escalate anesthesia. Remarkably, 92.4% of patients (n=97) expressed a preference for choosing LA only for any future repeat procedures. Among the few patients who preferred general anesthesia, the primary reasons cited were discomfort and a desire for amnesia during the procedure. The analysis revealed no significant differences in intraoperative pain or tolerability between scrotal and penile procedures. However, univariate analysis identified that longer procedure durations (p=0.003), cannabis use (p=0.01), and higher levels of intraoperative pain (p=0.005) were associated with lower tolerability.

The findings of this study highlight that performing invasive scrotal surgeries under LA alone in an office-based setting is not only feasible but also yields high patient tolerability, comparable to that observed in routine penile procedures conducted under LA. 

The successful adoption of this anesthetic approach could lead to substantial cost savings, reduced wait times, improved accessibility to surgical care, and enhanced overall surgical efficiency. This approach could serve as a promising alternative in the field of outpatient urological surgeries, aligning with the goals of patient-centered care and resource optimization.

Source: sciencedirect.com/science/article/abs/pii/S0090429524007398