Elsevier

Urology

Volume 55, Issue 2, February 2000, Pages 272-276
Urology

Pediatric Urology
Office pediatric urologic procedures from a parental perspective

https://doi.org/10.1016/S0090-4295(99)00571-3Get rights and content

Abstract

Objectives. To determine the parent perception of discomfort (PPD) in children receiving local anesthesia for the lysis of labial adhesions, meatotomy, and newborn circumcision; the parents’ perceived outcome of these procedures; and the overall satisfaction of parents when these procedures are performed in the office.

Methods. A confidential phone survey was given to 99 parent participants whose children had received local anesthesia for the lysis of labial adhesions (n = 14), meatotomy (n = 28), or newborn circumcision (n = 57). Parents in the labial adhesion and meatal stenosis groups were asked to rate their child’s level of discomfort (PPD) during the procedure as mild (1), moderate (2), or severe (3), and those in the circumcision group were asked to use the same scale to rate their child’s discomfort after the procedure. Parents were also asked whether they thought the procedure was successful and whether they were satisfied with their decision to have it done in the office using local anesthesia.

Results. Among the labial adhesion, meatotomy, and circumcision groups, the mean PPD ± SD was 1.64 ± 0.75, 1.54 ± 0.69, and 1.21 ± 0.53, respectively. The observed procedures, lysis of labial adhesions and meatotomy, had a significantly higher PPD score (P = 0.005) than the unobserved procedure (circumcision). Parents reported good outcomes in 94 (94.9%) of 99 children, with 4 girls experiencing recurrent labial adhesions and 1 boy experiencing recurrent meatal stenosis. Overall, 95 (96.0%) of 99 parents stated that they were satisfied with their decision to have the procedure done in the office with local anesthesia. Of the remaining 4 parents, 3 parents in the circumcision group stated they would have preferred general anesthesia, and 1 parent in the labial adhesion group was undecided.

Conclusions. The PPD is greater if the parent observes their child’s procedure. However, office procedures using local anesthesia for the lysis of labial adhesions, meatotomy, and newborn circumcision are well accepted among the parent population.

Section snippets

Material and methods

A total of 123 children received local anesthesia in the office for the lysis of labial adhesions, meatotomy, or newborn circumcision by a single pediatric urologist (D.P.S.) between September 1995 and June 1998. Informed consent was obtained in each case. The parents were told that local anesthesia would be provided but that this did not guarantee a painless procedure. Recurrent labial adhesions and meatal stenosis, as well as unsatisfactory circumcisions, were all discussed as possible

Demographics

Of the 123 children who were entered into the study, 99 parents (80.5%) responded to the phone survey. The procedures included lysis of labial adhesions (n = 14), meatotomy (n = 28), and newborn circumcision (n = 57). All parents who were reached agreed to participate in the survey.

The mean age of the patients who underwent lysis of labial adhesions was 3.50 years (range 0.5 to 7.5); the mean age of those who underwent meatotomy was 4.36 years (range 0.5 to 10.5). The mean age of newborns who

Comment

Lysis of labial adhesions, meatotomy, and circumcision are procedures that are routinely performed by pediatric urologists. Although they were conventionally performed without anesthesia or with general anesthesia, the development and medical acceptance of effective local anesthetic agents has changed the way various skin procedures such as these are performed. EMLA cream (2.5% lidocaine and 2.5% prilocaine) has been proved to greatly reduce the discomfort associated with venipuncture and skin

References (15)

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