Pediatric UrologyOffice pediatric urologic procedures from a parental perspective
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)
- et al.
Common office problems in pediatric urology and gynecology
Pediatr Clin North Am
(1997) - et al.
Pediatric office procedures
Urol Clin North Am
(1988) - et al.
Urethral meatotomy in the office using topical EMLA cream for anesthesia
J Urol
(1996) - Koren G: Use of the eutectic mixture of local anesthetics in young children for procedure-related pain. J Pediatr...
- Steward DJ: Eutectic mixture of local anesthetics (EMLA): What is it? What does it do? J Pediatr 122(Pt 2): S21–S23,...
- et al.
The EMLA patch—a new type of local anaesthetic application for dermal analgesia in children
Forum
(1994) - et al.
Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision
N Engl J Med
(1997)
Cited by (26)
Clinic meatotomy under topical anesthesia
2017, Journal of Pediatric UrologyCitation Excerpt :Three out of 58 (5%) had some discomfort during the procedure, and at a minimum follow-up of 3 months, 57 out of 58 (98%) did not have a recurrence. The findings by Cartwright et al. have been subsequently replicated in a few more studies 3–5. Despite all these, it appears that at the present time, 50% of meatotomies were still performed under general anesthesia (GA) [6].
Clinical Recommendation: Labial Adhesions
2015, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Because of the high rates of recurrence, parents should be informed about the possibility of recurrence during the course of treatment. Risks for recurrent adhesions decrease with increasing age, and are lowest after production of endogenous estrogen begins.2,11,17,18,22,23 Patients prone to recurrent labial adhesions might have had thick adhesions with a less visible midline raphe.
How should we treat prepubertal labial adhesions? Retrospective comparison of topical treatments: Estrogen only, betamethasone only, and combination estrogen and betamethasone
2011, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :Typically, the first line of treatment is attention to vulva hygiene and topical estrogen cream. Success rates of 50%-88% have been reported with the application of topical estrogen cream.2,3,5,13 Although they are well tolerated, side effects such as hyperpigmentation of the labia and breast budding have been reported.
Anesthesia for Office-Based Pediatric Anesthesia
2011, Smith's Anesthesia for Infants and Children: Expert Consult Premium Edition - Enhanced Online Features and PrintAnesthesia for Office-Based Pediatric Anesthesia
2011, Smith's Anesthesia for Infants and Children